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

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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, drift from 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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Acknowledgments

Dr. Aggarwal was supported by a NIMH T32 post-doctoral fellowship in clinical research. Dr. Aggarwal was an advisor to the DSM-5 Cultural Issues Subgroup of which Dr. Lewis-Fernández was the chairperson. The authors acknowledge a Grant from the American Psychiatric Association for the DSM-5 field trial.

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  1. Department of Psychiatry, Columbia University, New York, NY, USA

    Neil Krishan Aggarwal, Ravi DeSilva & Roberto Lewis-Fernández

  2. New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY, 10032, USA

    Neil Krishan Aggarwal, Andel Veronica Nicasio, Ravi DeSilva, Marit Boiler & Roberto Lewis-Fernández

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  1. Neil Krishan Aggarwal
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  2. Andel Veronica Nicasio
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Correspondence to Neil Krishan Aggarwal.

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Aggarwal, N.K., Nicasio, A.V., DeSilva, R. et al. Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study. Cult Med Psychiatry 37, 505–533 (2013). https://doi.org/10.1007/s11013-013-9325-z

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