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Background: The DSM-5 core Cultural Formulation Interview (CFI) is designed with the agenda of letting the patient’s perspective become as important for treatment and care as the clinician’s assessments. This is in line with the person-centered turn in every part of the health care system in Norway. However, international CFI research on majority populations and on adolescents remains scarce. This study is the first to test the feasibility, acceptability, and clinical utility of core CFI with adolescents in a specialized mental healthcare inpatient unit in Norway.

Methods: The study used a mixed methods design with three stages, inspired by and expanding the CFI testing research in the United States: 1) Cultural analysis of the clinical context and CFI training, 2) Data gathering with CFI interviews, debriefing instruments, and semi-structured interviews with six consecutive adolescents (aged 14–17 years) with various severe mental health problems, and multi-method data gathering with three interdisciplinary CFI-trained clinicians, and 3) Efficacy evaluation of the CFI.

Results: Adolescents and clinicians reported positive perceptions of the CFI’s feasibility, acceptability, and clinical utility. The CFI supported service user involvement and treatment planning, consistent with international evidence. Both patients and clinicians described the CFI as a type of intervention that initiated a process of reflection and deeper understanding of challenges as well as resources, with patients expecting their narratives to be understood, shared, and integrated into treatment planning.

Conclusion: This study contributes to person-centered care (PCC) research by underscoring the importance of actively involving adolescents in their treatment processes. Based on these findings, the clinic initiated a request to evaluate the integration of the CFI process (core interview and use of this information in treatment planning) into standard treatment protocols through an implementation study, which is currently underway.

Introduction: Patients with work-related musculoskeletal disorders risk becoming outsiders of society due to the complexity of their health and life situations. Chronic pain is often predominant, and the comorbidity rate is high, with anxiety and depression as the most common disorders. Due to the high prevalence and multidimensional character of chronic pain, there has been a call for person-centered and comprehensive approaches that include cultural aspects and an existential dimension. The DSM-5 Cultural Formulation Interview (CFI) is person-centered and was developed to explore all patients’ perceptions of illness, health and support in relation to their life contexts. The study forms part of a larger mix-methods project testing the efficacy of the core CFI (16 questions) in various Norwegian clinical contexts. The objective was to efficacy test the core CFI with patients in vocational rehabilitation treatment.

Methods: The design was inspired by field trials for efficacy testing of the core CFI in the United States. In Norway, the efficacy design went beyond conducting the core CFI in order to follow the use of the CFI information throughout the treatment process. This was referred to as the CFI process. Six consecutive patients were interviewed at three stages: the core CFI on day 1 of treatment, T2 interviews 5-7 days later, and T3 interviews at completion of treatment. Deductive content analysis, following Elo and Kyngäs, was used. Fidelity analysis for conducting the core CFI evidenced high scores.

Results: The main results were: 1) T1-core CFI: Eliciting complex and broad understandings of pain-related problems affecting daily life, 2) T2: The core CFI as a holistic experience, facilitating reflections and hope for the treatment, and 3) T3: The treatment as a significant learning arena with the core CFI as a reflexive basis for treatment processes and expectations.

Discussion: Patients found the CFI process to be complex, positive, and holistic, leading to reflections and expectations for their treatment. This was evidenced further by results from the Debriefing Instrument for Patients (DIP). Future clinical implementation of the core CFI should build on a person-centered foundation, incorporating accountable integration of patients’ treatment expectations and illness/health narrative information.

The primary objective of this evaluation research has been to conduct a pilot study of the Integrative Complexity (IC) Training Course in Sweden, during the initial three-year period 2019-2021, and with extended prolongation through to December 2024. The IC training course was developed and directed through the University of Cambridge. The Swedish course was initially named IC Sverige, and then changed to ICbility, which will be the reference name for the Swedish course in this evaluation report. The Swedish version of this course has been designed for youth, young adult populations, and adults working with these populations in non-clinical contexts. It can best be classified under the area of mental health promotion resources, and the underlying general design has been used in a variety of international settings to address extremism, and for building resilience to avoid extremist thinking.

This study explores the relationships between humiliation, perceived power loss, discrimination, and vulnerability to radicalisation across Denmark, the Netherlands, Norway, and the United Kingdom. Analysing survey data from 5,501 respondents, we developed a measure of radicalisation vulnerability that captures both general vulnerability factors and specific ideological orientations. Muslims and ethnic minorities were marginally more likely to experience humiliation than ethnic majorities, though this relationship varied by national context. A strong positive association was found between perceived ethnic power loss and radicalisation vulnerability, with higher perceived power loss linked to increased vulnerability. While humiliation positively correlated with discrimination, our analysis distinguished between discrete discrimination experiences and broader perceptions of ethnic power loss, suggesting distinct pathways to radicalisation vulnerability. Notably, humiliation mediated the relationship between Muslim or foreign-born status and radicalisation vulnerability, suggesting that addressing humiliation may be more effective than targeting specific demographic groups or ideologies. Cross-national comparisons revealed significant differences in radicalisation vulnerability, with the Netherlands showing the highest mean score and Denmark the lowest. These findings highlight the role of the national context in radicalisation processes and emphasise the need for culturally informed, holistic prevention strategies that address underlying psychological and social factors, particularly humiliation and perceived power loss.

Background: Despite the high prevalence of mental health challenges among adolescents, often they do not receive sufficient support in mental healthcare. Therefore, person-centered care (PCC) is essential for accessing adolescents' needs, resources and preferences. The DSM-5 core Cultural Formulation Interview (CFI) is a PCC tool designed to elicit patients' narratives about illness and health. However, knowledge about its application with adolescents remains limited. The existential dimension, an implicit content area of the CFI, is an important and often overlooked dimension in mental healthcare. This study aimed to explore the CFI's contribution to identifying the salient existential themes shared by adolescents while receiving treatment in a specialized mental healthcare inpatient unit in Norway. The study is framed by culturally-informed, multi-dimensional and holistic understandings of health and illness, where the existential dimension can play a fundamental role in PCC treatment planning and treatment process.

