Dissolved Lithium Concentrations and Dissolved Lithium Concentrations and Texas Suicide Mortality Rates 1980-1998Texas Suicide Mortality Rates 1980-1998

by William M Flanaganby William M Flanagan

University of North TexasUniversity of North Texas

Department of GeographyDepartment of Geography

IntroductionIntroduction

Spatial distribution of suicide mortality rates in Spatial distribution of suicide mortality rates in Texas counties, from 1980 – 1998.Texas counties, from 1980 – 1998.

Disease ecology conceptual framework. Disease ecology conceptual framework.

Suicide StatisticsSuicide Statistics

In US, 32,000 suicide deaths annually. In US, 32,000 suicide deaths annually.

11th leading causes of death in US.11th leading causes of death in US.

Texans ranked 37th in completed suicides Texans ranked 37th in completed suicides in 2002 in US.in 2002 in US.

Risk Predictors of Suicide MortalityRisk Predictors of Suicide Mortality

GenderGender• Females 3x more likely than males to Females 3x more likely than males to

attempt suicide.attempt suicide.

• Males complete suicide 4x more than Males complete suicide 4x more than females.females.

Risk Predictors of Suicide MortalityRisk Predictors of Suicide Mortality

RaceRace• White males have highest suicide White males have highest suicide

mortality rate.mortality rate.

• Minority females have the lowest. Minority females have the lowest.

Risk Predictors of Suicide MortalityRisk Predictors of Suicide Mortality

LithiumLithium

• Used in treating manic depressive illnessUsed in treating manic depressive illness

• Suicide, homicide, and forcible rapeSuicide, homicide, and forcible rape

• Continued lithium treatment is associated with Continued lithium treatment is associated with reduced suicide riskreduced suicide risk

• Dissolved lithium concentrations in Dissolved lithium concentrations in groundwater may provide a protective function groundwater may provide a protective function on suicide behavior and mortality.on suicide behavior and mortality.

Lithium Concentrations in NatureLithium Concentrations in Nature

Associated with volcanism, may explain Associated with volcanism, may explain presence in many aquiferspresence in many aquifers

Many counties and cities in Texas rely on Many counties and cities in Texas rely on groundwater for their water needs. groundwater for their water needs.

Nutritional uptake of lithium through Nutritional uptake of lithium through common foods and vegetables. common foods and vegetables.

HypothesesHypotheses Gender is a predictor of suicide mortality. Gender is a predictor of suicide mortality.

Race is a predictor of suicide mortality. Race is a predictor of suicide mortality.

County suicide mortality rates will be influenced by County suicide mortality rates will be influenced by dissolved lithium concentrations in the groundwater. dissolved lithium concentrations in the groundwater.

Suicide mortality rates are changing through time. Suicide mortality rates are changing through time.

Data SourcesData Sources

Age adjusted mortality data (1980 – 1998) Texas Age adjusted mortality data (1980 – 1998) Texas Department of Health’s Vital Statistics Division.Department of Health’s Vital Statistics Division.

Population and other data from the 2000 US Population and other data from the 2000 US Census.Census.

Dissolved lithium concentration data from Texas Dissolved lithium concentration data from Texas Water Development Board Groundwater Water Development Board Groundwater Database Database

MethodologyMethodology

Spearman’s 2-tailed Rank CorrelationSpearman’s 2-tailed Rank Correlation

Wilcoxon Two Sample TestWilcoxon Two Sample Test

GENDER AND SUICIDEGENDER AND SUICIDE

Males have a higher suicide rate than Males have a higher suicide rate than females (Z=-13.706, p=.000). females (Z=-13.706, p=.000).

Males Average = 22.5 per 100,000Males Average = 22.5 per 100,000

Females Average = 5.4 per 100,000Females Average = 5.4 per 100,000

RACE AND SUICIDERACE AND SUICIDE

Counties with higher % whites had higher Counties with higher % whites had higher suicide mortality (r=.315, p=.000). suicide mortality (r=.315, p=.000).

Counties with higher % Hispanics have Counties with higher % Hispanics have lower suicide mortality lower suicide mortality (r= -.250, p=.000).(r= -.250, p=.000).

No correlation between % African No correlation between % African Americans and suicide mortality rates Americans and suicide mortality rates (r= -.014, p=.827). (r= -.014, p=.827).

