Culture in la clínica: Evaluating the utility of the Cultural Formulation Interview (CFI) in a Mexican outpatient setting.

Abstract

While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents' application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers' and patients' views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers' understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to "culture" were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.