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Aggarwal NK, Sadaghiyani S, Kananian S, Lam P, Messner G, Marincowitz C, Narayan M, Luciano AC, van Balkom AJLM, Hezel D, Lochner C, Shavitt RG, van den Heuvel OA, Simpson B, Lewis-Fernández R. Patient Perceptions of Illness Causes and Treatment Preferences for Obsessive-Compulsive Disorder: A Mixed-Methods Study. Cult Med Psychiatry 2024:10.1007/s11013-024-09865-5. [PMID: 38898162 DOI: 10.1007/s11013-024-09865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a condition with high patient morbidity and mortality. Research shows that eliciting patient explanations about illness causes and treatment preferences promotes cross-cultural work and engagement in health services. These topics are in the Cultural Formulation Interview (CFI), a semi-structured interview first published in DSM-5 that applies anthropological approaches within mental health services to promote person-centered care. This study focuses on the New York City site of an international multi-site study that used qualitative-quantitative mixed methods to: (1) analyze CFI transcripts with 55 adults with OCD to explore perceived illness causes and treatment preferences, and (2) explore whether past treatment experiences are related to perceptions about causes of current symptoms. The most commonly named causes were circumstantial stressors (n = 16), genetics (n = 12), personal psychological traits (n = 9), an interaction between circumstantial stressors and participants' brains (n = 6), and a non-specific brain problem (n = 6). The most common treatment preferences were psychotherapy (n = 42), anything (n = 4), nothing (n = 4), and medications (n = 2). Those with a prior medication history had twice the odds of reporting a biological cause, though this was not a statistically significant difference. Our findings suggest that providers should ask patients about illness causes and treatment preferences to guide treatment choice.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA.
- New York State Psychiatric Institute, New York, USA.
| | | | - Schahryar Kananian
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Peter Lam
- New York State Psychiatric Institute, New York, USA
| | | | - Clara Marincowitz
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Madhuri Narayan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alan Campos Luciano
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest, Amsterdam, The Netherlands
| | - Dianne Hezel
- New York State Psychiatric Institute, New York, USA
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Roseli Gedanke Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, LIM-23, Instituto de Psiquiatria do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy and Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Compulsivity Impulsivity Attention Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Blair Simpson
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
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Wallin MI, DeMarinis V, Nevonen L, Bäärnhielm S. What information did the DSM-5 Cultural Formulation Interviews provide when used with Swedish-speaking patients in a psychiatric setting in Stockholm? Front Psychiatry 2024; 15:1377006. [PMID: 38840947 PMCID: PMC11151123 DOI: 10.3389/fpsyt.2024.1377006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Cultural and contextual factors affect communication and how psychiatric symptoms are presented, therefore psychiatric assessments need to include awareness of the patients' culture and context. The Cultural Formulation Interview (CFI) in DSM-5 is a person-centred tool developed to support the exploration of cultural and contextual factors in an individualized and non-stereotypic way. Methods The aim of this qualitative study was to find out what information the DSM-5 CFI revealed when used with native Swedish-speaking patients as part of routine clinical psychiatric assessment at an outpatient clinic. An additional aim was to enhance understanding of what kind of information the questions about background and identity yielded. The CFI was added to the psychiatric assessment of 62 native Swedish-speaking patients at an outpatient psychiatric clinic in Stockholm. Results From the thematic analysis of the documented CFI answers, six central themes were found; Descriptions of distress and dysfunction, Managing problems and distress, Current life conditions affecting the person, Perceived failure in meeting social expectations, Making sense of the problem, and Experiences of, and wishes for, help. The CFI questions about identity yielded much information, mainly related to social position and feelings of social failure. Discussion For further refinement of the CFI, we see a need for re-framing the questions about cultural identity and its impact on health so that they are better understood. This is needed for majority population patients as direct questions about culture may be difficult to understand when cultural norms are implicit and often unexamined. For clinical implications, our findings suggest that for cultural majority patients the DSM-5 CFI can be a useful person-centred tool for exploring cultural and, in particular, social factors and patients' perception and understanding of distress.
