{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:28:01Z","timestamp":1781717281628,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>As recognition of the importance of social determinants of mental health has increased, the limitations of clinical competence-enhancing interventions that do not emphasize this approach have emerged. The Cultural Formulation Interview (CFI) is a cultural competence intervention that emerges from a confluence of social medicine and medical anthropology traditions. Limited research has examined how patients respond to CFI questions on social-structural aspects of illness and care to assess whether the CFI adequately elicits information on social determinants of mental health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients\u2019 responses during a first intake appointment to three CFI questions on social stressors, supports, or barriers to care from 27 patient-clinician dyads are analyzed through qualitative content analysis. The data come from a hyper-diverse clinical setting in Queens, New York, where no ethnoracial group has a majority and all patient-clinician dyads reflect cross-cultural interactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At least one social determinant was coded in 89 of all cases, and nearly 44% included themes related to multiple determinants of health. The most-commonly coded theme was <jats:italic>social relationships<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u200921), followed by <jats:italic>financial instability<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20097), <jats:italic>stigma<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20095), <jats:italic>housing instability<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20092), and <jats:italic>poor access to healthcare, involvement in the criminal justice system, employment instability<\/jats:italic>, <jats:italic>area-level poverty,<\/jats:italic> and <jats:italic>immigration policies<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u20091 each).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our work shows that social determinants of mental health can be elicited through the CFI. Future work should examine how this information is included in clinicians\u2019 formulations and whether the cultural formulation approach would benefit from additional revision to facilitate assessment of socio-structural factors.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1148170","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T04:24:48Z","timestamp":1679977488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Eliciting social stressors, supports, and determinants of health through the DSM-5 cultural formulation interview"],"prefix":"10.3389","volume":"14","author":[{"given":"Neil Krishan","family":"Aggarwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Lewis-Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"key":"ref1","first-page":"1","article-title":"Cultural context of diagnosis and therapy: a view from medical anthropology","volume-title":"Mental health research and practice in minority communities: development of culturally sensitive training programs","author":"Good","year":"1986"},{"key":"ref2","first-page":"87","article-title":"Cultural formulation: development and critical review","volume-title":"Cultural formulation: A reader for psychiatric diagnosis","author":"Mezzich","year":"2008"},{"key":"ref3","volume-title":"Diagnostic and statistical manual of mental disorders","year":"1994"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1521\/psyc.2014.77.2.130","article-title":"Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5","volume":"77","author":"Lewis-Fern\u00e1ndez","year":"2014","journal-title":"Psychiatry"},{"key":"ref5","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1176\/appi.ap.32.4.291","article-title":"Using non-feature films to teach diversity, cultural competence, and the DSM-IV outline for cultural formulation","volume":"32","author":"Lim","year":"2008","journal-title":"Acad Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1176\/appi.ap.32.4.306","article-title":"Multicultural psychiatric education: using the DSM-IV-TR outline for cultural formulation to improve resident cultural competence","volume":"32","author":"Harris","year":"2008","journal-title":"Acad Psychiatry"},{"key":"ref8","first-page":"253","article-title":"Cultural competence in psychiatric education: using the cultural formulation interview","volume-title":"DSM-5 handbook on the cultural formulation interview","author":"Lim","year":"2016"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1177\/1363461517700812","article-title":"Training on the DSM-5 cultural formulation interview improves cultural competence in general psychiatry residents: a pilot study","volume":"54","author":"Mills","year":"2017","journal-title":"Transcult Psychiatry"},{"key":"ref10","volume-title":"Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed","author":"Cross","year":"1989"},{"key":"ref11","volume-title":"The solid facts: Social determinants of health","author":"Wilkinson","year":"1998"},{"key":"ref12","volume-title":"Promoting health equity: A resource to help communities address social determinants of health","author":"Brennan Ramirez","year":"2008"},{"key":"ref13","volume-title":"Mental health: Culture, race, and ethnicity. 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