A different lens on diagnosis: value of the CFI in asylum seekers' psychiatric diagnostic assessment.

Abstract

Background: Asylum seekers face significant mental health challenges but underutilise mental health services and are at increased risk of misdiagnosis. The Cultural Formulation Interview (CFI) could be helpful by introducing individuals' culture and context to psychiatric evaluation. However, its impact on the diagnostic process for asylum seekers remains underexplored.

Aims: This study aims to evaluate the added value of the CFI in the psychiatric diagnostic assessment of asylum seekers.

Method: A mixed-methods design was applied. Diagnostic shifts from the CFI were quantitatively described in 63 participating asylum seekers. The CFI's value was explored using qualitative content analysis.

Results: In about a third of cases, diagnoses were either confirmed (34.9%), changed (25.4%) or narrowed (33.3%), with notable shifts from depressive and psychotic disorders to either trauma- and stressor-related disorders or no psychopathology. Qualitative analysis revealed that the CFI enhanced understanding of participants' experiences, including the impact of trauma, migration and social context. It provided insights into their strengths and therapeutic needs. The shift towards stress-related diagnoses and away from other common DSM categories reflects the CFI's ability to provide a more nuanced, contextual understanding of asylum seekers' mental health.

Conclusion: This study underscored the CFI as a valuable tool in asylum seekers' diagnostic assessment. The CFI facilitated a shift towards a more holistic, recovery-oriented approach. It prompted conceptual reflections on psychopathology in asylum seekers. The CFI presents a promising yet underutilised tool for addressing diagnostic challenges in cross-cultural settings. The findings highlight its potential for broader clinical implementation.