title: The cultural formulation: a method for assessing cultural factors affecting the clinical encounter.
abstract: The growing cultural pluralism of US society requires clinicians to examine the impact of cultural factors on psychiatric illness, including on symptom presentation and help-seeking behavior. In order to render an accurate diagnosis across cultural boundaries and formulate treatment plans acceptable to the patient, clinicians need a systematic method for eliciting and evaluating cultural information in the clinical encounter. This article describes one such method, the Cultural Formulation model, expanding on the guidelines published in DSM-IV. It consists of five components, assessing cultural identity, cultural explanations of the illness, cultural factors related to the psychosocial environment and levels of functioning, cultural elements of the clinician-patient relationship, and the overall impact of culture on diagnosis and care. We present a brief historical overview of the model and use a case scenario to illustrate each of its components and the substantial effect on illness course and treatment outcome of implementing the model in clinical practice.
authors.affiliation: Columbia University, New York, NY, USA. rlewis@nyspi.cpmc.columbia.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernández
authors.forename: Naelys
authors.initials: N
authors.lastname: Díaz
mesh_terms: D001294:Attitude to Health; D003469:Culture; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000534:rehabilitation; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D007802:Language; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D012931:Social Environment; D012933:Social Identification; D012944:Social Support