The DSM-5 Cultural Formulation Interview: Bridging Barriers Toward a Clinically Integrated Cultural Assessment in Psychiatry

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (DSM-5) Cultural Formulation Interview (CFI) is a systematic, semi-structured interview developed to guide clinicians on conducting a cultural assessment in routine mental health settings. An international field trial with 318 patients, 75 clinicians, and 86 family members in 6 countries found the core version of the CFI to be feasible, acceptable, and clinically useful, and a growing evidence base has led to its inclusion in worldwide mental health services. We review the definition of culture that underlies the CFI, its development and components, and how to apply it in care. We also focus on barriers to its implementation and how these are being addressed by investigators and clinicians. The cultural formulation approach stemming from DSM-IV, of which the DSM-5 CFI is the latest iteration, constitutes the cultural competence paradigm with the largest evidence base in mental health service delivery. [Psychiatr Ann. 2018;48(3):154-159.] The Cultural Formulation Interview (CFI) was included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (DSM-5)1 to guide clinicians on how to conduct a cultural assessment in routine Ravi DeSilva, MD, MA, is an Assistant Professor, Department of Psychiatry, Columbia University, New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute; and the Unit Chief, Inpatient Psychiatry, New York-Presbyterian Hospital, Columbia University Irving Medical Center. Neil Krishan Aggarwal, MD, MBA, MA, is an Assistant Professor and a Research Psychiatrist, Department of Psychiatry, Columbia University, New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute. Roberto Lewis-Fernández, MD, MTS, is a Professor, Department of Psychiatry, Columbia University, and the Director, New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute. Address correspondence to Ravi DeSilva, MD, MA, Department of Psychiatry, Columbia University Medical Center, Milstein Hospital Building 9GN, 177 Ft. Washington Avenue, New York, NY 10032; email: [email protected]. Disclosure: Ravi DeSilva discloses previous consultant work for the development of the Cultural Formulation Interview (CFI). Neil Krishan Aggarwal discloses a grant received from the National Institutes of Health for research on the CFI. Roberto Lewis-Fernández discloses royalties received as an editor of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Hand-