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Dobosy P, Illés Á, Endrédi A, Záray G. Lithium concentration in tap water, bottled mineral water, and Danube River water in Hungary. Sci Rep 2023; 13:12543. [PMID: 37532748 PMCID: PMC10397251 DOI: 10.1038/s41598-023-38864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Due to increased manufacture and recycling of lithium batteries across the world, we may anticipate a rise in lithium pollution in the aquatic environment and drinking water reservoirs. In order to investigate the current status regarding the lithium content in Hungarian tap waters, samples were collected from the public drinking water supply systems of 19 county seats in Hungary during seasonally selected times. Depending on the water sources, such as bank-filtrated river water, surface water from open reservoirs, and groundwater, the lithium concentrations varied between 0.90-4.23, 2.12-11.7 and 1.11-31.4 µg/L, respectively, while the median values were 3.52, 5.02 and 8.55 µg/L, respectively. The lithium concentration in the bottled Hungarian mineral waters was also determined since the daily intake of lithium can be influenced by the consumption of mineral waters. The concentrations ranged from 4.2 to 209 µg/L, while the median value was only 17.8 µg/L. Additionally, a correlation was only found between lithium and potassium concentrations. The lithium concentration was also assessed at ten sampling locations in the Hungarian segment of the Danube River since the Danube water is also a water source for additional drinking water utilities using bank filtration technology. The mean and median lithium concentrations were 2.78 and 2.64 µg/L, respectively.
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Affiliation(s)
- Péter Dobosy
- Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary
- National Laboratory for Water Science and Water Security, Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary
| | - Ádám Illés
- Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary
- National Laboratory for Water Science and Water Security, Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary
| | - Anett Endrédi
- Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary
| | - Gyula Záray
- Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary.
- National Laboratory for Water Science and Water Security, Institute of Aquatic Ecology, Centre for Ecological Research, Karolina út 29, Budapest, 1113, Hungary.
- Institute of Chemistry, Eötvös Loránd University, Pázmány Péter sétány 1/A, Budapest, 1117, Hungary.
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An investigation into the association between suicide mortality rate and lithium levels in potable water: a review study. Int Clin Psychopharmacol 2023; 38:73-80. [PMID: 36719336 DOI: 10.1097/yic.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aimed to investigate the association between lithium levels in potable water and suicide mortality rates in the total inhabitants. We systematically searched Embase, PubMed/MEDLINE, Scopus, PubMed Central (PMC), Google Scholar databases, as well as medRxiv using the following keywords: drinking water, lithium, standardized mortality ratio (SMR), tap water, suicide, and ground water. Pearson regression analysis was used to test an association between variables with 95% confidence interval (CI). A value of P < 0.05 was considered significant. A total of 16 eligible articles were identified. Lithium concentrations in drinking water range from 0.4 to 32.9 μg/l. Average rates of suicide mortality (per 100 000 capita) range between 0.790 (±0.198) and 123 (±50). About 16 original studies confirmed the inverse relationship between lithium concentrations in potable water and suicide mortality rates (R = -0.576; R2 = 0.3323; 95% CI, -0.820 to -0.325; β = -0.3.2; P = 0.019). High lithium concentrations in potable water were associated with decreased suicide rates. We concluded that lithium concentration in potable water was inversely associated with suicide mortality rates among a total population. However, further research is required to clarify the relationship between lithium concentrations in drinking water and suicide rate.
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Muronaga M, Terao T, Kohno K, Hirakawa H, Izumi T, Etoh M. Lithium in drinking water and Alzheimer's dementia: Epidemiological Findings from National Data Base of Japan. Bipolar Disord 2022; 24:788-794. [PMID: 36073313 DOI: 10.1111/bdi.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between lithium levels in drinking water and prevalence of Alzheimer's dementia (AD). METHODS Lithium levels in the drinking water of 808 cities and wards (i.e., 785 Japanese cities of 46 prefectures and 23 wards of Tokyo) in Japan were examined in relation to the prevalence of AD during the 5 years from 2010 to 2014, which was calculated on the basis of the national data base of Ministry of Health, Labor, and Welfare of Japan. Multiple regression analyses were used to investigate the association of lithium levels with the prevalence of AD with adjustment for relevant factors (proportions of one-person households as a family factor and people in primary industry employment as a job factor, annual total sunshine hours as a meteorological factor, and total number of beds of psychiatric hospitals as a medical factor) in total, male, and female elderly populations. RESULTS The adjusted model showed a significant inverse association of lithium levels with female, but not with male, or total prevalence of AD. CONCLUSIONS These findings suggest that higher lithium levels in drinking water may be associated with lower prevalence of AD in female, but not male, populations.
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Affiliation(s)
- Masaaki Muronaga
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Hirofumi Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Toshihiko Izumi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Masaki Etoh
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Araya P, Martínez C, Barros J. Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations. Front Public Health 2022; 10:805774. [PMID: 35252091 PMCID: PMC8891154 DOI: 10.3389/fpubh.2022.805774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/24/2022] [Indexed: 12/07/2022] Open
Abstract
Although suicide is considered a major preventable cause of mortality worldwide, we do not have effective strategies to prevent it. Lithium has been consistently associated with lowering risk of suicide. This effect could occur at very low concentrations, such as trace doses of lithium in tap water. Several ecological studies and recent meta-analysis have suggested an inverse association between lithium in water and suicide in the general population, with a lack of knowledge of clinically significant side effects. This paper is aimed as a proposal to discuss the addition of lithium to drinking water to decrease the suicide rate. For this, we review the evidence available, use previous experiences, such as water fluoridation to prevent dental caries, and discuss the complexity involved in such a public policy. Considering the limited data available and the controversies contained in this proposal, we suggest that a consensus on lithium concentration in water is needed, where the suicide rates start to reduce, as happened with water fluoridation. This measure will require to develop community-controlled trials with strict monitoring of any side effects, where democratic procedures would constitute one of the most appropriate ways to validate its implementation according to the reality of each community.
