The Influence Of Culture On Diagnostics 2

404 views

Published on

lecture held in September, 2011, on the World Congress in Buenos Aires

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
404
On SlideShare
0
From Embeds
0
Number of Embeds
10
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

The Influence Of Culture On Diagnostics 2

  1. 1. The Influence of Culture on Diagnostics Analysis of the use of the Cultural Formulation in Diagnosis Hans Rohlof, Simon Groen, Rob van Dijk, Richard Starmans
  2. 2. Stichting Centrum ’45 <ul><li>The national institute for specialist diagnostics and the treatment of people with complex psychotrauma complaints </li></ul><ul><li>These complaints have a broad background: </li></ul><ul><ul><li>Result of persecution and / or war </li></ul></ul><ul><ul><li>Result of repeated / job-related violence </li></ul></ul><ul><ul><li>60 % of the patients are refugees from 45 different countries. </li></ul></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  3. 3. Rijnzichtweg 35 2342 AX Oegstgeest 071 5191500 Locations Centrum ‘45 Registration and Information Office 0800 2 245 245 Nienoord 5 1112 XE Diemen 020 6274974
  4. 4. The Cultural Formulation of Diagnosis (CF) <ul><li>Need of more sensitive diagnostics in different ethnic groups </li></ul><ul><li>Use of CF in assessment procedure </li></ul><ul><li>Initial version of Cultural Interview (CI) </li></ul><ul><li>Book in Dutch to promote use of CF </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  5. 5. Content of cultural formulation <ul><li>Cultural identity of the individual </li></ul><ul><li>Cultural explanation of the individual’s illness </li></ul><ul><li>Cultural factors related to psychosocial environment and levels of functioning </li></ul><ul><li>Cultural elements of the relationship between the individual and the clinician </li></ul>
  6. 6. Culture, classification and diagnostics October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  7. 7. Use of the Cultural Formulation in Refugees <ul><li>Article (2009) in Transcultural Psychiatry </li></ul><ul><li>Description of Cultural Interview as used in our clinic </li></ul><ul><li>Specific adaptation of the CF for refugees </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  8. 8. The Cultural Formulation of Diagnosis (CF) <ul><li>Developed on the basis of anthropological theories </li></ul><ul><li>Attached as a chapter in DSM-IV </li></ul><ul><li>Mostly unknown by diagnosing mental health workers </li></ul><ul><li>Lack of sufficient practical applicability </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  9. 9. Theoretical backgrounds <ul><li>cultural identity complex, but important with regard to expression of emotions and physician-patient-relationship </li></ul><ul><li>Idioms of illness, illness explanations and help seeking behavior are important in indications of treatment </li></ul><ul><li>social interactions important: social element of illness </li></ul><ul><li>Frequent misinterpretation of resources and level of functioning. </li></ul><ul><li>Diagnosis has to be reliable but also valid </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  10. 10. Research before DSM-IV <ul><li>APA committee on cross-cultural issues: 45 transcultural experts and 15 DSM-experts </li></ul><ul><li>Field trial with 4 large ethnical groups in the U.S.A.: African Am, Hispanics, Asians, Natives </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  11. 11. Literature search <ul><li>The terms: ‘cultural formulation’ and ‘cultural consultation’ related to ‘mental’ in PubMed (1994-present). </li></ul><ul><li>112 research articles and describing articles, and 28 case histories. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  12. 12. <ul><ul><ul><li>What is the status of implementation research on the CF? </li></ul></ul></ul><ul><ul><ul><li>How can the CF be implemented more uniformly? Have implementation guidelines been proposed? If not, which may be recommended? </li></ul></ul></ul><ul><ul><ul><li>What is the status of empirical effectiveness research on the impact of the CF… </li></ul></ul></ul><ul><ul><ul><ul><li>On diagnostic validity or reliability? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>On clinical response? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>In terms of cost effectiveness? </li></ul></ul></ul></ul><ul><ul><ul><li>What is the status of research on making the CF more efficient and disseminatable (i.e., simpler, shorter) without sacrificing its value as a narrative, comprehensive assessment? </li></ul></ul></ul><ul><ul><ul><li>How can the usefulness of the CF for every clinical encounter be emphasized, as opposed to the perceived use of the CF as applicable only in cross-cultural interactions or for “exotic” patients? </li></ul></ul></ul><ul><ul><ul><li>About the summary of the CF: What proposals have been made or tested to better systematize this application to facilitate dissemination and training? </li></ul></ul></ul><ul><ul><li>Are there data on adapting the CF specifically for refugees, as opposed to migrants more generally? </li></ul></ul>Questions asked October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  13. 