"I need to get back to a normal life": using the core DSM-5 Cultural Formulation Interview to explore existential themes shared by adolescents in specialized mental healthcare in Norway

Nina Therese Øversveen Svamo^1,2Sigrid Helene Kjørven Haug^1,3Valerie DeMarinis^1,4*

• ¹Research Center for Existential Health, Innlandet Hospital Trust, Brumunddal, Norway
• ²Faculty of Social and Health Sciences, University of Inland Norway, Lillehammer, Norway
• ³Faculty of Social and Health Sciences, University of Inland Norway, Elverum, Norway
• ⁴Department of Public Health and Clinical Medicine, Umea Universitet, Umeå, Sweden

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.