School of Medicine, Griffith University, Southport, QLD, Australia.
Metro South Mental Health and Addiction Services, Brisbane, QLD, Australia.
Aust N Z J Psychiatry. 2021 Feb;55(2):139-152. doi: 10.1177/0004867420963740. Epub 2020 Oct 13.
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.
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.
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 ( = -0.191, 95% confidence interval = [-0.287, -0.090], < 0.001) and meta-analysis of two studies including 5 million people found higher lithium concentrations were associated with fewer hospital admissions ( = -0.413, 95% confidence interval = [-0.689, -0.031], = 0.035). We found significant heterogeneity between studies ( = 67.4, < 0.001, = 80.7%) and the presence of publication bias (Egger's test; value = 2.90, = 0.013). Other included studies did not provide sufficient data to analyse other neuropsychiatric outcomes quantitatively.
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. The study was registered with PROSPERO, number CRD42018090145.
饮用水中的锂可能对心理健康有显著益处。我们调查了饮用水中锂浓度与其神经精神结局之间关联的证据。
我们进行了系统评价和荟萃分析，并于 2020 年 1 月 19 日前在 Pubmed、Embase、Web of Science、PsycINFO 和 CINAHL 中检索了评估饮用水中锂浓度与神经精神结局之间关联的同行评审研究。我们使用配对分析和随机效应模型对自杀率和精神病院入院率进行荟萃分析。我们使用 Egger 检验和 Duval 和 Tweedie 的 Trim and Fill 分析评估发表偏倚。
这项系统评价纳入了 27 项研究，共计 1.13 亿名受试者。对包括 9400 万人的 14 项研究的荟萃分析显示，较高的锂浓度与自杀率降低相关（ = -0.191，95%置信区间 = [-0.287，-0.090]， < 0.001），对包括 500 万人的 2 项研究的荟萃分析显示，较高的锂浓度与住院人数减少相关（ = -0.413，95%置信区间 = [-0.689，-0.031]， = 0.035）。我们发现研究之间存在显著的异质性（ = 67.4， < 0.001， = 80.7%）和发表偏倚的存在（Egger 检验； 值 = 2.90， = 0.013）。其他纳入的研究没有提供足够的数据来定量分析其他神经精神结局。
饮用水中较高的锂浓度可能与自杀率降低和精神病住院人数减少有关。与其他神经精神结局和并发症的关系尚不清楚。在提出任何公共卫生建议之前，需要进行进一步的研究。该研究在 PROSPERO 注册，编号 CRD42018090145。