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Affiliation(s)
- Malin Idar Wallin
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
| | - Valerie DeMarinis
- Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Västerbotten, Sweden
- Division Mental Health Care, Innlandet Hospital Trust, Hamar, Norway
| | - Lauri Nevonen
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Aleris Psychiatry Täby, Stockholm, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
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Brand AM, Groen SPN, Destoop N, Jongsma HE, Ghane S, Sabbe BGC, van Velsen H, van Houten K, Becan Ö, Al Alyan D, Braakman MH. The effect of the cultural formulation interview on therapeutic working alliance: a study protocol. Front Psychiatry 2024; 15:1322356. [PMID: 38501082 PMCID: PMC10945007 DOI: 10.3389/fpsyt.2024.1322356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Background The Cultural Formulation Interview (CFI) is designed to improve understanding of patients' mental health care needs. The lack of empirical evidence on the impact and effectiveness of CFI use in clarifying people's perspectives, experiences, context, and identity, and in preventing cultural misunderstandings between migrant patients and clinicians, inspired this study. The objective is to examine the effect of the CFI on the strength of therapeutic working alliances, and the potential mediating or moderating role of perceived empathy. Materials and methods A multicenter randomized controlled trial will be conducted, involving migrant patients, their confidants, and clinicians. The CFI will be administered in the intervention group, but not in the control group. Validated questionnaires will be used to assess therapeutic working alliances and perceived empathy. T-tests and linear regression analyses will be conducted to investigate between-group differences and possible mediating or moderating effects. Results This study will indicate whether or not the CFI strengthens the therapeutic working alliance between patients and clinicians, as moderated and/or mediated by perceived empathy. Discussion Research on the effect and impact of using the CFI in mental health care for migrant patients is important to clarify whether its use strengthens the therapeutic working alliance with clinicians. This can lead to a reduction in cultural misunderstandings and improve mental health care for migrant patients. The results may also be important for the implementation of the CFI as a standard of care. Ethics and dissemination This research protocol was tailored to the needs of patients in collaboration with experts by experience. It was approved by the Ethical Review Board of the Tilburg Law School and registered in the Clinical Trials Register under number NCT05788315. Positive results may stimulate further implementation of the CFI in clinical practice, and contribute to improving the impact of the CFI on the therapeutic working alliances.
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Affiliation(s)
- Alma M Brand
- Tilburg Law School, Tilburg University, Tilburg, Netherlands
| | - Simon P N Groen
- De Evenaar, Center for Transcultural Psychiatry, GGZ Drenthe, Beilen, Netherlands
| | - Nathalie Destoop
- Mobile 2B Team SPITT and Culture-sensitive Care POZAH, Psychiatric Hospital Sint-Alexius Grimbergen, Brussels, Belgium
| | - Hannah E Jongsma
- Center for Transcultural Psychiatry Veldzicht, Balkbrug, Netherlands
- University Center of Psychiatry, University Medical Center Groningen (UMCG), Groningen, Netherlands
| | | | - Bernard G C Sabbe
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute, University of Antwerpen, Antwerpen, Belgium
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Hoshmand S, Knegtering H, Spoelstra SK. Cultural competence of mental health practitioners in the Netherlands. Int J Soc Psychiatry 2024; 70:282-288. [PMID: 37874035 DOI: 10.1177/00207640231206062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. AIMS This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. METHODS A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. RESULTS Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. CONCLUSION The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.
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Affiliation(s)
- S Hoshmand
- Lentis Psychiatric institute, Groningen, The Netherlands
| | - H Knegtering
- Lentis Psychiatric institute, Groningen, The Netherlands
- University Medical Center Groningen, University of Groningen, Rob Giel Research Center, Groningen, The Netherlands
| | - S K Spoelstra
- Addiction care North Netherlands, Groningen, The Netherlands
- NHL Stenden Hogeschool, Leeuwarden, The Netherlands
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Zagaria A, Zennaro A. A close look at sociality in DSM criteria. Soc Psychiatry Psychiatr Epidemiol 2024; 59:475-492. [PMID: 37932472 PMCID: PMC10944442 DOI: 10.1007/s00127-023-02568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE The importance of sociality in psychology and psychotherapy is quite undisputed; however, this construct risks being underestimated in psychiatric nosography. The aim of the review was to assess the relevance of sociality in DSM 5 criteria. METHOD Sociality-laden criteria of 192 selected DSM categories have been identified through a textual grid. Second, the criteria have been classified into 6 categories, i.e., (1) Affiliation and Attachment (AA), (2) Social Communication (SC), (3) Perception and Understanding of Others (PUO), (4) Culture, (5) Clinical Significance Criterion (CSC) (6), and No Specific Construct (NSC). RESULTS 13% of all mental disorders mention AA in their criteria. 8.8% of all mental disorders mention SC; 8.8% of all mental disorders mention PUO in their criteria. 15% of all mental disorders mention culture in their criteria (exclusively ex negativo though). 40% of mental disorders mention non-specific sociality (NSC) in their criteria. CSC is mentioned in 85% of mental disorders. Personality disorders have the highest "concentration" of sociality mentions throughout the DSM categories. CONCLUSIONS The overall results suggest that DSM criteria offer a confused account of sociality. We believe that the descriptive approach is the underlying reason. We suggest that in the long run a theory-laden approach to sociality, informed by evolutionary insights about motivations, could be of help.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, 38068, Rovereto, TN, Italy.