13. Status of implementation research <ul><li>28 articles, in which was described the use of the CF in different clinical populations . </li></ul><ul><li>describing articles interesting for therapists who treat patients from the described population </li></ul><ul><li>In The Netherlands important in the education in transcultural mental health care : mental health psychologists, psychiatrists (new curriculum). Also in the education of general practitioners. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  14. 14. Guidelines & clinical interviews <ul><li>EMIC (Weiss, 1997): focused on illness experience. </li></ul><ul><li>Manual of Cultural Psychiatry (Lim, 2006) </li></ul><ul><li>McGill Illness Narrative- MINI (Groleau, 2006): focused on illness explanation. </li></ul><ul><li>Cultural Interview (Rohlof e.a., 2002): semi-structured interview; 90 minutes. </li></ul><ul><li>Short cultural interview (Groen, 2008): 30 minutes </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  15. 15. Status of research <ul><li>Qualitative studies in NL: </li></ul><ul><li>Borra et al (2002): improvement of diagnostic process, but danger of instrumentalisation without improvement of cultural competencies. </li></ul><ul><li>Starmans (2005): no diminishment of gap between GP and patient but also no sign of not accepting the status of the GP. </li></ul><ul><li>Beijers and Tempelman (2009): in mental health care diminishment of gap between patient and therapist. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  16. 16. Status of research <ul><li>Quantitative studies: </li></ul><ul><li>Lopez-Appelo (2000): research in Latin American patients (n=1003), divided in two groups, one with CF: success of treatment better in CF-group. </li></ul><ul><li>Neighbors et al (2003): with using the CF African American wer less frequently diagnosed with schizophrenia. </li></ul><ul><li>Zandi et al (2008): more agreement with clinical diagnosis when adding the CF to the CASH-questionnaire in Moroccan patients. </li></ul><ul><li>Harris et al, Kirmayer et al: more cultural competency in treatment when using the CF </li></ul><ul><li>Ton (2005): investigation of all cultural sensitive services in the U.S.A. Ethnic matching impossible, CF meaningful </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  17. 17. CF shorter, more applicable? <ul><li>Most important items: </li></ul><ul><li>Cultural identity: origin, ethnicity, acculturation, self image, gender. </li></ul><ul><li>Cultural illness explanations: awareness of illness, illness explanations, religious aspects. </li></ul><ul><li>Social network: position of the family, contacts with relatives, other social contacts, the role of shame, stigmatisation. </li></ul><ul><li>CF is also important for the relation with the patient: more adherence to therapy. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  18. 18. CF also for native patients? <ul><li>Better: Contextual Formulation of Diagnosis: </li></ul><ul><li>Social factors: social economical status, housing, discrimination, accessibility of care. Family backgrounds. </li></ul><ul><li>Juridical factors: procedures, permit to stay. </li></ul><ul><li>Cultural factors: language, culture differences, migration history. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  19. 19. Systematisation of summary <ul><li>Acculturation and quality of life can be quantified(Mezzich, 2008). </li></ul><ul><li>Describing cultural elements in terms of problems and possibilities (Rohlof, 2008). </li></ul><ul><li>Calling culture a process, also in therapy (van Dijk et al, 2002). </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  20. 20. Adaptations for refugees <ul><li>Acharya (2009): No adaptations but CF considered as important because of differences in self concept, diffrences in concept of stress involvement and stigmatisation and differences in symptom expression. </li></ul><ul><li>Rohlof et al (2009): adaptations: working with interpreters, attitude towards own culture of therapist and patient, discrimination and accessibility of care. Next to this cultural interview. </li></ul><ul><li>Groen (2008): improvement of diagnostics and treatment by interview. </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  21. 21. Conclusions and advices for DSM-V <ul><li>Attention to self concept en identity </li></ul><ul><li>Attention to illness explanations </li></ul><ul><li>Migration history </li></ul><ul><li>Discrimination and inaccessibility of care </li></ul><ul><li>Stigma </li></ul><ul><li>Social, economical and juridical factors. </li></ul><ul><li>In short: </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  22. 22. Attention to <ul><li>Contextual Formulation of Diagnosis </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  23. 23. More information about CF and CI <ul><li>www.rohlof.nl </li></ul><ul><li>www.centrum45.nl </li></ul>October 21, 2011 The Influence of Culture on Diagnostics. Hans Rohlof et al
  24. 24. 10/21/11 T I T E L V A N D E P R E S E N T A T I E www.centrum45.nl

×