A Qualitative Study of Clinicians’ Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder

Fortuna, Lisa R.; Porche, Michelle V.; Alegrı́a, Margarita

doi:10.1177/1363461509342948

Cited by 24 publications

(14 citation statements)

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“…72,74 Many excluded papers presented accounts of the cultural formulation, and its use as part of the formal psychiatric assessment process, yet none evaluated the cultural formulation, or offered a sufficiently critical evaluative statement. 87,107 In the new edition of its diagnostic manual Diagnostic and Statistical Manual of Mental Illness-Fifth Edition (DSM-V), 108 the American Psychiatric Association has included a section on the 'Cultural Interview' that promotes the assessment of cultural factors (at least this area is no longer in an appendix, as it was in previous editions of the manual) and sets out guidelines. However, this approach needs evaluation and some have expressed a concern that the approach will not be well known or widely adopted by practitioners.…”

Section: Other Study Designsmentioning

confidence: 99%

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Bhui

Aslam

Palinski

et al. 2015

Health Technology Assessment

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BackgroundBlack and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people.ObjectivesTo identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research.ParticipantsBlack African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people.InterventionsAny that improve TCs between BME patients and staff in psychiatric services.Data sourcesThe published literature, ‘grey’ literature, an expert survey, and patients' and carers’ perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations.Review methodsStudies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses.ResultsTwenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive–behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention.LimitationsStudies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs.ConclusionsEmpowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed.Study registrationThe study is registered as PROSPERO CRD42011001661.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Other Study Designsmentioning

confidence: 99%

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Bhui

Aslam

Palinski

et al. 2015

Health Technology Assessment

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“…Cross-cultural research has shown evidently that culture shapes belief systems and thus influences the perception of traumatic events and their meaning, attribution and coping behaviours [76]. Given the importance of cultural context of traumatic experience, the use of DSM-IV Cultural Formulation has been in recent use for diagnostic formulation of patients of PTSD [36].…”

Section: Resultsmentioning

confidence: 99%

Post Traumatic Eco-Stress Disorder (PTESD): A Qualitative Study from Sundarban Delta, India

Chowdhury¹,

Mondal²,

Biswas³

et al. 2013

Mental Disorders - Theoretical and Empirical Perspectives

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. Eco-Stress traumas resulting from natural disasters like cyclone, earthquake, flood, hurricane, tsunami, bushfire, tornado, drought and wild animal attacks.. Technological traumas like plane crash, industrial accidents, domestic accidents, nuclear reactor explosion and oil spills etc.. Human induced direct trauma like sexual assault and rape, violence, terrorist attack, vehicle accident, combat and military trauma, illness, death and hostage taking etc.The nature and extent of ecological traumas [ ] are usually more pervasive and collective [ ] and entail a strong sense of powerlessness and destiny/spiritual dimension among the victims [ ]. PTSD is quite common after eco-disasters and it is estimated that the prevalence rate of PTSD related to natural disasters is currently between . % and . % depending on assessment methodologies, instruments and timing [ ].The present work based on the case studies from Sundarban, India, attempting to highlight the development of post-traumatic symptomatology after wild animal attacks, viz., Tiger, Shark and Crocodile, in the context of a unique ecological landscape of the delta region. "ll natural disasters and incidents are ecological events and their impact on humans in terms of psychological, physical, economic and social can be seen as an extraordinary eco-stress that is operative behind the development of post-traumatic stress disorder and hence the defining terms PTESD to separate it from Technological and Human related traumas . . The Study Area: SundarbanSundarban is the largest estuarine mangrove forest in the world stretching over an area of about , Km % is in India and % in "angladesh . It comprises outer deltas of the Ganges, "rahmaputra and Meghna rivers at the confluence of "ay of "engal. The Indian portion is located about km southeast of Kolkata West "engal State , between ° to ° N and ° to ° E coordinates, at an altitude of m from the sea level.

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“… 53 , 55 Many excluded papers presented accounts of the cultural formulation (as described in the DSM-IV, 66 and now in modified form in DSM-5 67 ), and its use as part of the formal psychiatric assessment process, yet none evaluated the cultural formulation, or offered a sufficiently critical evaluative component for these studies to enter the review. 68 , 69 …”

Section: Discussionmentioning

confidence: 99%

Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review

et al. 2015

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BackgroundCommunication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services.AimsTo review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services.MethodSystematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the ‘grey’ literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations.ResultsTwenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18–0.75) than for moderate- or lower-quality studies (range of d 0.18–4.3). The review found only two studies offering weak economic evidence.ConclusionsCulturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.

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A Qualitative Study of Clinicians’ Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder

Cited by 24 publications

References 50 publications

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Post Traumatic Eco-Stress Disorder (PTESD): A Qualitative Study from Sundarban Delta, India

Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review

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