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This Month in Archives of Pediatrics and Adolescent Medicine
July 2007

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2007;161(7):629. doi:10.1001/archpedi.161.7.629
The Relationship Between Self-injurious Behavior and Suicide in a Young Adult Population

Self-injurious behavior starts during adolescence and may be an attempt to cope with psychological distress. In this study of 2875 students from 2 universities, 10.1% reported self-injurious behavior, three-fourths of whom reported this behavior occurring more than once. Those with such behavior were nearly 4-fold more likely to also report suicidality and nearly 10-fold more likely to have attempted suicide. Individuals with both self-injurious behaviors and suicidality were more likely to have been abused and to have an eating disorder than students without such behaviors. This study suggests that while self-injurious behavior may be a coping mechanism employed to avoid suicide, it may also serve as a harbinger of all forms of suicidality in some individuals and its presence should trigger assessment for suicide risk.

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Child Care and the Well-being of Children

Twelve million children spend a significant amount of their time each year in some type of child care, which has become a fact of life for many families in our society. Nevertheless, parents often express concerns about the potential harmful effects of care on their children. This review article summarizes what is known about the age of entry into child care, amount and type of care, and its quality and discusses how each of these affects children's social, physical, and cognitive development. The review provides pediatricians with important information on how to guide families with their child care decisions and how to care for children at home.

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Pay for Performance Alone Cannot Drive Quality

Despite the rapid growth of pay-for-performance programs in the United States, evidence of their impact on quality of care is limited. This study of 44 pediatric practices sought to determine whether coupling pay for performance with other interventions would accelerate improvement in the care of 13 380 children with asthma in those practices. The program rewarded practices with up to a 7% increase in their fee schedule, practice-level performance thresholds, and building improvement capacity for participating in the collaborative, achieving network. During the 3-year study period, the percentage of the network population of children with asthma who received optimal care increased from 4% to 88% and the proportion of children receiving influenza vaccine nearly tripled. This study demonstrated that pay for performance, when coupled with robust approaches for quality improvement, can accelerate transformation among pediatric health care providers.

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Effect of Regulatory Warnings on Antidepressant Prescribing for Children and Adolescents

Agencies in both the United Kingdom (UK) and the United States have issued warnings on the increased risk of suicide associated with the use of antidepressants in children and adolescents. Little is known about the effects of these warnings and accompanying publicity on the prescribing of antidepressants for pediatric patients. This study used data of more than 400 000 Tennessee Medicaid patients per month to examine trends in antidepressant prescribing to patients aged 2 to 17 years after the appearance of agency warnings compared with the 24 months before. There was a 33% decrease in the number of new users of antidepressants in the 21 months following the UK warning, most pronounced for nonfluoxetine antidepressants in which initiation of use decreased by 54%. In contrast, new users of fluoxetine increased by 60%. The public health effect of these changes in prescribing patterns is unknown.

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