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Wallin MI, DeMarinis V, Nevonen L, Bäärnhielm S. A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting. Front Psychiatry 2024; 15:1298920. [PMID: 38455521 PMCID: PMC10918747 DOI: 10.3389/fpsyt.2024.1298920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/19/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients. Materials and methods The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients. Results We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms. Discussion Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians' identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.
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Affiliation(s)
- Malin Idar Wallin
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
| | - Valerie DeMarinis
- Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Västerbotten, Sweden
- Division Mental Health Care, Innlandet Hospital Trust, Hamar, Norway
| | - Lauri Nevonen
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Aleris Psychiatry Täby, Stockholm, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) & Stockholm Health Care Services, Stockholm, Sweden
- Transcultural Centre, Region Stockholm, Stockholm, Sweden
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Owens EA, Barnes A, Marx C, Kreider TR. Resident Teaching of the Cultural Formulation Interview to Psychiatry Clerkship Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:77-80. [PMID: 38158541 DOI: 10.1007/s40596-023-01926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | - Alicia Barnes
- University of Tennessee Health Sciences Center, Memphis, TN, USA
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Weiss MG, Deshmukh A, Sarmukaddam SB, Paralikar VP. Sociocultural Framework for Psychiatric Case Formulation. J Nerv Ment Dis 2024; 212:16-27. [PMID: 37874984 DOI: 10.1097/nmd.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
ABSTRACT A Cultural Formulation Interview (CFI) field trial in India, widely reported racist violence in the United States, and casteist and religious communal conflicts in India highlighted inattention to structural issues affecting mental health problems in the Outline for Cultural Formulation (OCF) and the CFI in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Consequently, we revised the OCF as a sociocultural formulation (SCF) to better consider structures of society and culture. We studied and compared clinicians' ratings of SCF case formulations from a constructed assessment instrument (SCF Interview [SCFI]) and the CFI. Socio-cultural formulations from SCFI interviews were rated higher for details of societal structural impact, and overall interrater agreement was better. CFI interviews were rated higher for clinical rapport. Revision of the CFI should enhance consideration of structural issues and incorporate them in SCFs that better integrate assessment process and case formulation content. The need to acknowledge structural sources of mental health problems is clear, and our study indicates how a sociocultural framework may be used for that.
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Ioannou M, Olsson S, Bakken Wold A, Dellepiane M, Steingrímsson S. Approaching "highly sensitive person" as a cultural concept of distress: a case-study using the cultural formulation interview in patients with bipolar disorder. Front Psychiatry 2023; 14:1148646. [PMID: 37810603 PMCID: PMC10558047 DOI: 10.3389/fpsyt.2023.1148646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background Psychiatric patients may refer to concepts neither medically accepted nor easily understood to describe their experiences when seeking medical care. These concepts may lie outside the clinician's cultural references and consequently hinder the diagnostic consultation. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical instrument Cultural Formulation Interview (CFI) was included. The CFI aims to facilitate the gathering and synthesis of culturally relevant clinical information. The notion of Cultural Concepts of Distress (CCD) was also introduced in DSM-5. The CCD include the subterms of the cultural syndrome, cultural explanation, and cultural idiom of distress. No previous study has used CFI for conceptualizing a cultural notion as a CCD. This study aimed to approach the cultural notion of being a highly sensitive person (HSP) in patients with bipolar disorder (BD) by applying the CFI. The cultural notion of HSP has garnered great interest globally, although scientific evidence is limited. No direct correlation between BD and HSP was hypothesized before or during the study process. Methods In this case study, three patients with BD who reported being HSP were interviewed using the CFI. Furthermore, the applicability of the CCD was examined based on the outcomes of the CFI using an interpretive approach. Results All three patients reported that the CFI facilitated the clinical consultation, and in one of the cases, it may also have increased the treatment engagement. Based on the synthesis of the CFI outcomes in these illustrative cases, HSP could be understood as a cultural syndrome, a cultural explanation, and a cultural idiom of distress. Conclusion By applying a person-centered perspective, CFI was used for the conceptualization of a cultural notion as a CCD (i.e., HSP in our study). Moreover, the cases highlight the complexity of illness insight in BD as a medical phenomenon when patients' illness perspectives are taken into consideration. Future studies need to further examine the clinical relevance of the CFI in the management of BD.
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Affiliation(s)
- Michael Ioannou
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofia Olsson
- Region Skåne, Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Lund, Sweden
| | - Ane Bakken Wold
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marzia Dellepiane
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrímsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Psykiatri Affektiva, Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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Burke NL, Hazzard VM, Schaefer LM, Simone M, O’Flynn JL, Rodgers RF. Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity. Psychol Med 2023; 53:4255-4265. [PMID: 35574702 PMCID: PMC9666565 DOI: 10.1017/s0033291722001015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.
