Perspectives of family members participating in cultural assessment of psychiatric disorders: Findings from the DSM-5 International Field Trial

Abstract

Despite the important roles families play in the lives of many persons with mental illness across cultures, there is a dearth of data worldwide on how family members perceive the process of cultural assessment as well as to how to best include them. This study addresses this gap in our knowledge through analysis of data collected across six countries as part of a DSM-5 Field Trial of the Cultural Formulation Interview (CFI). At clinician discretion, individuals who accompanied patients to the clinic visit (i.e. patient companions) at the time the CFI was conducted were invited to participate in the cultural assessment and answer questions about their experience. The specific aims of this paper are (1) to describe patterns of participation of patient companions in the CFI across the six countries, and (2) to examine the comparative feasibility, acceptability, and clinical utility of the CFI from companion perspectives through analysis of both quantitative and qualitative data. Among the 321 patient interviews, only 86 (at 4 of 12 sites) included companions, all of whom were family members or other relatives. The utility, feasibility and acceptability of the CFI were rated favorably by relatives, supported by qualitative analyses of debriefing interviews. Cross-site differences in frequency of accompaniment merit further study.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial

“…Patients and clinicians could also invite companions (for example relatives) to participate in the interview and subsequent assessments. 24 All study clinicians participated in a 2 h CFI training session at their site consisting of (a) reviewing the core CFI's written guidelines; (b) a 24 min video demonstration; (c) interactive behavioural simulations with coaching and feedback from local principal investigators; and (d) a question-and-answer period.…”

“…27 Site-specific analyses of the field trial data have also found positive perceptions of implementation-related outcomes. 19,24,27 In the full sample, patients assessed the CFI more positively than clinicians, and the difference was significant for feasibility. Clinicians were more concerned about feasibility than about acceptability or utility.…”

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

“…It culminated in an international field trial conducted in 11 sites and 6 countries between November 2011 and October 2012 with 318 patients older than age 15 years, 75 clinicians, and 86 family members of patients. 11,12 Exclusion criteria were minimized to broadly test the implementation of the CFI in a wide range of patients and illnesses; patients were excluded if they were acutely suicidal, intoxicated or in substance withdrawal, or had a condition that interfered with their capacity to consent, such as dementia, intellectual disability, or florid psychosis.…”

“…Quantitative and qualitative assessment of patients, providers, and family members found the CFI to be feasible, acceptable, and clinically useful. [11][12][13] Nevertheless, qualitative analyses of the New York site data and then of the full trial revealed limitations with this field trial version. Internal barriers to implementing the CFI were reported by patients and clinicians, pertaining to the content or format of the instrument itself, such as lack of differentiation of the CFI from routine clinical assessments or concerns about question clarity and ordering.…”

“…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.…”