The Cultural Appropriateness of the Structured Clinical Interview for DSM-IV TR, AXIS I for Indigenous Populations

The Cultural Appropriateness of the Structured Clinical Interview for DSM-IV TR, AXIS I for Indigenous Populations

Background: Although mental illness among Indigenous
Australians is generally accepted to be a major health
problem, there is little evidence to show whether a clinical
diagnostic tool is culturally appropriate for this population.

Objectives: To determine the cultural appropriateness
of the Structured Clinical Interview for the Diagnostic
and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV) (SCID-I) in the diagnosis of mental illness among
Indigenous Australians.

Methods: SCID-I, a semi-structured clinical interview
that uses the clinical judgement of the psychologist as
well as the information collected by the SCID-I tool itself,
was administered by culturally trained psychologists to
544 Indigenous adults living in Southern Queensland and
Northern New South Wales.

Findings: The feedback questionnaire was completed
by 498 (91.5%) participants. Administrating psychologists
provided qualitative feedback for 502 (92.3%) interviews.
Most (95.6%) participants were totally comfortable or
mostly comfortable during the interview: 96.2% felt that
they psychologist understood their responses during the
interview; and 83% said that there were no culturally
inappropriate questions. For psychologists, 72.5% of
interviews did not encounter any cultural challenges to
reach a clinical diagnosis; and 40.4% developed an excellent
rapport with the participant. Sections of the interview
where cultural aspects did need to be considered included
those of psychosis (n = 99, 19.7%), anxiety (n = 4, 0.8%) and
trauma sections (n = 4, 0.8%).

Conclusions: Cultural nuances need to be considered
when SCID-I is used for Indigenous Australians. When
administered by a culturally trained psychologist, SCID-I is
considered culturally appropriate in this group.

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