Anjum Memon1, Imogen Rogers1, Sophie M D D Fitzsimmons1, Ben Carter2, Rebecca Strawbridge3, Diego Hidalgo-Mazzei4, Allan H Young3. 1. Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK. 2. Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. 3. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. 4. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, CIBERSAM, Spain.
Abstract
BACKGROUND: The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population. AIMS: To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates. METHOD: The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375). RESULTS: The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = -0.27, 95% CI -0.47 to -0.08; P = 0.006, I2 = 83.3%), male (pooled β = -0.26, 95% CI -0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = -0.13, 95% CI -0.24 to -0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration. CONCLUSIONS: This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.
BACKGROUND: The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population. AIMS: To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates. METHOD: The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375). RESULTS: The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = -0.27, 95% CI -0.47 to -0.08; P = 0.006, I2 = 83.3%), male (pooled β = -0.26, 95% CI -0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = -0.13, 95% CI -0.24 to -0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration. CONCLUSIONS: This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.
Entities:
Keywords:
Lithium in drinking water; ecological studies; epidemiology of suicide; suicide; suicide prevention
Authors: J Schoepfer; R Gernhäuser; S Lichtinger; A Stöver; M Bendel; C Delbridge; T Widmann; S Winkler; M Graw Journal: Sci Rep Date: 2021-03-25 Impact factor: 4.379
Authors: Giuseppe Fanelli; Marcus Sokolowski; Danuta Wasserman; Siegfried Kasper; Joseph Zohar; Daniel Souery; Stuart Montgomery; Diego Albani; Gianluigi Forloni; Panagiotis Ferentinos; Dan Rujescu; Julien Mendlewicz; Diana De Ronchi; Alessandro Serretti; Chiara Fabbri Journal: Am J Med Genet B Neuropsychiatr Genet Date: 2022-02-21 Impact factor: 3.358
Authors: Sviatlana Pankavec; Jerzy Falandysz; Izabela Komorowicz; Anetta Hanć; Danuta Barałkiewicz; Alwyn R Fernandes Journal: Environ Sci Pollut Res Int Date: 2021-04-30 Impact factor: 4.223