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Affiliation(s)
- Pablo Araya
- Department of Escuela de Medicina PUC School of Medicine, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Martínez
- Department of Escuela de Medicina PUC School of Medicine, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Barros
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Jorge Barros
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Izumi T, Kanehisa M, Terao T, Shiotsuki I, Shirahama M, Satoh M, Muronaga M, Kohno K, Hirakawa H, Etoh M, Matsukawa T. Naturally absorbed lithium may prevent suicide attempts and deliberate self-harm while eicosapentaenoic acid may prevent deliberate self-harm and arachidonic acid may be a risk factor for deliberate self-harm: The updated different findings in new analyses. Front Psychiatry 2022; 13:1083739. [PMID: 36590619 PMCID: PMC9802576 DOI: 10.3389/fpsyt.2022.1083739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Since our previous investigation on the effects of trace lithium, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) on deliberate self-harm and suicide attempts in 2018, to our knowledge, no replication study has been conducted on this topic. SUBJECTS AND METHODS We increased 37 new patients and totally 234 patients were re-analyzed to further investigate the association of suicide-related behaviors with levels of trace lithium, EPA, DHA, and AA in a different way to avoid multicollinearity. RESULTS Higher lithium levels were significantly associated with fewer suicide attempts and deliberate self-harm, higher EPA levels were significantly associated with fewer deliberate self-harm, and higher AA levels were significantly associated with more deliberate self-harm. DISCUSSION Although the sample size was only slightly larger than the previous study, the present results were clearly different from the previous ones due to the use of different statistical analyses to avoid multicollinearity. CONCLUSION The present findings suggest that naturally absorbed lithium may protect against suicide and deliberate self-harm, while naturally absorbed EPA may protect against deliberate self-harm. However, naturally absorbed AA may be a risk factor for deliberate self-harm.
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Affiliation(s)
- Toshihiko Izumi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | | | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Ippei Shiotsuki
- Psychiatric Medical Center, Oita Prefectural Hospital, Oita, Japan
| | | | - Moriaki Satoh
- Psychiatric Medical Center, Oita Prefectural Hospital, Oita, Japan
| | - Masaaki Muronaga
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Hirofumi Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Masaki Etoh
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, Juntendo University School of Medicine, Tokyo, Japan.,Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Ishii N, Terao T, Hirakawa H. The Present State of Lithium for the Prevention of Dementia Related to Alzheimer's Dementia in Clinical and Epidemiological Studies: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157756. [PMID: 34360049 PMCID: PMC8345730 DOI: 10.3390/ijerph18157756] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022]
Abstract
Despite the unavailability of essential anti-dementia drugs, lithium may inhibit glycogen synthase kinase-3 (GSK-3) and decrease beta-amyloid and hyper-phosphorylated tau. In this review, we hypothesized that trace to standard levels of lithium (i.e., corresponding to the therapeutic levels for bipolar disorder) may be effective for dementia prevention. Excluding three insufficient level studies, we obtained two and one excellent clinical studies on standard and trace lithium levels, respectively, all of which supported the effects of lithium for dementia prevention. In addition, we identified good clinical and epidemiological studies (four each) on standard lithium levels, of which six studies supported the effects of lithium. Moreover, of three good epidemiological studies on trace lithium levels, two supported the aforementioned effects of lithium. The number of studies were substantially small, particularly those on trace lithium levels. Moreover, studies on standard lithium levels were insufficient to establish the efficacy of lithium for dementia prevention. This necessitates accumulating good or excellent clinical evidence for the effects of trace to standard lithium levels on dementia prevention.
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Liaugaudaite V, Naginiene R, Raskauskiene N, Mickuviene N, Bunevicius A, Sher L. Relationship between Lithium Levels in Drinking Water and Suicide Rates: A Nationwide Study in Lithuania. Arch Suicide Res 2021; 25:340-352. [PMID: 31596179 DOI: 10.1080/13811118.2019.1674226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To investigate an association of lithium levels in the drinking water with suicide mortality rates in Lithuania. Methods: Samples from public drinking water systems were taken in all districts of Lithuania. Lithium levels were determined using the ion chromatography method. For the statistical calculations, lithium levels were averaged per district municipality and plotted against suicide standardized mortality rates (SMR) per 100,000 populations, within the 5-year period from 2012 to 2016. Results: We found that lithium concentrations in drinking water were significantly negatively associated with total suicide rates in a nonlinear way. Conclusion: Lithium intake with drinking water may affect suicide rates in some geographical areas.
