The Cultural Formulation (CF) of the Diagnostic and Statistical Manual (DSM) provides a potential framework for improving the diagnostic assessment of Posttraumatic Stress Disorder (PTSD) in culturally diverse patients. We analyzed data from the Patient-Provider Encounter Study, a multi-site study that examines the process of diagnosis and clinical decision-making during an initial clinical intake session, in order to examine use of CF for PTSD diagnosis. We find that while the CF is generally used inconsistently or underutilized in routine community settings, when employed appropriately it may assist the formulation and interpretation of traumatic experiences. We discuss the implications for improving the assessment of PTSD in the time-limited setting of the clinical intake encounter and across race/ethnicity.
Alegría, M., Nakash, O., Lapatin, S., Oddo, V., Gao, S., Lin, J., et al. (2008). How missing information in diagnosis can lead to disparities in the clinical encounter. Journal of Public Health Management Practice (Supplement), 14(6), S26-S35.
2.
Alim, T.N., Charney, D.S., & Mellman, T.A. ( 2006). An overview of posttraumatic stress disorder in African Americans. Journal of Clinical Psychology, 62(7), 801-813.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
4.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.
5.
Antai-Otong, D. ( 2002). Culture and traumatic events. Journal of the American Psychiatric Nurses Association, 8(6), 203-208.
6.
Barrett, R.J. ( 1997). Cultural formulation of psychiatric diagnosis: Death on a horse’s back: Adjustment disorder with panic attacks. Culture, Medicine & Psychiatry, 21(4), 481-496.
7.
Blanchard, J., Nayar, S., & Lurie, N. ( 2007). Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting. Journal of General Internal Medicine, 22(8), 1184-1189.
8.
Brave Heart, M.Y. ( 1999). Gender differences in the historical trauma response among the Lakota. Journal of Health and Social Policy, 10(4), 1-21.
9.
Breslau, N., Davis, G.C., Andreski, P., Peterson, E.L., & Schultz, L.R. ( 1997). Sex differences in posttraumatic stress disorder . Archives of General Psychiatry, 54(11), 1044-1048.
10.
Breslau, N., & Kessler, R.C. ( 2001). The stressor criterion in DSM-IV posttraumatic stress disorder: An empirical investigation. Biological Psychiatry , 50(9), 699-704.
11.
Bucardo, J.A., Patterson, T.L., & Jeste, D.V. ( 2008). Cultural formulation with attention to language and cultural dynamics in a Mexican psychiatric patient treated in San Diego, California . Culture, Medicine & Psychiatry, 32(1), 102-121.
12.
Carlson, E.B., & Rosser-Hogan, R. (1994). Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. Journal of Traumatic Stress, 7(1), 43-58.
13.
Dedier, J., Penson, R., Williams, W., & Lynch, T., Jr. (1999). Race, ethnicity, and the patient-caregiver relationship. Oncologist, 4(4), 325-331.
14.
De Girolamo, G., & McFarlane, A. ( 1996). The epidemiology of PTSD: A comprehensive review of the international literature. In A. Marsella , M. Friedman, E. Gerrity, & R. Scurfield (Ed.), Ethnocultural aspects of post-traumatic stress disorder: Issues, research, and clinical applications. Washington, DC: American Psychological Association.
15.
De Wilde, J., Broekaert, E., Rosseel, Y., Delespaul, P., & Soyez, V. ( 2007). The role of gender differences and other client characteristics in the prevalence of DSM-IV affective disorders among a European therapeutic community population. Psychiatry Quarterly, 78(1), 39-51.
16.
Dougherty, R.H. ( 2004). Reducing disparity in behavioral health services: A report from the American College of Mental Health Administration. Administration and Policy in Mental Health and Mental Health Services Research , 31(3), 253-263.
17.
Elsass, P. ( 2001). Individual and collective traumatic memories: A qualitative study of post-traumatic stress disorder symptoms in two LatinAmerican localities. Transcultural Psychiatry, 38(3), 306-316.
18.
Fabrega, H., Jr. ( 2007). How psychiatric conditions were made. Psychiatry, 70(2), 130-153.
19.
Fleming, C.M. ( 1996). Cultural formulation of psychiatric diagnosis. Case No. 01. An American Indian woman suffering from depression, alcoholism and childhood trauma. Culture, Medicine & Psychiatry, 20(2), 145-154.
20.
Fortuna, L.R., Porche, M.V., & Alegria, M. ( 2008). Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States . Ethnicity and Health, 13(5), 435-463.
21.
Harris, P.A. ( 2004). The impact of age, gender, race, and ethnicity on the diagnosis and treatment of depression. Journal of Managed Care Pharmacy, 10(2Suppl), S2-7.
22.
Harry, B., Sturgis, K.M., & Klinger, J.K. ( 2005). Mapping the process: An exemplar of process and challenge in grounded theory analysis. Educational Researcher , 34(2), 3.
23.
Hernandez, P. ( 2002). Trauma in war and political persecution: Expanding the concept. Amercian Journal of Orthopsychiatry, 72(1), 16-25.
24.
Hernandez, P., Gangsei, D., & Engstrom, D. ( 2007). Vicarious resilience: A new concept in work with those who survive trauma. Family Process, 46(2), 229-241.
25.
Jenkins, J.H., & Cofresi, N. ( 1998). The sociosomatic course of depression and trauma: A cultural analysis of suffering and resilience in the life of a Puerto Rican woman. Psychosomatic Medicine, 60(4), 439-447.
