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Cited by 159Cultural Competency in Health CareMental Health and PsychiatryCultural, Psychoanalytic, and Sociopolitical Reflections

Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study

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Aggarwal, Neil Krishan, Nicasio, Andel Veronica, DeSilva, Ravi, Boiler, Marit, Lewis-Fernández, Roberto·2013·Culture, Medicine, and Psychiatry
DOI 10.1007/s11013-013-9325-zPMC PMC4299818
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Abstract

The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients (n = 32) and clinicians (n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy-in, ambiguity of design, over-standardization of the CFI, and severity of illness. The most frequent clinician threats were lack of conceptual relevance between intervention and problem, driftfrom the format, repetition, severity of patient illness, and lack of clinician buy-in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI’s reception among patients and clinicians.

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  • For clinicians, the most common concerns about CFI implementation included lack of clarity about the relevance of the CFI to the presenting problem, diagnostic assessment, and intervention planning; doubts about using the full CFI at the beginning of an evaluation; repetitiveness; difficulty engaging patients with severe illness; and lack of clinician buy-in.

    “For clinicians, the most common concerns included lack of clarity about the relevance of the CFI to the presenting problem, diagnostic assessment, and intervention planning; doubts about using the full CFI at the beginning of an evaluation; repetitiveness; difficulty engaging patients with severe illness; and lack of clinician buy-in, which may mostly reflect lack of familiarity with the CFI.”

    From Update on the Cultural Formulation Interview (2020) · cites this paper as [17]

  • For patients, the most common concerns about CFI implementation were lack of differentiation from other interviews, discomfort with discussing the past or talking about religion, and difficulty understanding some CFI questions.

    “For patients, the most common concerns were lack of differentiation from other interviews they had received, discomfort with discussing the past or talking about religion, and difficulty understanding some CFI questions.”

    From Update on the Cultural Formulation Interview (2020) · cites this paper as [17]

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Research works printed but not linked: 3

  1. Kleinman Arthur 1996 How is Culture Important for DSM-IV? Culture and Psychiatric Diagnosis: A DSM-IV Perspective Washington, D.C American Psychiatric Press, Inc
  2. Lewis-Fernández Roberto 1996 Cultural Formulation of Psychiatric Diagnosis Culture, Medicine, and Psychiatry 20 3 133 144 8853962
  3. Mezzich Juan E 2008 Cultural Formulation: Development and Critical Review Cultural Formulation: A Reader for Psychiatric Diagnosis Lanham Jason Aronson

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Authors
Aggarwal, N. K., Nicasio, A. V., DeSilva, R., Boiler, M., & Lewis-Fernández, R.
Affiliations
New York State Psychiatric Institute (US)
Corresponding author
Aggarwal, Neil Krishan
ORCID
Venue
Culture, Medicine, and Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2013-07-09
Volume
37
Issue
3
Pages
505-533
ISSN
  • 0165-005X (ISSN-L)
  • 1573-076X
DOI
10.1007/s11013-013-9325-z
PMC
PMC4299818
OpenAlex
W1981427618
Semantic Scholar
35ee4a59216b05cf7df8dd8e94077fdd1fb312f6
Cited by
159
References
85
Citations by year
2026: 10 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 20 · 2021: 10 · 2020: 15 · 2019: 8 · 2018: 11 · 2017: 40 · 2016: 8 · 2015: 8 · 2014: 6 · 2013: 2 · 2012: 2
FWCI
24.69
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Culture Medicine and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • McGill University
  • National Institutes of Health
  • National Institute of Mental Health (T32MH015144)
Topics
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Cultural Studies › Cultural, Psychoanalytic, and Sociopolitical Reflections
Keywords
Cultural Formulation Interview, DSM-5, cultural formulation, implementation barriers, implementation fidelity, clinician buy-in, patient perspectives, cross-cultural psychiatry
MeSH terms
Adult, Aged, Anthropology, Cultural, Mental Disorders, Ethnopsychology, Female, Humans, Interview, Psychological, Male, Middle Aged, New York, Qualitative Research, Diagnostic and Statistical Manual of Mental Disorders, Anthropology, Medical

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