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DSM-5 Cultural Formulation Interview

The DSM-5 Cultural Formulation Interview (CFI) is a structured interview to help clinicians assess the impact of cultural features or other factors that might be relevant to a patient’s diagnosis or treatment.1,2 It was developed by the American Psychiatric Association’s DSM-5 Cross-Cultural Issues Subgroup.1
Description: The DSM-5 Cultural Formulation Interview (CFI) is a structured interview to help clinicians assess the impact of cultural features or other factors that might be relevant to a patient’s diagnosis or treatment.1,2 It was developed by the American Psychiatric Association’s DSM-5 Cross-Cultural Issues Subgroup.1
Disease States: General
Validated Uses: Diagnosis
Administration Method: Clinician-report
Time to administer: 20-30 minutes
Commonly used in: Clinical Practice
Detailed Description: The CFI is a structured interview designed to help clinicians assess the impact of cultural factors or issues that might be relevant to a patient’s diagnosis or treatment.1,2 The CFI is designed to be used with any informational interview.4
 
The CFI includes 16 open-ended questions, comprising what is known as the core CFI, that are divided into 4 topic areas: (1) the cultural definition of the problem; (2) cultural perceptions of cause, context, and support; (3) cultural factors affecting self-coping and past help-seeking; and (4) cultural factors affecting current help-seeking. It also includes 12 supplementary modules with additional basic assessment questions as well as more detailed questions that cover topics for specific populations, such as children and adolescents, older adults, migrants, and refugees.3
Scale Validity: Validity statistics for the CFI have not been reported. An international study examined patient and clinician scores of feasibility, acceptability, and clinical utility on the CFI that was pilot tested in the DSM-5 Field Trials. This version differed slightly from the final, published version (e.g., the pilot version contained only 14 items in the core CFI). The study’s analysis found positive results overall.1 Specifically, patients reported positive ratings across all 3 scores, whereas clinicians reported generally positive but lower ratings for feasibility than for utility and acceptability. Clinician ratings of feasibility were also lower than patients’ ratings.
 
An additional analysis of the clinical utility, feasibility, and acceptability of the final, published core CFI also found positive ratings for all three scores among patients and clinicians.2
Alternative Versions: The Cultural Formulation Interview–Fidelity Instrument (CFI-FI) was developed to assess clinician adherence to the CFI.4
Cited Limitations: Research suggests that implementation of the CFI can be challenging, especially in short-staffed clinics, because it takes additional time to implement and to fully explore patients’ cultural experiences and narratives. Further, certain questions on the CFI may need to be revised over time, such as those that are too abstract and unclear in asking about a patient’s identity and background. Such questions might be especially problematic for patients experiencing language barriers, like low language proficiency.2 Another limitation is the lack of instructions on how to implement the CFI into various clinical settings and how to incorporate it into diagnostic and treatment decisions. Finally, additional research on the CFI suggests modifications are needed to better assess the concept of cultural identity and to address social structures and institutional aspects of culture that could be relevant to diagnosis or treatment (e.g., social determinants of health).5

Footnotes:

Supporting references for the filers are as follows: Disease States: Any mental disorder;1,2 Validated Uses: Diagnosis;2 Administration Method: Clinician interview;4 Time to Administer: 20-30 minutes;1 Commonly Used In: Clinical practice1

References:

  1. Lewis-Fernandez, R et al. Brit J Psychiatry. 2017;210:290-297.
  2. Wallin, MI et al. Transcult Psychiatry. 2020;57(4):542-555.
  3. Strand & Baarnhielm. Cult Med Psychiatry. 2021; Dec 8:1-8.
  4. Aggarwal, NK et al. J Health Care Poor Underserved. 2014; 25(3): 1397–1417.
  5. Lewis-Fernandez, R et al. Transcult Psychiatry. 2020;57(4)487-496.

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