Methods: This qualitative study is part of a larger mixed-methods project. Six consecutive adolescents aged 14–17 years, with various mental health problems, were interviewed by trained clinicians, using the semi-structured CFI interview. The interviews were analyzed with inductive content analysis.

Results: Four main categories emerged through the analysis: (1) Striving to achieve a normal everyday life, (2) Seeking supportive understanding from family and clinicians, (3) Dealing with adverse childhood experiences, and (4) Struggling with ongoing challenges and future uncertainty.

Conclusion: This study highlights the potential of the CFI as a narrative tool to enhance understanding of adolescents' existential concerns and needs in mental healthcare treatment. Their narratives concerned multi-dimensional and interacting aspects of illness and health (biological-physical, psychological, social, ecological, and existential aspects) of relevance to treatment planning and the treatment process. Notably, a functional understanding of the existential dimension, designed for clinical contexts, provided a deeper and more nuanced perspective on how existential issues influence decision-making and coping with everyday challenges. The findings indicate the importance of including existential themes in mental healthcare and treatment for adolescents. The qualitative data in this study were derived from a larger mixed-methods project designed to test the efficacy of the CFI in different clinical contexts.

Introduction: Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients.

Materials and methods: The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients.

Results: We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms.

Discussion: Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians’ identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.

Introduction: According to the United Nations Convention on the Rights of the Child, adolescents' involvement in their healthcare is a fundamental right, and self-engagement in mental health treatment is vital for realizing their potential within person-centered care (PCC). Research exists that highlights barriers to involving adolescents in their care decisions. However, research on adolescents' own voices about self-engagement in mental health treatment has been scarce. This scoping review aimed to examine and summarize current knowledge on adolescents' voices regarding self-engagement in mental health treatment.

Method: The review followed the scoping methodology of Arksey and O'Malley from 2005, updated by Levac and colleagues in 2010, involving five stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing and reporting the results. Results: Nineteen studies were included. The following themes on adolescents' voices regarding self-engagement in mental health treatment were identified: (1) the therapeutic alliance, (2) the need for active engagement in treatment, (3) different experiences due to time of data collection, (4) treatment context and healthcare system, and (5) adolescent-caregiver interaction.

Conclusion: Adolescents' understanding of self-engagement was multilevel and comprehensive, including individual, contextual and relational factors. A strong therapeutic alliance with healthcare providers, and a need to be actively engaged in treatment were highlighted. To succeed in strengthening PCC in mental healthcare for adolescents, health professionals must take this complex understanding into consideration, as treatment without adolescents' self-engagement may worsen their clinical outcomes. Future research should explore specific PCC interventions and incorporate diverse methodologies in various clinical contexts. Additionally, insights from healthcare providers and caregivers on self-engagement in mental health treatment will complement these findings.

Introduction: Cultural and contextual factors affect communication and how psychiatric symptoms are presented, therefore psychiatric assessments need to include awareness of the patients’ culture and context. The Cultural Formulation Interview (CFI) in DSM-5 is a person-centred tool developed to support the exploration of cultural and contextual factors in an individualized and non-stereotypic way.

Methods: The aim of this qualitative study was to find out what information the DSM-5 CFI revealed when used with native Swedish-speaking patients as part of routine clinical psychiatric assessment at an outpatient clinic. An additional aim was to enhance understanding of what kind of information the questions about background and identity yielded. The CFI was added to the psychiatric assessment of 62 native Swedish-speaking patients at an outpatient psychiatric clinic in Stockholm.

Results: From the thematic analysis of the documented CFI answers, six central themes were found; Descriptions of distress and dysfunction, Managing problems and distress, Current life conditions affecting the person, Perceived failure in meeting social expectations, Making sense of the problem, and Experiences of, and wishes for, help. The CFI questions about identity yielded much information, mainly related to social position and feelings of social failure.

Discussion: For further refinement of the CFI, we see a need for re-framing the questions about cultural identity and its impact on health so that they are better understood. This is needed for majority population patients as direct questions about culture may be difficult to understand when cultural norms are implicit and often unexamined. For clinical implications, our findings suggest that for cultural majority patients the DSM-5 CFI can be a useful person-centred tool for exploring cultural and, in particular, social factors and patients’ perception and understanding of distress.

Objective: To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources.

Design: Qualitative method using the Cultural Formulation Interview (CFI) from the DSM-5 as an interview guide. Analysis of participants’ experiences of acculturation through systematic text condensation.

Participants: Eleven Swedish former members of ideological or religion-based cults.

Setting: Swedish mainstream, secular society.

Results: Former cult members experience an ‘in-between time’ in the period after leaving the cult and find themselves in a confusing, chaotic state. They describe having lived in an honor culture where acts of violence were normalized. In the cult, they felt disconnected from themselves, and post-cult they try to regain access to their own values and feelings as well as create new bonds with family members and friends outside the cult. They find it hard to talk about their cult background and find relief in communicating with other former cult members. In their post-cult life, they eventually start seeing the world in a brighter, more hopeful way than before. However, they are also at risk of re-experiencing cult-related traumatic events and of new traumatic experiences within the post-cult acculturation process, and of persistent psychological distress.

Conclusion: Former cult members face a challenging acculturation process, having lost a functioning worldview upon leaving the cult but not yet gained another to take its place. While the in-between time is often transient, they may need support from the healthcare system, especially regarding mental health concerns, while establishing themselves into mainstream society.