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Affiliation(s)
- Natasha L. Burke
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
| | - Vivienne M. Hazzard
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Lauren M. Schaefer
- Sanford Center for Bio-behavioral Research, 120 Eighth Street South, Fargo, ND 58103, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, 1919 Elm Street N, Fargo, ND, 58102, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Jennifer L. O’Flynn
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, MA, 02139, USA
| | - Rachel F. Rodgers
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
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Gómez-Carrillo A, Kirmayer LJ, Aggarwal NK, Bhui KS, Fung KPL, Kohrt BA, Weiss MG, Lewis-Fernández R. Integrating neuroscience in psychiatry: a cultural-ecosocial systemic approach. Lancet Psychiatry 2023; 10:296-304. [PMID: 36828009 DOI: 10.1016/s2215-0366(23)00006-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Psychiatry has increasingly adopted explanations for psychopathology that are based on neurobiological reductionism. With the recognition of health disparities and the realisation that someone's postcode can be a better predictor of health outcomes than their genetic code, there are increasing efforts to ensure cultural and social-structural competence in psychiatric practice. Although neuroscientific and social-cultural approaches in psychiatry remain largely separate, they can be brought together in a multilevel explanatory framework to advance psychiatric theory, research, and practice. In this Personal View, we outline how a cultural-ecosocial systems approach to integrating neuroscience in psychiatry can promote social-contextual and systemic thinking for more clinically useful formulations and person-centred care.
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Affiliation(s)
- Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada.
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Epidemiology and Public Health, University of Basel, Basel, Switzerland
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Urcuyo AE, Conroy K, Sanchez AL, Silva K, Furr JM, Bagner DM, Comer JS. Psychometric Evaluation of the Abbreviated Multidimensional Acculturation Scale (AMAS) in a Treatment-Seeking Sample of First-Generation Immigrant Caregivers. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01525-w. [PMID: 36964458 DOI: 10.1007/s10578-023-01525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
The unique needs of first-generation immigrants and their families have not been prioritized in mental healthcare. Cultural tailoring of child services requires valid, reliable, and efficient assessments of family cultural identity. The Abbreviated Multidimension Acculturation Scale (AMAS) is a self-report of acculturation and enculturation that has been evaluated in community, but not clinical, samples. We offer the first AMAS psychometric evaluation in a treatment-seeking sample of first-generation immigrant caregivers presenting for children's mental healthcare (N = 219). Analyses examined the internal consistency, concurrent validity, and factor structures of the long-form AMAS (42 items, six subscales), AMAS-10 (10 items, four subscales), and AMAS-14 (14 items, six subscales). Findings provide support for the AMAS-10 and AMAS-14, but not the full-length AMAS, in the present sample. Given urgent needs for culturally responsive care for first-generation populations, the AMAS-10 and AMAS-14 can be used in clinical settings to support cultural assessment, case conceptualization, and treatment planning.
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Affiliation(s)
- Anya E Urcuyo
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | | | - Karina Silva
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jami M Furr
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Daniel M Bagner
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Jonathan S Comer
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA.
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Bridgwater MA, Petti E, Giljen M, Akouri-Shan L, DeLuca JS, Rakhshan Rouhakhtar P, Millar C, Karcher NR, Martin EA, DeVylder J, Anglin D, Williams R, Ellman LM, Mittal VA, Schiffman J. Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States. Front Psychiatry 2023; 14:1117022. [PMID: 36993932 PMCID: PMC10040591 DOI: 10.3389/fpsyt.2023.1117022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundSince its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature.ResultsExisting literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population.ConclusionsCollectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.
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Affiliation(s)
- Miranda A. Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Emily Petti
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Maksim Giljen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - LeeAnn Akouri-Shan
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Joseph S. DeLuca
- Department of Psychological and Brain Sciences, Fairfield University, Fairfield, CT, United States
| | | | - Caroline Millar
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Nicole R. Karcher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Elizabeth A. Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Deidre Anglin
- Department of Psychology, The City College of New York, New York, NY, United States
| | | | - Lauren M. Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Jason Schiffman
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14
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Johnson-Lafleur J, Zoldan Y, Frounfelker RL, Rousseau C. Collective case formulation in situations of violent radicalization: A critical perspective in training. Transcult Psychiatry 2023; 60:302-312. [PMID: 36632689 PMCID: PMC10149881 DOI: 10.1177/13634615221134932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners' investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.