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Eyre-Watt B, Mahendran E, Suetani S, Firth J, Kisely S, Siskind D. The association between lithium in drinking water and neuropsychiatric outcomes: A systematic review and meta-analysis from across 2678 regions containing 113 million people. Aust N Z J Psychiatry 2021; 55:139-152. [PMID: 33045847 DOI: 10.1177/0004867420963740] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Lithium in drinking water may have significant mental health benefits. We investigated the evidence on the association between lithium concentrations in drinking water and their neuropsychiatric outcomes. METHODS We conducted a systematic review and meta-analysis and searched Pubmed, Embase, Web of Science, PsycINFO and CINAHL up to 19 January 2020, for peer-reviewed research examining the association between lithium concentrations in drinking water and neuropsychiatric outcomes. We used a pairwise analysis and a random effects model to meta-analyse suicide rates and psychiatric hospital admissions. We assessed for publication bias using Egger's test and Duval and Tweedie's Trim and Fill analysis. RESULTS Twenty-seven studies including 113 million subjects were included in this systematic review. Meta-analysis of 14 studies including 94 million people found higher lithium concentrations were associated with reduced suicide rates (r = -0.191, 95% confidence interval = [-0.287, -0.090], p < 0.001) and meta-analysis of two studies including 5 million people found higher lithium concentrations were associated with fewer hospital admissions (r = -0.413, 95% confidence interval = [-0.689, -0.031], p = 0.035). We found significant heterogeneity between studies (Q = 67.4, p < 0.001, I2 = 80.7%) and the presence of publication bias (Egger's test; t value = 2.90, p = 0.013). Other included studies did not provide sufficient data to analyse other neuropsychiatric outcomes quantitatively. CONCLUSION Higher lithium concentrations in drinking water may be associated with reduced suicide rates and inpatient psychiatric admissions. The relationship with other neuropsychiatric outcomes and complications remains unclear. Further research is required before any public health recommendations can be made.Trial registration number: The study was registered with PROSPERO, number CRD42018090145.
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Affiliation(s)
| | | | - Shuichi Suetani
- School of Medicine, Griffith University, Southport, QLD, Australia.,Metro South Mental Health and Addiction Services, Brisbane, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, Western Sydney University, Sydney, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Steve Kisely
- Metro South Mental Health and Addiction Services, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Dan Siskind
- Metro South Mental Health and Addiction Services, Brisbane, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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9
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Kugimiya T, Ishii N, Kohno K, Kanehisa M, Hatano K, Hirakawa H, Terao T. Lithium in drinking water and suicide prevention: The largest nationwide epidemiological study from Japan. Bipolar Disord 2021; 23:33-40. [PMID: 32780508 DOI: 10.1111/bdi.12983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aims of the present study thus were (a) to further investigate the association between lithium levels in drinking water and suicide rates by adjusting relevant factors using the so far largest available dataset in Japan, (b) to confirm sex differences, (c) to estimate the effects of long-term exposure to trace lithium, (d) to investigate the effects of drinking bottled instead of tap water, and (e) to exploratorily investigate which lithium levels may be associated with lower suicide rates. METHODS Mean lithium levels in drinking water of all 808 cities and wards (ie, 785 cities of 46 prefectures and 23 wards of Tokyo) in Japan were examined in relation to mean suicide standardized mortality ratios (SMRs) during the 7 years from 2010 to 2016. Multiple regression analyses adjusted for the size of each population were used to investigate the association of lithium levels with suicide SMRs with adjustments for relevant factors. RESULTS The adjusted model showed significant inverse associations of lithium levels with total and male SMRs, but not with female SMRs. Neither the proportion of residents who continued to live in the same city nor the consumption of bottled water changed the association between lithium levels and suicide SMRs. Finally, it was 30 μg/L or more that was associated with lower suicide SMRs. CONCLUSIONS The present findings reconfirm the inverse association between lithium levels in drinking water and suicide rates particularly in the male population.
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Affiliation(s)
- Tsuyoshi Kugimiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Koji Hatano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Hirofumi Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu city, Japan
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Memon A, Rogers I, Fitzsimmons SMDD, Carter B, Strawbridge R, Hidalgo-Mazzei D, Young AH. Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies. Br J Psychiatry 2020; 217:667-678. [PMID: 32716281 DOI: 10.1192/bjp.2020.128] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Diego Hidalgo-Mazzei
- 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
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Decreased motor impulsivity following chronic lithium treatment in male rats is associated with reduced levels of pro-inflammatory cytokines in the orbitofrontal cortex. Brain Behav Immun 2020; 89:339-349. [PMID: 32688024 DOI: 10.1016/j.bbi.2020.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
Lithium's efficacy in reducing both symptom severity in bipolar disorder (BD) and suicide risk across clinical populations may reflect its ability to reduce impulsivity. Changes in immune markers are associated with BD and suicidality yet their exact role in symptom expression remains unknown. Evidence also suggests that lithium may decrease levels of pro-inflammatory cytokines in the periphery and central nervous system, and that such changes are related to its therapeutic efficacy. However, issues of cause and effect are hard to infer from clinical data alone. Here, we investigated the effects of chronic dietary lithium treatment on rats' performance of the 5-Choice Serial Reaction Time Task (5CSRTT), a well-validated operant behavioural task measuring aspects of impulsivity, attention and motivation. Male Long-Evans rats received a diet supplemented with 0.3% LiCl (n = 13), or the equivalent control diet (n = 16), during behavioural testing. Blood and brain tissue samples were assayed for a wide range of cytokines once any changes in impulsivity became significant. After 12 weeks, chronic lithium treatment reduced levels of motor impulsivity, as indexed by premature responses in the 5CSRTT; measures of sustained attention and motivation were unaffected. Plasma levels of IL-1β, IL-10 and RANTES (CCL-5) were reduced in lithium-treated rats at this time point. IL-1β, IL-6 and RANTES were also reduced selectively within the orbitofrontal cortex of lithium-treated rats, whereas cytokine levels in the medial prefrontal cortex and nucleus accumbens were comparable with control subjects. These results are consistent with the hypothesis that lithium may improve impulse control deficits in clinical populations by minimising the effects of pro-inflammatory signalling on neuronal activity, particularly within the orbitofrontal cortex.
