Cultural identity and trauma: Construction of meaning among Afghan and Iraqi refugees under treatment in Dutch mental health care

For a better understanding of the mental health problems of patients whose cultural background differs from their clinicians, the Diagnostic and Statistical Manual for Mental Disorders includes the Cultural Formulation of Diagnosis. One of its components is cultural identity that as a concept remains unclear, yet a case study of a Somalian patient showed the relevance and utility of exploring cultural identity for a better understanding of the mental health problems. In this study, the concept of cultural identity is explored among traumatized Afghan and Iraqi refugees who were referred for specialized mental health care at De Evenaar, Center for Transcultural Psychiatry. In a qualitative analysis of Brief Cultural Interviews with these refugee patients, cultural identity was subdivided in personal identity, ethnic identity and social identity that each could be related to stress and migration issues. In a mixed methods analysis, post-migration stress and acculturation were included in the relationship between experienced traumatic events, cultural identity and trauma, anxiety and depression symptoms. Post-migration stress appeared to be associated with these symptoms. All of the risk factors to develop mental health problems appeared to contribute to cultural identity confusion. When patients were compared to non-patients, the norms and values of their resilience not to be needing mental health care were interrelated with norms and values of their cultural identity. These new insights are converted to recommendations to enhance the cultural competence of clinicians by means of exploring the cultural identity of their patients to better understand their mental health problems

Implementation of the Cultural Formulation through a newly developed Brief Cultural Interview: Pilot data from the Netherlands

The Outline for a Cultural Formulation (OCF) has remained underutilized in clinical practice since its publication in the DSM-IV in 1994. In the Netherlands, a Cultural Interview (CI) was developed in 2002 as a tool to facilitate use of the OCF in clinical practice. The time needed to conduct the interview, however, prevented its systematic implementation within mental health institutions. This article presents the development of a shortened and adapted version, the Brief Cultural Interview (BCI), and a pilot study on the feasibility, acceptability, and utility of its implementation with refugee and asylum seeking patients in a Dutch centre for transcultural psychiatry. Results show that the brief version scores better on feasibility and acceptability, while utility for clinical practice remains similar to that of the original CI. These results support the systematic use of the OCF in psychiatric care for a culturally diverse patient population through the application of a relatively brief cultural interview. A secondary finding of the study is that patients’ cultural identity was considered by clinicians to be more relevant in the treatment planning sessions than their illness explanations

Cultural Identity Among Afghan and Iraqi Traumatized Refugees: Towards a Conceptual Framework for Mental Health Care Professionals

Cultural identity in relation with mental health is of growing interest in the field of transcultural psychiatry. However, there is a need to clarify the concept of cultural identity in order to make it useful in clinical practice. The purpose of this study is to unravel the complexity and many layers of cultural identity, and to assess how stress and acculturation relate to (changes in) cultural identity. As part of a larger study about cultural identity, trauma, and mental health, 85 patients from Afghanistan and Iraq in treatment for trauma-related disorders were interviewed with a Brief Cultural Interview. The interviews were analysed through qualitative data analysis using the procedures of grounded theory. The analysis resulted in three domains of cultural identity: personal identity, ethnic identity and social identity. Within each domain relationships with stress and acculturation were identified. The results offer insight into the intensity of changes in cultural identity, caused by pre-and post-migration stressors and the process of acculturation. Based on the research findings recommendations are formulated to enhance the cultural competency of mental health workers

Implementation of the Cultural Formulation through a newly developed Brief Cultural Interview : Pilot data from the Netherlands

The Outline for a Cultural Formulation (OCF) has remained underutilized in clinical practice since its publication in the DSM-IV in 1994. In the Netherlands, a Cultural Interview (CI) was developed in 2002 as a tool to facilitate use of the OCF in clinical practice. The time needed to conduct the interview, however, prevented its systematic implementation within mental health institutions. This article presents the development of a shortened and adapted version, the Brief Cultural Interview (BCI), and a pilot study on the feasibility, acceptability, and utility of its implementation with refugee and asylum seeking patients in a Dutch centre for transcultural psychiatry. Results show that the brief version scores better on feasibility and acceptability, while utility for clinical practice remains similar to that of the original CI. These results support the systematic use of the OCF in psychiatric care for a culturally diverse patient population through the application of a relatively brief cultural interview. A secondary finding of the study is that patients’ cultural identity was considered by clinicians to be more relevant in the treatment planning sessions than their illness explanations