26.
Lewis-Fernandez, R. ( 1996). Cultural formulation of psychiatric diagnosis. Case no. 02. Diagnosis and treatment of Nervios and Ataques in a female Puerto Rican migrant. Culture, Medicine & Psychiatry, 20(2), 155-163.
27.
Lewis-Fernandez, R., & Diaz, N. ( 2002). The cultural formulation: a method for assessing cultural factors affecting the clinical encounter. Psychiatry Quarterly , 73(4), 271-295.
28.
Lim, R. F. (Ed.). (2006). Clinical manual of cultural psychiatry. Washington, DC : American Psychiatric Publishing.
29.
Lim, R.F., & Lin, K.M. ( 1996). Cultural formulation of psychiatric diagnosis. Case no. 03. Psychosis following Qi-gong in a Chinese immigrant. Culture, Medicine & Psychiatry, 20(3), 369-378.
30.
Loo, C.M. ( 1994). Race-related PTSD: The Asian American Vietnam veteran , Journal of Traumatic Stress, 7(4), 637-656.
31.
Loo, C.M., Fairbank, J.A., & Chemtob, C.M. ( 2005). Adverse race-related events as a risk factor for posttraumatic stress disorder in Asian American Vietnam veterans. The Journal of Nervous and Mental Disease, 193(7), 455-463.
32.
Loo, C.M., Fairbank, J.A., Scurfield, R.M., Ruch, L.O., King, D.W., Adams, L.J., et al. (2001). Measuring exposure to racism: Development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans. Psychological Assessment, 13(4), 503-520.
33.
Loo, C.M., Lim, B.R., Koff, G., Morton, R.K., & Kiang, P.N. ( 2007). Ethnic-related stressors in the war zone: Case studies of Asian American Vietnam veterans. Military Medicine , 172(9), 968-971.
34.
Manson, S.M. ( 1996). The wounded spirit: A cultural formulation of posttraumatic stress disorder. Culture, Medicine & Psychiatry , 20(4), 489-498.
35.
Marshall, G.N., & Orlando, M. ( 2002). Acculturation and peritraumatic dissociation in young adult Latino survivors of community violence. Journal of Abnormal Psychology, 111(1), 166-174.
36.
Marshall, R.D., Spitzer, R., & Liebowitz, M.R. (1999). Review and critique of the new DSM-IV diagnosis of acute stress disorder. American Journal of Psychiatry, 156(11), 1677-1685.
37.
Mezzich, J.E. ( 1995). Cultural formulation and comprehensive diagnosis: Clinical and research perspectives. Psychiatric Clinics of North America , 18(3), 649-657.
38.
Miles, M.B., & Huberman, A.M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: SAGE.
39.
Munir, K.M., & Beardslee, W.R. (2001). A developmental and psychobiologic framework for understanding the role of culture in child and adolescent psychiatry . Child and Adolescent Psychiatric Clinics of North America , 10(4), 667-677.
40.
Norris, F.H., & Alegria, M. ( 2005). Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence. CNS Spectrum, 10(2), 132-140.
41.
Pole, N., Best, S.R., Weiss, D.S., Metzler, T., Liberman, A.M., Fagan, J., et al. (2001). Effects of gender and ethnicity on duty-related posttraumatic stress symptoms among urban police officers. Journal of Nervous and Mental Disorders, 189(7), 442-448.
42.
Ruskin, P.E., Reed, S., Kumar, R., Kling, M.A., Siegel, E., Rosen, M., et al. (1998). Reliability and acceptability of psychiatric diagnosis via telecommunication and audiovisual technology. Psychiatric Services, 49(8), 1086-1088.
43.
Schreiber, S. ( 1995). Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder county in Ethiopia. British Journal of Medical Psychology , 68(Pt 2), 135-142.
44.
Sokoloff, N.J., & Dupont, I. ( 2005). Domestic violence at the intersections of race, class, and gender: Challenges and contributions to understanding violence against marginalized women in diverse communities. Violence Against Women, 11(1), 38-64.
45.
Sorenson, S.B. ( 2006). Judgments about intimate partner violence: a statewide survey about immigrants. Public Health Reports, 121(4), 445-452.
46.
Spitzer, R.L., First, M.B., & Wakefield, J.C. (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders, 21(2), 233-241.
47.
Suarez-Orozco, C., Todorova, I.L., & Louie, J. ( 2002). Making up for lost time: the experience of separation and reunification among immigrant families. Family Process , 41(4), 625-643.
48.
Tamayo, J.M., Rovner, J., & Munoz, R. ( 2007). La importancia de la deteccion y el tratamiento de los sintomas somaticos en pacientes latinoamericanos con depresion mayor [The importance of detection and treatment of somatic symptoms in Latin American patients with major depression]. Revista Brasileira de Psiquiatria , 29(2), 182-187.
49.
Ton-That, N. ( 1998). Post-traumatic stress disorder in Asian refugees . Psychiatry and Clinical Neurosciences, 52(Suppl), S377-S379.
50.
Yilmaz, A.T., & Weiss, M.G. ( 2000). Cultural formulation: Depression and back pain in a young male Turkish immigrant in Basel, Switzerland. Culture, Medicine & Psychiatry, 24(2), 259-272.
51.
Zayas, L., Cabassa, L., & Perez, M. ( 2005). Capacity-to-consent in psychiatric research: Development and preliminary testing of a screening tool. Research on Social Work Practice, 15(5), 545-556.