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Del Matto L, Muscas M, Murru A, Verdolini N, Anmella G, Fico G, Corponi F, Carvalho A, Samalin L, Carpiniello B, Fagiolini A, Vieta E, Pacchiarotti I. Lithium and suicide prevention in mood disorders and in the general population: A systematic review. Neurosci Biobehav Rev 2020; 116:142-153. [DOI: 10.1016/j.neubiorev.2020.06.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
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Kozaka N, Takeuchi S, Ishii N, Terao T, Kuroda Y. Association between lithium in tap water and suicide mortality rates in Miyazaki Prefecture. Environ Health Prev Med 2020; 25:26. [PMID: 32593289 PMCID: PMC7321541 DOI: 10.1186/s12199-020-00865-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background Most studies have reported that suicide mortality rates are negatively associated with lithium levels in tap water; however, a few studies showed either no association or a positive association. Thus, the association between suicide mortality and lithium levels in tap water remains controversial. To clarify the association, our study evaluated the association between lithium levels in tap water and suicide mortality rates in Miyazaki Prefecture of Japan, after adjusting for confounding factors. Methods We measured lithium levels in tap water across the 26 municipalities of Miyazaki Prefecture in Japan. We examined the standardized mortality ratio (SMR) for suicide in each municipality and used the data as the average suicide SMRs over 5 years (2009–2013). Weighted least-squares regression analysis, adjusted for the size of each municipality’s population, was used to investigate the association between lithium levels in tap water and suicide SMRs. In addition to a crude model, in an adjusted model, potential confounding factors (proportion of elderly people, proportion of one-person households, annual marriage rate, annual mean income, unemployment rate, the density of medical doctors per 100,000 people, annual total rainfall, and proportion of people with a college education or higher) were added as covariates. Results We showed that male and female suicide SMRs were not associated with lithium levels in tap water in Miyazaki Prefecture. After adjusting for confounders, male suicide SMRs were significantly and positively associated with the proportion of elderly people in the population and annual total rainfall, and female suicide SMRs were associated with the proportion of elderly people in the population. Conclusions No association between lithium levels in tap water and suicide mortality rates was found in Miyazaki Prefecture.
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Affiliation(s)
- Naomi Kozaka
- Department of Public Health, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shouhei Takeuchi
- Department of Nutrition Science, Faculty of Nursing and Nutrition, University of Nagasaki, 1-1-1 Manabino, Nagayo, Nishisonogi, Nagasaki, 851-2195, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yoshiki Kuroda
- Department of Public Health, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
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Voica C, Roba C, Iordache AM. Lithium Levels in Food from the Romanian Market by Inductively Coupled Plasma – Mass Spectrometry (ICP-MS): A Pilot Study. ANAL LETT 2020. [DOI: 10.1080/00032719.2020.1748642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- C. Voica
- National Institute for Research and Development of Isotopic and Molecular Technologies, Cluj-Napoca, Romania
| | - C. Roba
- Faculty of Environmental Science and Engineering, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - A. M. Iordache
- National Research and Development Institute for Cryogenics and Isotopes Technologies, Ramnicu Valcea, Romania
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Barjasteh-Askari F, Davoudi M, Amini H, Ghorbani M, Yaseri M, Yunesian M, Mahvi AH, Lester D. Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis. J Affect Disord 2020; 264:234-241. [PMID: 32056756 DOI: 10.1016/j.jad.2019.12.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population. METHODS A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model. RESULTS We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total. LIMITATIONS The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders. CONCLUSIONS Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.
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Affiliation(s)
- Fateme Barjasteh-Askari
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mojtaba Davoudi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Homayoun Amini
- Department of Psychiatry & Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER),Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Mahvi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - David Lester
- Distinguished Professor of Psychology, Emeritus, Stockton University, Galloway, NJ, USA
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Lithium alters expression of RNAs in a type-specific manner in differentiated human neuroblastoma neuronal cultures, including specific genes involved in Alzheimer's disease. Sci Rep 2019; 9:18261. [PMID: 31797941 PMCID: PMC6892907 DOI: 10.1038/s41598-019-54076-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/08/2019] [Indexed: 02/08/2023] Open
Abstract
Lithium (Li) is a medication long-used to treat bipolar disorder. It is currently under investigation for multiple nervous system disorders, including Alzheimer's disease (AD). While perturbation of RNA levels by Li has been previously reported, its effects on the whole transcriptome has been given little attention. We, therefore, sought to determine comprehensive effects of Li treatment on RNA levels. We cultured and differentiated human neuroblastoma (SK-N-SH) cells to neuronal cells with all-trans retinoic acid (ATRA). We exposed cultures for one week to lithium chloride or distilled water, extracted total RNA, depleted ribosomal RNA and performed whole-transcriptome RT-sequencing. We analyzed results by RNA length and type. We further analyzed expression and protein interaction networks between selected Li-altered protein-coding RNAs and common AD-associated gene products. Lithium changed expression of RNAs in both non-specific (inverse to sequence length) and specific (according to RNA type) fashions. The non-coding small nucleolar RNAs (snoRNAs) were subject to the greatest length-adjusted Li influence. When RNA length effects were taken into account, microRNAs as a group were significantly less likely to have had levels altered by Li treatment. Notably, several Li-influenced protein-coding RNAs were co-expressed or produced proteins that interacted with several common AD-associated genes and proteins. Lithium's modification of RNA levels depends on both RNA length and type. Li activity on snoRNA levels may pertain to bipolar disorders while Li modification of protein coding RNAs may be relevant to AD.
