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Agreement Among Three Evaluators for Ratings of SCF Categories Using ICC for Comparing Patients Assessed With CFI and SCFI
Source publication
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...
Contexts in source publication
Context 1
... an indication of the reliability of assessment for SCF case formulations, we examined the agreement of the three evaluators' ratings for each rated category, and for summaries of detail, relevance, clinical value, and all rated items. We compared the ICCs for the ordinal ratings in the two interview groups (Table 7). For all rated categories, agreement was higher for patients in the SCFI interview group except for clinical rapport, for which agreement was nearly the same for the two interview groups. ...Context 2
... and poor for the remaining 7 ratings. For the SCFI, however, the ICC was at the level of good for the overall summary of all 11 ratings, good for composite ratings of the clinical relevance of four domains, and excellent for composite ratings of the level of detail of four domains (Table 7). This may be explained by the topical specificity of SCFI questions linked to domains of the SCF. ...Citations
... Evidence supports mental health interventions adapted to incorporate cultural components (e.g., language, metaphors, values, traditions) that are important for youth from specific minoritized ethnic and racial groups [69]. Recent research also supports person-centered practices that are based on assessment of the cultural context and engaging patients to articulate which aspects of their identity [70] and social environment [71] matter most for their mental health. Instead of tailoring interventions for specific groups, individual patients' perspectives on their cultural and social context can inform case formulations and guide clinical care. ...
Background/Objectives: Ethnic identity development is associated with positive mental health in young adults from ethnic minority groups. How a sense of belonging and attachment to one’s ethnic culture is related to personal mental health recovery remains unexplained. This study examines the experiences of ethnic minority young adults in the U.S. to understand the aspects of culture and identity development that are relevant to their recovery processes. Methods: Young adults who were living with chronic mental disorders were recruited from four rehabilitation programs. Interviews produced quantitative and qualitative data. An explanatory sequential mixed methods design was used to integrate the qualitative findings from a sub-group of young adults (n = 44) with the results from the quantitative study. Directed content analysis was used to analyze the qualitative data, and the integrated data were analyzed in joint displays. Results: The prominent themes characterizing ethnic identity development in personal recovery were (a) cultural history, traditions, and values; (b) mental illness stigma within the ethnic community; and (c) bias and discrimination in mental health services. Young adults with high ethnic identity development reported having more support from family, but they also described experiences with stigma and racism. Conclusions: The integrated results suggest that ethnic identity development promotes mental health recovery in minoritized young adults through social support and improved well-being and resilience. Experiences of intersectional stigma and structural racism associated with ethnic identity can interfere with self-determination and access to care among minoritized Hispanic/Latine, Black, and multiracial young adults in the U.S.
... In this paper, I have attempted to show the critical importance of all these elements that may well have been lost from view in a more conventional sociocultural analysis. This is why I believe we need "ecological factors" as a new concept in cultural psychiatry: it provides a novel approach to considering the broader context beyond the intersubjective relationship between clinician and patient, an aspect whose importance has been highlighted by several authors (see for example Metzl & Hansen, 2014;Weiss, et al., 2024). ...
Through a longstanding collaboration, psychiatrists and anthropologists have assessed the impact of sociocultural context on mental health and elaborated the concept of culture in psychiatry. However, recent developments in ecological anthropology may have untapped potential for cultural psychiatry. This paper aims to uncover how “ecologies” inform patients’ and clinicians’ experiences, as well as their intersubjective relationships. Drawing on my ethnography with Jerome, a carriage driver who became my patient in a shelter-based psychiatric clinic, and on anthropological work about how psychic life is shaped ecologically, I describe how more-than-human relationality and the affordances of various places—a clinic and a stable—influenced both Jerome’s well-being and my perceptions as a clinician. I also explore how these ecologies shaped our different roles, including my dual roles as psychiatrist and ethnographer. In the discussion, I define ecological factors, describe their implications for clinical practice, and suggest how they could be integrated into DSM’s cultural formulation.
Over the past decade, researchers translating anthropological theories for clinical use have debated how practitioners should assess cultural factors, social structures, and social determinants of health with patients. Advocates of structural competency have suggested that clinical cultural competency programs demonstrate limited effects on health outcomes because of the static understanding of culture employed. They recommend that cultural factors be reformulated with an emphasis on social structures. In response, researchers in cultural psychiatry specializing in cultural assessments have developed three models—sociocultural formulation (SCF), the cultural-ecosocial view, and the contextual developmental assessment—to integrate cultural and structural factors. Their methods for integration, however, differ, resulting in various understandings of psychopathology mechanisms. This paper analyzes arguments from all four positions in this debate. It reveals a lack of consensus about interrelationships among these constructs, their definitions, and methods for assessment. The article concludes with recommendations, such as developing consensus definitions with broad stakeholder involvement; adopting a data-driven approach to clarify how specific cultural, social, or structural factors interact; and identifying how extant assessments capture clinically relevant factors across constructs to develop additional assessment tools.