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Affiliation(s)
| | - Yann Zoldan
- Department of Health Sciences, 14661Université du Québec à Chicoutimi (UQAC), Chicoutimi, Quebec, Canada
| | - Rochelle L Frounfelker
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, 5620McGill University, Montreal, Quebec, Canada
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15
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Jones-Lavallée A, Bernard G, Taing J, Leanza Y. The State of Current Knowledge on the Cultural Formulation Interview: A Scoping Review. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-10009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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16
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Lindberg LG, Carlsson J, Kristiansen M, Skammeritz S, Johansen KS. The Cultural Formulation Interview-Generating distance or alliance? A qualitative study of practice changes in Danish mental healthcare. Transcult Psychiatry 2022; 59:740-755. [PMID: 35331059 DOI: 10.1177/13634615211065617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI's ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and 'othering' in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Center Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
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Reflection on Culture and Social Structure in Comprehensive Case Formulation: A Proposal for a Culture-Sensitive Assessment of Mental Health Challenges From a Developmental Perspective. J Nerv Ment Dis 2022; 210:883-890. [PMID: 36302084 DOI: 10.1097/nmd.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Arshad SH, Chua J, Wayne SA, Bryant JL, Al-Mateen CS. Tools to Craft a Cultural Formulation. Child Adolesc Psychiatr Clin N Am 2022; 31:583-601. [PMID: 36182212 DOI: 10.1016/j.chc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinicians should strive to understand every patient from their own perspective. The authors present tools to help patients narrate their own experiences and elaborate on the context of their symptoms, allowing clinicians to appreciate the cultural influences on a patient and how that affects their symptomatology. This knowledge can then be crafted into a nuanced cultural formulation of the patient, with the goals of not only better understanding the patient's specific, intersectional context but also guiding treatment planning. As a result, the patient is evaluated in a holistic manner, and their specific needs are central in their care.
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Affiliation(s)
- Sarah H Arshad
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania School of Medicine, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Jaclyn Chua
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania School of Medicine, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | | | - Cheryl S Al-Mateen
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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19
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Wright AJ, Vardanian MM, Constantine K. The Wright-Constantine Structured Cultural Interview and Integration of Culture into Case Conceptualization. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000221127408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although multicultural counseling competence is crucial to the field of counseling psychology and clinical assessment, there remains a gap in how cultural data can be collected and used in clinical case conceptualization. The present study evaluated the case conceptualizations of doctoral-level trainees and focused on whether the integration of culture into the conceptualizations/formulations was influenced by the use of the Wright-Constantine Structured Cultural Interview (WCSCI), as compared to the use of one of two other cultural interviews (the Patient Cultural Identity Assessment and the DSM-5 Cultural Formulation Interview). Unsurprisingly, clients with minoritized identities and supervisors (but not trainees) with minoritized identities produced case conceptualizations that integrated culture at higher rates. Further, those conceptualizations that utilized the WCSCI were around 3.5 to 4.5 times more likely to integrate culture than those that used one of the other two cultural interviews. Implications for psychology practice are discussed.
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20
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Camacho D, Rodriguez CV, Moore KL, Lukens EP. Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project. QUALITATIVE SOCIAL WORK : QSW : RESEARCH AND PRACTICE 2022; 21:932-955. [PMID: 36381022 PMCID: PMC9645408 DOI: 10.1177/14733250211027644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.
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Affiliation(s)
- David Camacho
- Department of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Kiara L Moore
- Silver School of Social Work, New York University, New York, NY, USA
| | - Ellen P Lukens
- School of Social Work, Columbia University, New York, NY, USA
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21
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Meyer EG, DeSilva RB, Hann MC, Aggarwal NK, Brim WL, Engel CC, Lu FG, Lewis-Fernández R. Adapting the Cultural Formulation Interview for the Military. Psychiatr Serv 2022; 73:978-983. [PMID: 35193377 DOI: 10.1176/appi.ps.202100523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE U.S. military service members, veterans, and their families increasingly seek care from providers with limited knowledge of military culture. The 16-item core DSM-5 Cultural Formulation Interview (CFI) was designed to integrate cultural factors into assessment and treatment of mental disorders. Although the CFI was designed for use with all patients, it is unknown whether the CFI adequately assesses military culture. The authors describe a methodology to determine the need for specific CFI versions and how to create a version for use with persons affiliated with the military. METHODS Published articles on cultural competence in the military were systematically reviewed. Cultural domains were abstracted from each article, inductively coded, and hierarchically organized for assessment against the core CFI. A military CFI was created with additional implementation instructions, questions, and probes when the core CFI was inadequate for eliciting relevant cultural domains. RESULTS Sixty-three articles were included. Coding revealed 22 military culture domains, of which only five would be elicited in the core CFI without additional guidance. Twelve of 16 questions in the core CFI required additional instructions, five benefited from question edits, and 10 needed additional probing questions. On the basis of these results, the authors crafted a military version of the CFI for service members, veterans, and their families. CONCLUSIONS The military CFI for clinicians assesses aspects of military culture that are not comprehensively evaluated through the core CFI. The development process described in this article may inform the creation of other versions when the core CFI does not comprehensively assess cultural needs for specific populations.
