Use of an Expanded Version of the DSM-IV Outline for Cultural Formulation on a Cultural Consultation Service

Abstract

Objectives-This study assessed cultural consultants' impression of the utility of an expanded version of the DSM-IV Outline for Cultural Formulation in cultural psychiatric consultation and identified ways to improve the usefulness of the cultural formulation. Methods-A structured interview and questionnaire on the use of the cultural formulation was administered to 60 consultants working for an outpatient Cultural Consultation Service (CCS).Results-Most consultants (93%) found the cultural formulation to be moderately to very useful. More than half (57%) had little or no familiarity with the cultural formulation before working with the CCS. The main suggestions for improvement of the cultural formulation were to expand sections on migration experience and include sections on religious and spiritual practice.Conclusions-Although many consultants had little previous familiarity with the cultural formulation, most found it useful in organizing their assessment and preparing consultation reports. The cultural formulation is a useful tool for nonmedical consultants and culture brokers, as well as for clinicians.Clinical work with diverse populations requires assessment and treatment planning that are sensitive to ethnocultural background and social context (1-3). To assist clinicians in identifying clinically relevant aspects of patients' cultural background, DSM-IV introduced an outline for cultural formulation (4,5). The cultural formulation has not been widely incorporated into standard clinical practice; however, and despite a report that identified the refinement of cultural formulation as a high priority in preparation for DSM-V (6), there are no published evaluations of its utility. This study assessed the usefulness of the DSM-IV Outline for Cultural Formulation from the perspective of consultants working for a Cultural Consultation Service (CCS) in an outpatient psychiatry department of a general hospital in Montreal, Canada (7). Disclosures CIHR Author Manuscript CIHR Author Manuscript CIHR Author Manuscript MethodsThe CCS is based in an urban area where 45% of the population comprises immigrants and refugees (8). The service receives requests for assistance from primary care providers and mental health professionals throughout the region who are facing difficulties with the assessment or treatment of ethnically diverse patients. The CCS has a clinical coordinator and a network of interpreters; cultural consultants, who are clinicians; and culture brokers, who are nonclinicians with specific cultural knowledge and who assist a CCS clinician in conducting the assessment.The CCS developed and uses an expanded version of the DSM-IV-TR (9) Outline for Cultural Formulation, which has specific questions on migration history, citizenship status, multiple cultural backgrounds and identities, and extended family network (the expanded version is available at www.mcgill.ca/ccs). Additional areas explored in this expanded version of the cultural formulation include details on migration trajectory (origins, re...

Common mental health problems in immigrants and refugees: general approach in primary care

“…106 The outline for cultural formulation in the Diagnostic and statistical manual of mental disorders, fourth edition, provides a basic set of considerations that can be incorporated into assessment of patients to explore clinically relevant aspects of their identity, illness explanations, psychosocial environment and expectations for patient-physician relationships. [107][108][109][110] Most patients in primary care with mental health problems present with physical complaints, which can lead to underrecognition and treatment of common mental disorders. 111 Patients with depression or anxiety sometimes focus on physical symptoms or use culture-specific bodily idioms to express distress.…”

Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site

“…First, busy clinicians have struggled to formulate questions from its vague outline (Lewis-Fernández 2009). Second, researchers have questioned the reliability of reproducing data without a standardized design (Alarcón 2009) given the different OCF-inspired questionnaires (Group for the Advancement of Psychiatry 2001; Bäärnhielm and Rosso 2009; Groen 2009a; Kirmayer et al 2008; Mezzich et al 2009). Third, the lack of clinician instructions has raised questions about whether it is a separate assessment from the standard interview (Caballero Martínez 2009) and in what service settings it should be conducted (Aggarwal 2012b).…”

Influence of the DSM‐IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health

“…The core CCS team includes three part-time psychiatrists, a network of interpreters and 'culture brokers' (cultural consultants) and administrative support. Typically, one of the CCS psychiatrists assesses the patient, usually with the aid of an interpreter or a culture broker, who is asked to provide the cultural context of the patient's illness and afterward to prepare a report following an expanded version of the DSM-IV-TR guidelines for the cultural formulation (Kirmayer et al 2008). The culture broker may interview patients or members of their entourage without the psychiatrist present if more cultural background information is required.…”

“…Subsequent publications have discussed its clinical application (Group for the Advancement of Psychiatry 2001; Lewis-Ferna´ndez 1996;Mezzich et al 2009). Other publications have provided illustrations of its clinical use (Kirmayer et al 2003(Kirmayer et al , 2008Walsh 2004). To date, however, there has been no study of its effects on clinical case formulation in a multidisciplinary case conference context.…”