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Szklarska D, Rzymski P. Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification. Biol Trace Elem Res 2019; 189:18-27. [PMID: 30066063 PMCID: PMC6443601 DOI: 10.1007/s12011-018-1455-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Abstract
Lithium compounds have been widely used in psychopharmacology, particularly in the treatment of bipolar disorder. Their normothymic and neuroprotective properties when used at high doses have been well established. However, a number of observations suggest that environmentally relevant lithium doses may also exert beneficial health effects, leading to a decrease in the rate of suicides and levels of violence. Despite the fact that this element is not officially considered to be a micronutrient, some authors have suggested provisional recommended intakes set at 1000 μg/day for a 70-kg adult (14.3 μg/kg body weight). The present paper reviews the biological action of lithium, its bioavailability and metabolism, and content in different foodstuffs and water. It also assesses epidemiological data on potential correlations between lithium intake and suicide rate as well as examines the concept of fortifying food with this element as a strategy in the primary prevention of mood disorders and pre-suicidal syndrome.
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Affiliation(s)
- Daria Szklarska
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznań, Poland.
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18
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Palmer A, Cates ME, Gorman G. The Association Between Lithium in Drinking Water and Incidence of Suicide Across 15 Alabama Counties. CRISIS 2019; 40:93-99. [DOI: 10.1027/0227-5910/a000535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Recent studies have shown that lithium may be effective at reducing suicide at low doses, such as those found in drinking water. Aims: The purpose of this study was to compare suicide rates with natural lithium levels in the drinking water of various Alabama counties. Method: Five drinking water samples from each of 15 Alabama counties were collected. Lithium levels were measured in triplicate using an inductively coupled plasma emission spectrophotometer and compared with suicide rate data for the period 1999–2013. Age, gender, and poverty were evaluated as potential confounding variables. Results: The average measured lithium concentrations ranged from 0.4 ppb to 32.9 ppb between the counties tested. The plot of suicide rate versus lithium concentration showed a statistically significant inverse relationship ( r = −.6286, p = .0141). Evaluation of male-only suicide rate versus lithium concentration data also yielded significant results; however, the female-only rate was not significant. Age standardized suicide rates and poverty when individually compared against lithium levels were also found to be statistically significant; unexpectedly, however, poverty had a parallel trend with suicide rate. Conclusion: Lithium concentration in drinking water is inversely correlated with suicide rate in 15 Alabama counties.
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Affiliation(s)
- Anna Palmer
- McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Marshall E. Cates
- McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Greg Gorman
- McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
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Affiliation(s)
- Peter Devadason
- Senior Lecturer, The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia.,Staff Specialist Psychiatrist, The Prince Charles Hospital, Metro North Mental Health, Chermside, QLD, Australia.,Consultant Psychiatrist, City Specialists Clinic, Brisbane, QLD, Australia
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20
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Kurosawa K, Terao T, Kanehisa M, Shiotsuki I, Ishii N, Takenaka R, Sakamoto T, Matsukawa T, Yokoyama K, Ando S, Nishida A, Matsuoka Y. Naturally absorbed polyunsaturated fatty acids, lithium, and suicide-related behaviors: A case-controlled study. J Affect Disord 2018; 241:200-205. [PMID: 30130685 DOI: 10.1016/j.jad.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/18/2018] [Accepted: 08/04/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Previous studies have investigated the effects of omega-3, omega-6 and lithium on suicide-related behaviors separately. This study was performed to comprehensively investigate the effects of naturally absorbed EPA, DHA, arachidonic acid and lithium in relation to suicide attempt and deliberate self-harm, with adjustment for each other. METHODS We analyzed plasma EPA, DHA, arachidonic acid levels and serum lithium levels of 197 patients including 33 patients with suicide attempts, 18 patients with deliberate self-harm, and 146 control patients. RESULTS Multivariate logistic regression analysis with adjustment for age, gender, EPA, DHA, arachidonic acid and log-transformed lithium levels revealed that the negative associations with EPA levels (adjusted OR 0.972, 95% CI 0.947-0.997, p = 0.031) and log-transformed lithium levels (adjusted OR 0.156, 95% CI 0.038-0.644, p = 0.01) and the positive association with DHA levels (adjusted OR 1.026, 95% CI 1.010-1.043, p = 0.002) were significant in patients with suicide attempts than in control patients. The analysis also demonstrated that the positive association with arachidonic acid levels (adjusted OR 1.015, 95% CI 1.005-1.025, p = 0.004) was significant in patients with deliberate self-harm than in control patients. LIMITATIONS The limitations are relatively small number of patients and the effects of demographics of individual patients could not be adjusted for the analyses. CONCLUSIONS The present findings suggest that, as naturally absorbed nutrients, higher EPA and lithium levels may be associated with less suicide attempt, and that higher arachidonic acid levels may be associated with more deliberate self-harm.
