TY  - JOUR
PY  - 2019//
TI  - Partnering with Indigenous Elders in primary care improves mental health outcomes of inner-city Indigenous patients: Prospective cohort study
JO  - Canadian family physician
A1  - Tu, David
A1  - Hadjipavlou, George
A1  - Dehoney, Jennifer
A1  - Price, Elder Roberta
A1  - Dusdal, Caleb
A1  - Browne, Annette J.
A1  - Varcoe, Colleen
SP  - 274
EP  - 281
VL  - 65
IS  - 4
N2  - OBJECTIVE: To determine whether including Indigenous Elders as part of routine primary care improves depressive symptoms and suicidal ideation in Indigenous patients.  DESIGN: Prospective 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.  SETTING: Western Canadian inner-city primary care clinic.  PARTICIPANTS: A 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.  INTERVENTION: Participants met with an Indigenous Elder as part of individual or group cultural sessions over the 6-month study period.  MAIN OUTCOME MEASURES: Changes 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.  RESULTS: Characteristics 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.  CONCLUSION: Encounters 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.<p /> <p>Language: en</p>
LA  - en
SN  - 0008-350X
UR  - http://dx.doi.org/
ID  - ref1
ER  -