Culture in Diagnostics of Refugees: The Cultural Formulation of Diagnosis

Abstract

Background and purpose: The Cultural Formulation of Diagnosis (CFD) is a qualitative instrument in DSM-IV to describe the influence of culture on diagnostics. In ethnic minorities and refugees it is important to use this instrument in order to enhance diagnostic validity, communication and compliance. Method: A review of English and Dutch literature concerning qualitative and quantitative research of the use of the CFD in clinical practice, with special regard to the use of the CFD in refugees. Search terms: ‘‘cultural formulation’, ‘cultural assessment’, ‘cultural consultation’ and ‘cultural interview’. Results: 112 research studies and 28 case histories have been found. Only 9 qualitative and 7 quantitative studies were suitable for further analysis. The CFD was used in quite diverse populations, among them refugees. The qualitative studies propagated the use of the CFD, and recommended several improvements. The quantitative studies found difference in treatment effect and improvement of therapeutic competencies in therapists. Conclusion: The CFD is used successfully in diverse ethnic minority populations, as shown by qualitative and quantitative research. In refugees it is advisable to use the CFD, but improvements in the CFD have to be added.