title: Relationships of local lithium concentrations in drinking water to regional suicide rates in Italy.
abstract: OBJECTIVE
  Higher natural concentrations of lithium in drinking water may be associated with lower local rates of suicide.
  
  
  METHODS
  Lithium concentrations in drinking water were assayed by mass spectrometry at 145 sites in Italy, and compared with reported local suicide rates for men and women between 1980 and 2011.
  
  
  RESULTS
  Lithium concentrations in drinking water averaged 5.28 [CI: 4.08-6.48] μg/L (0.761 [0.588-0.934] μEq/L) and ranged from 0.110 to 60.8 μg/L (1.58 to 8.76 μEq/L). Lithium concentrations and local suicide rates were not significantly inversely related, except in 1980-1989, particularly among women.
  
  
  CONCLUSIONS
  A proposed association between trace lithium concentrations in drinking water and risk of suicide was only partially supported, and mechanisms for potential clinical effects of trace levels of lithium are unknown.
authors.affiliation: a Department of Neurosciences , Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.affiliation: b National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health , Rome , Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Vichi
authors.affiliation: c Department of Biological , Geological and Environmental Sciences, University of Bologna , Bologna , Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Dinelli
authors.affiliation: d Department of Psychiatry , Brunico , Italy.
authors.forename: Roger
authors.initials: R
authors.lastname: Pycha
authors.affiliation: e Department of Civil-Environmental Engineering and Architecture , University of Cagliari , Cagliari Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Valera
authors.affiliation: f Department of Earth Sciences , University of Naples , Naples , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Albanese
authors.affiliation: f Department of Earth Sciences , University of Naples , Naples , Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Lima
authors.affiliation: f Department of Earth Sciences , University of Naples , Naples , Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: De Vivo
authors.affiliation: g Department of Science and Technology , University of Sannio , Benevento , Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Cicchella
authors.affiliation: h Department of Psychiatry , University of Naples SUN , Naples , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorillo
authors.affiliation: i Department of Neuroscience , Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa , Genoa , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.affiliation: a Department of Neurosciences , Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.affiliation: j Department of Psychiatry , Harvard Medical School , Boston , MA , USA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006801:Humans; D007558:Italy; D016014:Linear Models; D008094:Lithium / Q000032:analysis*; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology*; D015999:Multivariate Analysis; D011788:Quality of Life; D018570:Risk Assessment; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data*
chemical_list: D060766:Drinking Water; D008094:Lithium
keywords: affective disorders; lithium; mood stabilizers; quality of life; suicide