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Int. J. Environ. Res. Public Health 2017, 14(6), 627; doi:10.3390/ijerph14060627

Lithium in Drinking Water and Incidence of Suicide: A Nationwide Individual-Level Cohort Study with 22 Years of Follow-Up

National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen, Denmark
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
Geological Survey of Denmark and Greenland (GEUS), Hydrological Department, Øster Voldgade 10, 1350 Copenhagen, 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
Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
Shared Last Authorship.
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 29 April 2017 / Revised: 28 May 2017 / Accepted: 6 June 2017 / Published: 10 June 2017
View Full-Text   |   Download PDF [1907 KB, uploaded 10 June 2017]   |  


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. View Full-Text
Keywords: drinking water; lithium; suicide; individual-level data; spatial analysis; Denmark; exposure assessment drinking water; lithium; suicide; individual-level data; spatial analysis; Denmark; exposure assessment

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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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. Lithium in Drinking Water and Incidence of Suicide: A Nationwide Individual-Level Cohort Study with 22 Years of Follow-Up. Int. J. Environ. Res. Public Health 2017, 14, 627.

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