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Affiliation(s)
- Keiko Kurosawa
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita, Japan; Advanced Trauma, Emergency and Critical Care Center, Faculty of Medicine, Oita University, Oita, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita, Japan.
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita, Japan; Advanced Trauma, Emergency and Critical Care Center, Faculty of Medicine, Oita University, Oita, Japan
| | - Ippei Shiotsuki
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita, Japan; Advanced Trauma, Emergency and Critical Care Center, Faculty of Medicine, Oita University, Oita, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Oita, Japan
| | - Ryuichi Takenaka
- Advanced Trauma, Emergency and Critical Care Center, Faculty of Medicine, Oita University, Oita, Japan
| | - Teruo Sakamoto
- Advanced Trauma, Emergency and Critical Care Center, Faculty of Medicine, Oita University, Oita, Japan
| | - Takehisa Matsukawa
- Department of Epidemiology and Environmental Health, School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhito Yokoyama
- Department of Epidemiology and Environmental Health, School of Medicine, Juntendo University, Tokyo, Japan
| | - Shuntaro Ando
- Department of Psychiatry, Faculty of Medicine, Tokyo University, Tokyo, Japan
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Science, National Cancer Center Japan, Tokyo, Japan
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Shimodera S, Koike S, Ando S, Yamasaki S, Fujito R, Endo K, Iijima Y, Yamamoto Y, Morita M, Sawada K, Ohara N, Okazaki Y, Nishida A. Lithium levels in tap water and psychotic experiences in a general population of adolescents. Schizophr Res 2018; 201:294-298. [PMID: 29895414 DOI: 10.1016/j.schres.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 10/14/2022]
Abstract
Recently, several epidemiologic studies have reported that lithium in drinking water may be associated with lower rates of suicide mortality, lower incidence of dementia, and lower levels of adolescents' depression and aggression at the population level. However, to our knowledge, no study has investigated lithium level in tap water in relation to psychotic experiences in a general population of adolescents. This is the first study to investigate this using a large dataset. Information on psychotic experiences, distress associated with these experiences, and depressive symptoms were collected in 24 public junior high schools in Kochi Prefecture in Japan. Samples were collected from sources that supplied drinking water to schools, and lithium levels were measured using atomic absorption spectrophotometry. The association of lithium levels with psychotic experiences, considering distress as a degree of severity, was examined using an ordinal logistic regression model with schools and depressive symptoms as random effects. In total, 3040 students responded to the self-reporting questionnaire (response rate: 91.8%). Lithium levels in tap water were inversely associated with psychotic experiences (p = 0.021). We concluded that lithium level in tap water was inversely associated with psychotic experiences among a general population of adolescents and may have a preventive effect for such experiences and distress.
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Affiliation(s)
- Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan
| | - Shinsuke Koike
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
| | - Shuntaro Ando
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Syudo Yamasaki
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ryosuke Fujito
- Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan
| | - Kaori Endo
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yudai Iijima
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yu Yamamoto
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masaya Morita
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Sawada
- Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan
| | - Nobuki Ohara
- Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan
| | - Yuji Okazaki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
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Brown EE, Gerretsen P, Pollock B, Graff-Guerrero A. Psychiatric benefits of lithium in water supplies may be due to protection from the neurotoxicity of lead exposure. Med Hypotheses 2018; 115:94-102. [PMID: 29685207 DOI: 10.1016/j.mehy.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Lithium is a medication used to treat bipolar disorder and may also prevent cognitive decline and suicide. Lithium is also found naturally, in levels well below clinical doses, in drinking water worldwide, and levels have been inversely associated with rates of psychiatric disorders. Lead (Pb) is another element in the environment but is a toxin of public health concern. Negative effects of chronic lead exposure and possible benefits of environmental lithium exposure appear complementary. HYPOTHESIS Exposure to environmental lithium has associated benefits, which may be due to the mitigation of lead toxicity by lithium. METHODS A series of reviews tested each element of the hypothesis. A systematic review clarified the psychiatric and medical correlates of lithium in drinking water. Non-systematic reviews clarified the harms of environmental lead, summarized experimental studies of lithium used to prevent lead toxicity, and explored overlapping biological mechanisms in lithium and lead exposure. RESULTS Higher levels of lithium in drinking water were associated with lower suicide rates in 13 of 15 identified studies. While fewer studies were available for other outcomes, lithium was associated with lower rates of homicide, crime, dementia, and mortality. Lead was reported to be ubiquitous in the environment, and chronic low-level exposure has been associated with adverse effects, including effects opposite to the outcomes associated with lithium. Animal studies demonstrated that lithium pre-treatment mitigates lead toxicity. Neurophysiological correlates of lead and lithium exposure overlap. CONCLUSIONS Microdose lithium is associated with better psychiatric and medical outcomes, which are complementary to harms of environmental lead exposure. Experimental animal evidence is supportive, and lead and lithium impact overlapping neurophysiologic pathways. Therefore, several lines of circumstantial evidence suggest that lithium protects against the neurotoxic effects of lead. Further studies are required to clarify the benefits and mechanisms of low-dose lithium. There are significant public health implications if this paper's hypothesis is true.
