Culture inla clínica: Evaluating the utility of the Cultural Formulation Interview (CFI) in a Mexican outpatient setting

Abstract

While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents' application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers' and patients' views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers' understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to "culture" were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.

Loneliness, adolescence, and global mental health:Soledadand structural violence in Mexico

“…Ethnographic studies of mental health services in Mexico have documented the need for (and scarcity of) mental health treatment in Mexico (Duncan, 2014(Duncan, , 2018Foster-Reyes, 2018). To take culture more directly into account for psychiatric assessment and treatment, the DSM-5 Cultural Formulation Interview (CFI) was pilot tested in Mexican settings (Ramirez Stege & Yarris, 2017). While the CFI was observed to enhance patient-provider rapport, many of the questions concerning ''culture'' were judged as methodologically lacking in cultural validity.…”

Moral Matters: Schizophrenia and Masculinity in Mexico

“…While public mental health researchers have demonstrated the utility and cost‐effectiveness of combining psychotherapy with antipsychotic medication, (Lara‐Muñoz et al. ), few patients receiving treatment under Seguro Popular or in public mental health facilities have access to such care (see also Ramírez Stege and Yarris ).…”

The DSM-5 Cultural Formulation Interview: Bridging Barriers Toward a Clinically Integrated Cultural Assessment in Psychiatry

“…Alternatively, the CFI may be administered as a free-standing interview. 14,15 Empirical data are needed to test the method of implementation with outcomes such as patient satisfaction or clinician fidelity to the CFI, which will likely depend on the overall clinical goal, staff availability, and the facility's procedures.…”

“…9 These meaning processes are often seen by patients as takenfor-granted commonsense ("just the way things are") or derive from unexamined influences related to their background and position in society not usually seen as cultural, such as education, class, or occupation, even though these strongly influence meaning-making. 14 Training, and potentially ongoing supervision, may also be necessary to prevent use of the CFI as a superficial checklist that does not fundamentally alter how patients and clinicians interact or how care is negotiated. 17 Instead, the goal of the CFI is to advance a radical agenda-to change the way clinicians conduct a diagnostic interview so that the perspective of the patient becomes at least as important as the signs and symptoms of disease identified by the clinician; the mission of the CFI is, in effect, to expand what counts as data in a clinical encounter.…”

“…Although a growing research base shows that patients, clinicians, and family members perceive the CFI as useful for rapport and trust-building, eliciting information, enhancing clinicians' understanding of illness, fostering patient's self-realizations and validating their experience, and guiding treatment planning, [11][12][13][14][15]21 no comparative efficacy research has yet examined the specific contribution of CFI-augmented care against usual mental health services. Research on cultural formulation approaches that operationalized the OCF prior to the CFI showed enhanced diagnostic validity compared to standard diagnostic procedures, [22][23][24] suggesting this may also be the case for the CFI.…”