• David Tu, George Hadjipavlou, Jennifer Dehoney, Elder Roberta Price, Caleb Dusdal, Annette J Browne, and Colleen Varcoe.
• Family physician at the Urban Indigenous Health and Healing Cooperative, the Lu'ma Medical Centre, and St Paul's Hospital in Vancouver, BC, and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia (UBC). davidtu9@gmail.com.
• Can Fam Physician. 2019 Apr 1; 65 (4): 274281274-281.

ObjectiveTo determine whether including Indigenous Elders as part of routine primary care improves depressive symptoms and suicidal ideation in Indigenous patients.DesignProspective cohort study with quantitative measures at baseline and 1, 3, and 6 months postintervention, along with emergency department (ED) utilization rates before and after the intervention.SettingWestern Canadian inner-city primary care clinic.ParticipantsA total of 45 people who were older than age 18, who self-identified as Indigenous, and who had no previous visits with the clinic-based Indigenous Elders program.InterventionParticipants met with an Indigenous Elder as part of individual or group cultural sessions over the 6-month study period.Main Outcome MeasuresChanges in depressive symptoms, measured with the PHQ-9 (Patient Health Questionnaire), following Indigenous patients' encounters with Indigenous Elders. Secondary outcomes included changes in suicide risk (measured with the SBQ-R [Suicidal Behaviors Questionnaire-Revised]) and ED use.ResultsCharacteristics among those who consented to participate were as follows: 71% were female; mean age was 49 years; 31% had attended residential or Indian day school; and 64% had direct experience in the foster care system. At baseline 28 participants had moderate to severe depressive symptoms (PHQ-9 score of ≥ 10). There was a 5-point decrease that was sustained over a 6-month period (P = .001). Fourteen participants had an above-average suicide risk score at baseline (SBQ-R score of ≥ 7), and there was a 2-point decrease in suicide risk that was sustained over a 6-month period (P = .005). For all participants there was a 56% reduction in mental health-related ED visits (80 vs 35) when comparing the 12 months before and after enrolment.ConclusionEncounters with Indigenous Elders, as part of routine primary care, were associated with a clinically and statistically significant reduction in depressive symptoms and suicide risk among Indigenous patients. Emergency department use decreased, which might reduce crisis-oriented mental health care costs. Further expansion and evaluation of the role of Indigenous Elders as part of routine primary care is warranted.Copyright© the College of Family Physicians of Canada.

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