title: Lithium in drinking water and suicide mortality: interplay with lithium prescriptions.
abstract: BACKGROUND
  Little is known about the effects of lithium intake through drinking water on suicide. This intake originates either from natural rock and soil elution and/or accumulation of lithium-based pharmaceuticals in ground water.
  
  
  OBJECTIVE
  To examine the interplay between natural lithium in drinking water, prescribed lithium-based pharmaceuticals and suicide in Austria.
  
  
  METHODS
  Spatial Bayesian regressions for males, females and pooled suicide mortality rates were estimated.
  
  
  RESULTS
  Although the expected inverse association between lithium levels in drinking water and suicide mortality was confirmed for males and for total suicide rates, the relationship for females was not significant. The models do not indicate that lithium from prescriptions, assumed to accumulate in drinking water, is related to suicide risk patterns either as an individual effect or as a moderator of lithium levels in drinking water. Gender-specific differences in risk factors and local risk hot spots are confirmed.
  
  
  CONCLUSIONS
  The findings do not support the hypotheses that lithium prescriptions have measureable protective effects on suicide or that they interact with lithium in drinking water.
authors.affiliation: Marco Helbich, PhD, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands; Michael Leitner, PhD, Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, USA; Nestor D. Kapusta, PhD, Department for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria m.helbich@uu.nl.
authors.forename: Marco
authors.initials: M
authors.lastname: Helbich
authors.affiliation: Marco Helbich, PhD, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands; Michael Leitner, PhD, Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, USA; Nestor D. Kapusta, PhD, Department for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Leitner
authors.affiliation: Marco Helbich, PhD, Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands; Michael Leitner, PhD, Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, USA; Nestor D. Kapusta, PhD, Department for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Nestor D
authors.initials: ND
authors.lastname: Kapusta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001317:Austria; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006801:Humans; D008094:Lithium / Q000032:analysis* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000401:mortality*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D060766:Drinking Water; D008094:Lithium