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Affiliation(s)
- Eric G Meyer
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Ravi B DeSilva
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Michael C Hann
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Neil K Aggarwal
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - William L Brim
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Charles C Engel
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Francis G Lu
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
| | - Roberto Lewis-Fernández
- Department of Psychiatry (Meyer, Hann) and Center for Deployment Psychology (Brim), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Directorate for Mental Health, Naval Medical Center San Diego, San Diego (DeSilva); Department of Psychiatry, Columbia University, New York City (DeSilva, Aggarwal, Lewis-Fernández); Directorate for Mental Health, U.S. Naval Hospital Yokosuka, Japan (Hann); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Engel); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu)
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Luis Sanchez BE, Klein CC, Corcoran F, Barnett ML. A Mixed-Methods Study of Clinician Adaptations to Parent-Child Interaction Therapy - What about Culture? EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:269-285. [PMID: 37456065 PMCID: PMC10348697 DOI: 10.1080/23794925.2022.2070883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an evidence-based practice (EBP) for young children with challenging behaviors. PCIT has been adapted to treat varying presentations and culturally diverse families. Although efforts have been made to disseminate PCIT into community settings, which often serve clinically complex, socio-culturally diverse, and marginalized communities, barriers to disseminating adapted models remain. An alternative strategy to understanding how to increase access to appropriately adapted PCIT is to learn from community clinicians' practice-based adaptations to meet their clients' diverse needs related to clinical presentation, culture, and language. This mixed-method study investigated community clinician adaptations of PCIT. Clinicians (N = 314) were recruited via PCIT listservs to complete a survey collecting background information, and adaptations to PCIT. Most clinicians had a master's degree (72.1%), were licensed (74.2%), and were PCIT-certified (70.7%). Qualitative interviews were conducted with a purposeful sample of 23 community clinicians, who were 39% Spanish-speaking, were 30% Latinx, and 30% reported serving a ≥50% Latinx clientele. Clinicians reported engaging in adaptations aimed at augmenting PCIT more extensively than adaptations involving removing core components. Themes from qualitative interviews converged with quantitative findings, with clinicians most frequently describing augmenting adaptations, and highlighted reasons for adapting PCIT. Clinicians primarily augmented treatment to address clients' clinical presentations. Clinicians rarely adapted treatment specifically for culture, but when mentioned, clinicians discussed tailoring idioms and phrases to match clients' culture for Spanish-speaking clients. Implications for training PCIT clinicians in intervention adaptations will be discussed.
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Affiliation(s)
| | | | | | - Miya L Barnett
- University of California Santa Barbara, Santa Barbara, CA
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23
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Gureje O, Ojagbemi A. Applicability and future status of schizophrenia as a construct in Africa. Schizophr Res 2022; 242:52-55. [PMID: 35151534 DOI: 10.1016/j.schres.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria; Department of Psychiatry, Stellenbosch University, South Africa.
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
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Wallin MI, Galanti MR, Nevonen L, Lewis-Fernández R, Bäärnhielm S. Impact on routine psychiatric diagnostic practice from implementing the DSM-5 cultural formulation interview: a pragmatic RCT in Sweden. BMC Psychiatry 2022; 22:149. [PMID: 35216555 PMCID: PMC8876131 DOI: 10.1186/s12888-022-03791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive tool, the DSM-5 core Cultural Formulation Interview (CFI), to routine diagnostic procedures impacts the psychiatric diagnostic process. METHOD We compared the outcome of a diagnostic procedure that included the CFI with routine diagnostic procedures used at Swedish psychiatric clinics. New patients (n = 256) admitted to a psychiatric outpatient clinic were randomized to a control (n = 122) or CFI-enhanced diagnostic procedure (n = 134) group. An intention-to-treat analysis was conducted and the prevalence ratio and corresponding 95% confidence intervals (CI) were calculated across arms for depressive and anxiety disorder diagnoses, multiple diagnoses, and delayed diagnosis. RESULTS The prevalence ratio (PR) of a depressive disorder diagnosis across arms was 1.21 (95% CI = 0.83-1.75), 33.6% of intervention-arm participants vs. 27.9% of controls. The prevalence ratio was higher among patients whose native language was not Swedish (PR =1.61, 95% CI = 0.91-2.86). The prevalence ratio of receiving multiple diagnoses was higher for the CFI group among non-native speaking patients, and lower to a statistically significant degree among native Swedish speakers (PR = .39, 95% CI = 0.18-0.82). CONCLUSIONS The results suggest that the implementation of the DSM-5 CFI in routine psychiatric diagnostic practice may facilitate identification of symptoms of certain psychiatric disorders, like depression, among non-native speaking patients in a migration context. The CFI did not result in a reduction of patients with a non-definite diagnosis. TRIAL REGISTRATION ISRCTN51527289 , 30/07/2019. The trial was retrospectively registered.