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Affiliation(s)
- Eric E Brown
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Philip Gerretsen
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Bruce Pollock
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ariel Graff-Guerrero
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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Ishii N, Terao T. Trace lithium and mental health. J Neural Transm (Vienna) 2017; 125:223-227. [DOI: 10.1007/s00702-017-1824-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/05/2017] [Indexed: 01/16/2023]
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Matsuzaki H, Terao T, Inoue T, Takaesu Y, Ishii N, Kohno K, Takeshima M, Baba H, Honma H. Re-analysis of the association of temperature or sunshine with hyperthymic temperament using lithium levels of drinking water. J Affect Disord 2017; 223:126-129. [PMID: 28753470 DOI: 10.1016/j.jad.2017.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Japanese archipelago stretches over 4000km from north to south and has four large islands: Hokkaido, Honshu, Shikoku, and Kyushu. Previously, using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire version (TEMPS-A), we compared the hyperthymic scores of residents in Sapporo, Obihiro, Takaoka, Koshigaya, and Oita cities (which are located at latitudes of 43°N, 42°N, 36°N, 36°N and 33°N with various combinations of ambient temperament and sunshine in Japan, respectively). We found that latitude predicted significant variance in hyperthymic temperament, and that ambient temperature, but not sunshine, significantly affected hyperthymic temperament scores. However, the analysis failed to consider the effects of naturally occurring low-dose lithium on temperament. METHODS In addition to the TEMPS-A data previously collected, we measured lithium levels of the five cities. The effect of temperature, sunshine, and lithium levels on hyperthymic temperament was analyzed for the five cities. RESULTS A stepwise multiple regression analysis revealed that lithium levels as well as latitude, but not temperature or sunshine, predicted significant variance in hyperthymic temperament scores. Hyperthymic temperament scores were significantly and positively associated with lithium levels whereas they were significantly and negatively associated with latitude. LIMITATIONS The light, temperature, lithium exposure that residents actually received was not measured. The number of regions studied was limited. The findings might not be generalized to residents across Japan or other countries. CONCLUSIONS The present findings suggest that lithium in drinking water may positively maintain hyperthymic temperament, and that latitude may negatively maintain it.
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Affiliation(s)
- Hideki Matsuzaki
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Japan; Matsuzaki Clinic, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Japan.
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Japan
| | | | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Japan
| | | | - Hajime Baba
- Department of Psychiatry, Juntendo Koshigaya Hospital, Japan
| | - Hiroshi Honma
- Department of Psychiatry, Obihiro National Hospital, Japan
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Kanehisa M, Terao T, Shiotsuki I, Kurosawa K, Takenaka R, Sakamoto T, Shigemitsu O, Ishii N, Hatano K, Hirakawa H. Serum lithium levels and suicide attempts: a case-controlled comparison in lithium therapy-naive individuals. Psychopharmacology (Berl) 2017; 234:3335-3342. [PMID: 28849243 DOI: 10.1007/s00213-017-4729-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/23/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Several epidemiological studies have shown the inverse association of lithium levels in drinking water and suicide rates; however, it is necessary to perform a clinical study dealing with individual patients. METHODS We analyzed 199 patients including 31 patients with suicide attempts, 21 patients with self-harm, and 147 control patients. All were transferred to a university emergency department suffering from intoxication or injury, were aged 20 or more years, and were alive at the start of the study. The exclusion criteria consisted of suffering from schizophrenia and a past or present history of lithium therapy. These exclusions were applied because it is difficult to determine whether their suicide attempt was induced by the intent to end their life or by psychotic symptoms such as auditory hallucinations, and if the patient had received lithium therapy, the association between the small amount of lithium taken from drinking water and food and serum lithium levels cannot be detected. RESULTS There was a significant difference (p = 0.043) between the three groups whereby patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.012) in males but not females. Multivariate logistic regression analysis with adjustment for age and gender revealed that patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.032, odds ratio 0.228, 95% CI 0.059-0.883). LIMITATIONS The limitations of the present study are the nature of observational research which cannot reveal a causal relationship and the relatively small number of subjects. CONCLUSIONS The present findings suggest that higher serum lithium levels may be protective against suicide attempts in lithium therapy-naive individuals.
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Affiliation(s)
- Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan.
| | - Ippei Shiotsuki
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Keiko Kurosawa
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Ryuichi Takenaka
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Teruo Sakamoto
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Osamu Shigemitsu
- Advanced Trauma, Emergency and Critical Care Center, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Koji Hatano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Hirofumi Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu city, Oita, 879-5593, Japan
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Liaugaudaite V, Mickuviene N, Raskauskiene N, Naginiene R, Sher L. Lithium levels in the public drinking water supply and risk of suicide: A pilot study. J Trace Elem Med Biol 2017; 43:197-201. [PMID: 28385387 DOI: 10.1016/j.jtemb.2017.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 01/27/2023]
Abstract
Suicide is a major public health concern affecting both the society and family life. There are data indicating that higher level lithium intake with drinking water is associated with lower suicide rate. This pilot study examined the relationship between lithium levels in drinking water and suicide rates in Lithuania. Twenty-two samples from public drinking water systems were taken in 9 cities of Lithuania. The lithium concentration in these samples was determined by inductively coupled plasma mass spectrometry (ICP-MS). The suicide data were obtained from the Lithuania Database of Health Indicators, and comprised all registered suicides across all ages and gender within the 5-year period from 2009 to 2013. The study demonstrated an inverse correlation between levels of lithium (log natural transformed), number of women for 1000 men and standardized mortality rate for suicide among total study population. After adjusting for confounder (the number of women for 1000 men), the lithium level remained statistically significant in men, but not in women. Our study suggested that higher levels of lithium in public drinking water are associated with lower suicide rates in men. It might have a protective effect on the risk of suicide in men.
