Lithium in drinking water and incidence of suicide: A nationwide individual-level cohort study with 22 years of follow-up

Nikoline N. Knudsen; Jörg Schullehner; Birgitte Hansen; Lisbeth F. Jørgensen; Søren M. Kristiansen; Denitza D. Voutchkova; Thomas A. Gerds; Per K. Andersen; Kristine Bihrmann; Morten Grønbæk; Lars V. Kessing; Annette K. Ersbøll

doi:10.3390/ijerph14060627

Lithium in drinking water and incidence of suicide: A nationwide individual-level cohort study with 22 years of follow-up

Nikoline N. Knudsen, Jörg Schullehner, Birgitte Hansen, Lisbeth F. Jørgensen, Søren M. Kristiansen, Denitza D. Voutchkova, Thomas A. Gerds, Per K. Andersen, Kristine Bihrmann, Morten Grønbæk, Lars V. Kessing, Annette K. Ersbøll^*

^*Corresponding author for this work

27 Citations (Scopus)

93 Downloads (Pure)

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.

Original language	English
Article number	627
Journal	International Journal of Environmental Research and Public Health
Volume	14
Issue number	6
Pages (from-to)	1-13
Number of pages	13
ISSN	1661-7827
DOIs	https://doi.org/10.3390/ijerph14060627
Publication status	Published - 10 Jun 2017

Keywords

Denmark
Drinking water
Exposure assessment
Individual-level data
Lithium
Spatial analysis
Suicide

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3390/ijerph14060627Licence: CC BY

Lithium in Drinking Water and Incidence of Suicide A Nationwide Individual-Level Cohort Study with 22 Years of Follow-UpFinal published version, 1.87 MBLicence: CC BY

Cite this

Knudsen, N. N., Schullehner, J., Hansen, B., Jørgensen, L. F., Kristiansen, S. M., Voutchkova, D. D., Gerds, T. A., Andersen, P. K., Bihrmann, K., Grønbæk, M., Kessing, L. V., & Ersbøll, A. K. (2017). 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, 14(6), 1-13. [627]. https://doi.org/10.3390/ijerph14060627

Lithium in drinking water and incidence of suicide : A nationwide individual-level cohort study with 22 years of follow-up. / Knudsen, Nikoline N.; Schullehner, Jörg; Hansen, Birgitte et al.

In: International Journal of Environmental Research and Public Health, Vol. 14, No. 6, 627, 10.06.2017, p. 1-13.

Research output: Contribution to journal › Journal article › Research › peer-review

Knudsen, NN, Schullehner, J, Hansen, B, Jørgensen, LF, Kristiansen, SM, Voutchkova, DD, Gerds, TA , Andersen, PK, Bihrmann, K, Grønbæk, M, Kessing, LV & Ersbøll, AK 2017, '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, vol. 14, no. 6, 627, pp. 1-13. https://doi.org/10.3390/ijerph14060627

@article{481b8d2c0f2e4cfab3fade18543e8acc,

title = "Lithium in drinking water and incidence of suicide: A nationwide individual-level cohort study with 22 years of follow-up",

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.",

keywords = "Denmark, Drinking water, Exposure assessment, Individual-level data, Lithium, Spatial analysis, Suicide",

author = "Knudsen, {Nikoline N.} and J{\"o}rg Schullehner and Birgitte Hansen and J{\o}rgensen, {Lisbeth F.} and Kristiansen, {S{\o}ren M.} and Voutchkova, {Denitza D.} and Gerds, {Thomas A.} and Andersen, {Per K.} and Kristine Bihrmann and Morten Gr{\o}nb{\ae}k and Kessing, {Lars V.} and Ersb{\o}ll, {Annette K.}",

year = "2017",

month = jun,

day = "10",

doi = "10.3390/ijerph14060627",

language = "English",

volume = "14",

pages = "1--13",

journal = "International Journal of Environmental Research and Public Health",

issn = "1661-7827",

publisher = "MDPI AG",

number = "6",

}

TY - JOUR

T1 - Lithium in drinking water and incidence of suicide

T2 - A nationwide individual-level cohort study with 22 years of follow-up

AU - Knudsen, Nikoline N.

AU - Schullehner, Jörg

AU - Hansen, Birgitte

AU - Jørgensen, Lisbeth F.

AU - Kristiansen, Søren M.

AU - Voutchkova, Denitza D.

AU - Gerds, Thomas A.

AU - Andersen, Per K.

AU - Bihrmann, Kristine

AU - Grønbæk, Morten

AU - Kessing, Lars V.

AU - Ersbøll, Annette K.

PY - 2017/6/10

Y1 - 2017/6/10

N2 - 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.

AB - 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.

KW - Denmark

KW - Drinking water

KW - Exposure assessment

KW - Individual-level data

KW - Lithium

KW - Spatial analysis

KW - Suicide

UR - http://www.scopus.com/inward/record.url?scp=85020768130&partnerID=8YFLogxK

U2 - 10.3390/ijerph14060627

DO - 10.3390/ijerph14060627

M3 - Journal article

C2 - 28604590

AN - SCOPUS:85020768130

SN - 1661-7827

VL - 14

SP - 1

EP - 13

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

IS - 6

M1 - 627

ER -

Lithium in drinking water and incidence of suicide: A nationwide individual-level cohort study with 22 years of follow-up

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this