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Affiliation(s)
- Malin Idar Wallin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Region Stockholm, Sweden.
| | - Maria Rosaria Galanti
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, & Centre for Epidemiology and Community Medicine (CES), Stockholm, Region Stockholm Sweden
| | - Lauri Nevonen
- grid.15895.300000 0001 0738 8966Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, & Aleris Psychiatry AB, Stockholm, Sweden
| | - Roberto Lewis-Fernández
- grid.413734.60000 0000 8499 1112Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Sofie Bäärnhielm
- grid.467087.a0000 0004 0442 1056Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Region Stockholm Sweden
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Abstract
In this paper, I set out the challenges of care for refugees and suggest approaches to assessment and intervention. I discuss clinical interventions that can address the immediate concern of the clinician in a bio-psycho-social framework, and the value of considering eco-social and structural influences that can hinder recovery and perpetuate inequalities. Refugees face multiple adversities before, during and after escaping from life-threatening situations, political violence, torture and persecution. They present with complex health needs and encounter hostility from host countries and public services, which see their needs as an additional demand on the public purse. Regrettably, existing care practice and training of professionals do not often include skills for working across cultures, including cultural formulations and fair assessment, cultural adaptation of interventions, cultural competence and cultural consultation methods, including clinical ethnography and exploration of cultural identity and explanatory models. There are little data on effective and kind models of interpretation and translation. Care systems are rarely designed to fully address the needs of refugees. Health practitioners are not trained to address structural and institutional racism and discrimination, which leads to exclusion of the most marginalised, with little attention to social justice and fair processes as part of appropriate healthcare.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; East London NHS Foundation Trust, UK; Oxford Health NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre in Research, Training, Policy and Practice, UK
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Wahid SS, Sarker M, Arafat ASME, Apu AR, Kohrt BA. Tension and Other Idioms of Distress Among Slum Dwelling Young Men: A Qualitative Study of Depression in Urban Bangladesh. Cult Med Psychiatry 2022; 46:531-563. [PMID: 34328610 PMCID: PMC9034992 DOI: 10.1007/s11013-021-09735-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
In low- and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an under-researched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18-29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or "brain"), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word "tension" was the central idiom of distress. "Tension" existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected "tension" to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes.
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Affiliation(s)
- Syed Shabab Wahid
- Department of Global Health, George Washington University, Washington, DC, USA. .,Division of Global Mental Health, George Washington University, Washington, DC, USA.
| | - Malabika Sarker
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh ,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Arifur Rahman Apu
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Brandon A. Kohrt
- Department of Global Health, George Washington University, Washington, DC USA ,Division of Global Mental Health, George Washington University, Washington, DC USA
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Strand M, Bäärnhielm S. Could the DSM-5 Cultural Formulation Interview Hold Therapeutic Potential? Suggestions for Further Exploration and Adaptation Within a Framework of Therapeutic Assessment. Cult Med Psychiatry 2022; 46:846-863. [PMID: 34881417 PMCID: PMC9596502 DOI: 10.1007/s11013-021-09761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
The Cultural Formulation Interview (CFI), included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, is a person-centered instrument for systematically appraising the impact of cultural factors in psychiatric assessment. A number of key areas in the future development of the CFI have been identified in order to ensure further clinical uptake. In this paper, we suggest that applying a Therapeutic Assessment (TA) approach in using the CFI-i.e., framing the interview in a way that gives primacy to its self-transformative potential by explicitly focusing on those issues that are seen as the most urgent, relevant, and meaningful by the patient-could prove helpful in alleviating patients' suffering beyond what is achieved by merely collecting relevant cultural information that may inform diagnosis and subsequent treatment interventions. The TA methodology has been designed as a collaborative approach to psychological assessment in which the assessment procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health problems or psychosocial well-being; these questions are then allowed to guide the assessment process and the interpretation of the findings. We suggest a number of potential modifications to the related Outline for Cultural Formulation and to the CFI content that could strengthen a TA-inspired focus. With this paper, we do not claim to offer a definitive integration of the TA approach in using the CFI but hope to further the discussion of a therapeutic potential of the instrument.
