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.