This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD, constitute the disorder group in which the most changes were made. In order to understand how information from the OCF interview led clinicians to revise diagnoses, data from clinical discussions were analysed through qualitative content analysis. This revealed four major themes related to the reevaluation, and at times confirmation, of given clinical psychiatric diagnoses: new information; expression of distress in emotional language; expression of distress in relation to life experiences; and improved understanding of the patient's suffering. The findings suggest that the OCF may be useful for: (a) formulating culture in relation to illness experiences, (b) contextualising diagnostic categorisation, and (c) improving overall understanding of the patient that may facilitate individualised planning of treatment and therapy. © 2014, SAGE Publications. All rights reserved.

cultural psychiatry Migrants cultural formulation Psychiatric diagnosis

personal experience patient care disease classification immigrant refugee anxiety disorder Ethnopsychology cultural psychology human Refugees middle aged Interview, Psychological outpatient care psychiatric diagnosis Cultural Competency ethnology cultural competence diagnostic and statistical manual of mental disorders procedures mental health care Mental Disorders mental disease attitude to illness Sweden Humans migrant ethnic difference psychology psychological interview Empathy male Emigrants and Immigrants female qualitative analysis clinical article cultural factor cultural psychiatry Article naturalistic inquiry adult emotionality posttraumatic stress disorder content analysis distress syndrome mental hospital Outline for Cultural Formulation treatment planning DSM-IV