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Affiliation(s)
- Mattias Strand
- Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Solnavägen 4, 113 65, Stockholm, Sweden. .,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77, Stockholm, Sweden.
| | - Sofie Bäärnhielm
- grid.467087.a0000 0004 0442 1056Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77 Stockholm, Sweden
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Ojagbemi A, Gureje O. Sociocultural contexts of mental illness experience among Africans. Transcult Psychiatry 2021; 58:455-459. [PMID: 34427458 DOI: 10.1177/13634615211029055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
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Wright AJ. Deliberate Context-Driven Conceptualization in Psychological Assessment. J Pers Assess 2021; 104:700-709. [PMID: 34227917 DOI: 10.1080/00223891.2021.1942024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clinical formulation and case conceptualization in clinical psychological assessment typically organize a client's presenting problems within a psychological framework and narrative that explains the cluster of symptoms, etiological and maintenance factors, and explaining both how and why a client is struggling or suffering. However, many of the most commonly used models of case conceptualization, as well as the preponderance of tests and measures used in psychological assessment, minimize or ignore the impacts of contextual factors, including dominant culture's expectations for normative behavior and the client's history of trauma and adverse and negative events. This paper presents a rationale and model for encouraging psychologists conducting clinical psychological assessment to be deliberate in first considering contextual factors in case conceptualization before relying entirely on primarily intrapsychic models. While contextual conceptualizations will not always replace (or join) intrapsychic models of case formulation, being deliberate and explicit about at least considering them is an important way to mitigate some of psychologists' biases and has the potential to situate a narrative of client difficulties in a way that takes at least some of the burden off the client.
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Conroy K, Frech N, Sanchez AL, Hagan MB, Bagner DM, Comer JS. Caregiver stress and cultural identity in families of preschoolers with developmental delay and behavioral problems. Infant Ment Health J 2021; 42:573-585. [PMID: 33961711 PMCID: PMC8363575 DOI: 10.1002/imhj.21923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Research on families of young children with developmental delay and disruptive behavior problems has failed to examine caregiver stress in the context of cultural factors. METHODS Families of 3-year-old children with developmental delay and behavior problems were recruited from Early Intervention sites. All caregivers in the current analysis (n = 147) were from immigrant and/or cultural minority backgrounds. Regarding income-to-needs, most families (57.8%) fell into the extreme poverty, poor, or low-income categories. Caregivers reported on their own experiences of acculturation and enculturation as well as their child's problems. RESULTS Path analyses revealed that higher caregiver acculturation was associated with less parenting-specific stress, and higher caregiver enculturation was associated with less caregiver general stress. Severity of child problems was associated with more parenting-specific stress and general stress. Exploratory analysis yielded significant differences in associations between acculturation, enculturation, and caregiver stress in Black/African American caregivers versus Hispanic White caregivers. CONCLUSION Findings suggest that among cultural minority caregivers of young children with developmental and behavioral problems, acculturation and enculturation may influence caregiver stress. While the cross-sectional nature of the study precludes causal conclusions, clinicians should consider how cultural factors can be harnessed to strengthen caregiver resiliency and improve engagement in parenting interventions.
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Affiliation(s)
- Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Natalie Frech
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Amanda L. Sanchez
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary B. Hagan
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Daniel M. Bagner
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Jonathan S. Comer
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
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Sanchez AL, Comer JS, LaRoche M. Enhancing the Responsiveness of Family-Based CBT Through Culturally Informed Case Conceptualization and Treatment Planning. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Wojtkowiak J, Lind J, Smid GE. Ritual in Therapy for Prolonged Grief: A Scoping Review of Ritual Elements in Evidence-Informed Grief Interventions. Front Psychiatry 2020; 11:623835. [PMID: 33613334 PMCID: PMC7887294 DOI: 10.3389/fpsyt.2020.623835] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
The aim of this article of to analyze ritual in evidence-informed treatments for prolonged and traumatic grief. A scoping review is conducted in order to give an overview of existing literature on ritual and symbolic interventions in grief therapies for prolonged grief and the type of evidence supporting these interventions. The 22 studies reported in this review reveal a variety of ritual elements ranging from symbolic expression and interaction, writing assignments, dialogue with the deceased or an imaginary person, to farewell ceremonies at the end of the treatment. The interventions are studied within different populations (e.g., bereaved spouses, perinatal loss, grief after violent death, and genocide). Almost all studies show significant effects of the grief treatment, trauma and related symptoms. However, the effects are mostly measured for the entire treatment and not separately for the ritual intervention. In the discussion we focus on the role of ritual and culture in prolonged grief treatment.
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Affiliation(s)
- Joanna Wojtkowiak
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands
| | - Jonna Lind
- ARQ National Psychotrauma Center, Diemen, Netherlands
| | - Geert E Smid
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands.,ARQ National Psychotrauma Center, Diemen, Netherlands
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