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Affiliation(s)
- Vilma Liaugaudaite
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Narseta Mickuviene
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Nijole Raskauskiene
- Behavioral Medicine Institute of the Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Rima Naginiene
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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27
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The Treadmill Exercise Protects against Dopaminergic Neuron Loss and Brain Oxidative Stress in Parkinsonian Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:2138169. [PMID: 28713483 PMCID: PMC5497606 DOI: 10.1155/2017/2138169] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/23/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
Parkinson's disease (PD), a progressive neurological pathology, presents motor and nonmotor impairments. The objectives were to support data on exercise benefits to PD. Male Wistar rats were distributed into sham-operated (SO) and 6-OHDA-lesioned, both groups without and with exercise. The animals were subjected to treadmill exercises (14 days), 24 h after the stereotaxic surgery and striatal 6-OHDA injection. Those from no-exercise groups stayed on the treadmill for the same period and, afterwards, were subjected to behavioral tests and euthanized for neurochemical and immunohistochemical assays. The data, analyzed by ANOVA and Tukey post hoc test, were considered significant for p < 0.05. The results showed behavioral change improvements in the 6-OHDA group, after the treadmill exercise, evaluated by apomorphine rotational behavior, open field, and rota rod tests. The exercise reduced striatal dopaminergic neuronal loss and decreased the oxidative stress. In addition, significant increases in BDNF contents and in immunoreactive cells to TH and DAT were also observed, in striata of the 6-OHDA group with exercise, relatively to those with no exercise. We conclude that exercise improves behavior and dopaminergic neurotransmission in 6-OHDA-lesioned animals. The increased oxidative stress and decreased BDNF contents were also reversed, emphasizing the importance of exercise for the PD management.
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Knudsen NN, Schullehner J, Hansen B, Jørgensen LF, Kristiansen SM, Voutchkova DD, Gerds TA, Andersen PK, Bihrmann K, Grønbæk M, Kessing LV, Ersbøll AK. Lithium in Drinking Water and Incidence of Suicide: A Nationwide Individual-Level Cohort Study with 22 Years of Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060627. [PMID: 28604590 PMCID: PMC5486313 DOI: 10.3390/ijerph14060627] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 05/28/2017] [Accepted: 06/06/2017] [Indexed: 11/26/2022]
Abstract
Suicide is a major public health concern. High-dose lithium is used to stabilize mood and prevent suicide in patients with affective disorders. Lithium occurs naturally in drinking water worldwide in much lower doses, but with large geographical variation. Several studies conducted at an aggregate level have suggested an association between lithium in drinking water and a reduced risk of suicide; however, a causal relation is uncertain. Individual-level register-based data on the entire Danish adult population (3.7 million individuals) from 1991 to 2012 were linked with a moving five-year time-weighted average (TWA) lithium exposure level from drinking water hypothesizing an inverse relationship. The mean lithium level was 11.6 μg/L ranging from 0.6 to 30.7 μg/L. The suicide rate decreased from 29.7 per 100,000 person-years at risk in 1991 to 18.4 per 100,000 person-years in 2012. We found no significant indication of an association between increasing five-year TWA lithium exposure level and decreasing suicide rate. The comprehensiveness of using individual-level data and spatial analyses with 22 years of follow-up makes a pronounced contribution to previous findings. Our findings demonstrate that there does not seem to be a protective effect of exposure to lithium on the incidence of suicide with levels below 31 μg/L in drinking water.
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Affiliation(s)
- Nikoline N Knudsen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen, Denmark.
| | - Jörg Schullehner
- Geological Survey of Denmark and Greenland (GEUS), Department of Groundwater and Quaternary Geology Mapping, C.F. Møllers Allé 8, Aarhus, 8000 Aarhus, Denmark.
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark.
- National Centre for Register-Based Research, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus, Denmark.
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland (GEUS), Department of Groundwater and Quaternary Geology Mapping, C.F. Møllers Allé 8, Aarhus, 8000 Aarhus, Denmark.
| | - Lisbeth F Jørgensen
- Geological Survey of Denmark and Greenland (GEUS), Hydrological Department, Øster Voldgade 10, 1350 Copenhagen, Denmark.
| | - Søren M Kristiansen
- Department of Geoscience, Aarhus University, Høegh-Guldbergs Gade 2, 8000 Aarhus, Denmark.
| | - Denitza D Voutchkova
- Geological Survey of Denmark and Greenland (GEUS), Department of Groundwater and Quaternary Geology Mapping, C.F. Møllers Allé 8, Aarhus, 8000 Aarhus, Denmark.
- Department of Geoscience, Aarhus University, Høegh-Guldbergs Gade 2, 8000 Aarhus, Denmark.
- Current affiliation (DDV): Department of Geography, National University of Singapore, AS2, #03-01, 1 Arts Link, Kent Ridge, 117570 Singapore, Singapore.
| | - Thomas A Gerds
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
| | - Per K Andersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen, Denmark.
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen, Denmark.
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Annette K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen, Denmark.
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29
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Abstract
PURPOSE OF REVIEW Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide. RECENT FINDINGS The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools. SUMMARY The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.
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