1Psychologist, KEM Hospital & KEM Hospital Research Center, Pune, India
2Psychiatrist, KEM Hospital & KEM Hospital Research Center, Pune, India
3Consultant & Scientific Assistant, Dept. of Public Health & Epidemiology, Swiss Tropical & Public Health Inst. and University of Basel, Basel, Switzerland
4Senior Consultant Statistician, KEM Hospital & KEM Hospital Research Center, Pune, India
5Scientist, Dept. of Public Health & Epidemiology, Swiss Tropical & Public Health Inst. and University of Basel, Basel, Switzerland
Online published on 29 December, 2017.
Expression of cultural identity (CI) reflects personal and family values, which may have positive and/or negative associations. In clinical field trials of the Cultural Formulation Interview for DSM-5 (CFI) in Pune, respondents’ difficulty understanding, and clinicians’ difficulty assessing CI indicated need for improved assessment.
Assess key features of CI and perceived positive and/or negative impact with a particular focus on the role of family, and compare accounts of CI among outpatient psychiatry patients and non-patient community residents.
A semi-structured interview was used to examine 12 domains of CI. Prominence of each domain—ranging from 0 (not mentioned) to 2 (definite feature)—was analysed based on respondent accounts. Positive and negative impact of CI was also analysed. Thematic analysis was used for qualitative elaboration and comparison.
Family was the most prominent domain of CI for clinic (n=302) and community (n=163) respondents. Themes of family identity focussed on the family name, respondent roles with reference to key relationships and responsibilities. Community respondents regarded the impact of the family more positively, though violence and deprivation were also acknowledged. Clinic patients had less positive views of family relationships, elaborated in accounts of criticism, neglect and exploitation.
Family is the most prominent feature of CI, and in-depth assessment of CI helps both patients and community respondents understand and express features of cultural identity that are otherwise difficult to articulate spontaneously. Findings indicate that assessment and consideration of the role of CI and its impact are relevant for clinical care and for community mental health planning.
Both assessing CI and considering implications for inking culturally competent clinical psychiatric services to culturally sensitive community mental health planning have been challenging goals. The approach to assessment and the clinic-community comparative design are unique contributions of this study.
Cultural Formulation Interview, Cultural Identity, Cultural Competence, Community Mental