LITHIUM CONCENTRATIONS AND SUICIDELITHIUM CONCENTRATIONS AND SUICIDE

Dissolved lithium concentrations in Dissolved lithium concentrations in groundwater is inversely related to groundwater is inversely related to suicide mortality rates (r= -.150, suicide mortality rates (r= -.150, p=.017). p=.017).

TEMPORAL VARIATIONS OF SUICIDETEMPORAL VARIATIONS OF SUICIDE

Suicide mortality rates (1980-1989) Suicide mortality rates (1980-1989) are lower than 1990-1998 are lower than 1990-1998

(Z = -2.351, p=.019). (Z = -2.351, p=.019).

CONCLUSIONSCONCLUSIONS Male suicide rates are significantly higher than female Male suicide rates are significantly higher than female

suicide mortality rates suicide mortality rates

% Whites is positively correlation to suicide mortality rates% Whites is positively correlation to suicide mortality rates

% Hispanics account for a negative correlation to suicide % Hispanics account for a negative correlation to suicide mortality rates.mortality rates.

Counties with lower rates of dissolved lithium Counties with lower rates of dissolved lithium concentrations in groundwater have higher suicide ratesconcentrations in groundwater have higher suicide rates

Suicide mortality rates are increasing with time.Suicide mortality rates are increasing with time.

SUGGESTIONS FOR FURTHER RESEARCHSUGGESTIONS FOR FURTHER RESEARCH

Intra-county variations ignoredIntra-county variations ignored

Other water sources (e.g surface and tap Other water sources (e.g surface and tap water) must be addressed.water) must be addressed.

Finer geographical scale required.Finer geographical scale required.

How the underlying geology affects lithium How the underlying geology affects lithium concentrations. concentrations.

ReferencesReferences

1)1) Bronisch T Bronisch T et alet al. 2005. A multicenter study about Neurobiology of . 2005. A multicenter study about Neurobiology of Suicidal Behavior: design, development, and preliminary results. Suicidal Behavior: design, development, and preliminary results. Arch Arch Suicide Res.Suicide Res. 9(1):19-26. 9(1):19-26.

2)2) Cipriani A. Cipriani A. et alet al. 2005 Oct. Lithium in the prevention of suicidal behavior . 2005 Oct. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. review of randomized trials. Am J Psychiatry. Am J Psychiatry. 162(10):1805-19. 162(10):1805-19.

3)3) Dawson EB. The relationship of tap water and physiological levels of Dawson EB. The relationship of tap water and physiological levels of lithium to mental hospital admission and homicide in Texas. In lithium to mental hospital admission and homicide in Texas. In Schrauzer GN, KlippelKF (eds): " Lithium in Biology and Medicine." Schrauzer GN, KlippelKF (eds): " Lithium in Biology and Medicine." Weinheim: VCH Verlag, pp 171–187, 1991. Weinheim: VCH Verlag, pp 171–187, 1991.

4)4) Dawson EB, Moore TD, McGanity WJ. The mathematical relationship of Dawson EB, Moore TD, McGanity WJ. The mathematical relationship of drinking water lithium and rainfall on mental hospital admission. drinking water lithium and rainfall on mental hospital admission. Dis Dis Nerv Syst Nerv Syst 31: 1–10. 31: 1–10.

5)5) Dumais A. Dumais A. et alet al. 2005 Nov. Risk factors for suicide completion in major . 2005 Nov. Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors depression: a case-control study of impulsive and aggressive behaviors in men. in men. Am J Psychiatry. Am J Psychiatry. 162(11):2116-24. 162(11):2116-24.

6)6) Henderson JP, Mellin C, Patel F. 2005. Suicide - A statistical analysis by Henderson JP, Mellin C, Patel F. 2005. Suicide - A statistical analysis by age, sex and method. age, sex and method. J Clin Forensic Med.J Clin Forensic Med. 12(6):305-9. 12(6):305-9.

7)7) Kaslow NJ Kaslow NJ et alet al. 2005 Aug. Social risk and protective factors for suicide . 2005 Aug. Social risk and protective factors for suicide attempts in low income African American men and women. attempts in low income African American men and women. Suicide Life Suicide Life Threat Behav. Threat Behav. 2005 Aug;35(4):400-12. 2005 Aug;35(4):400-12.

References (cont.)References (cont.)

8)8) Kessing LV Kessing LV et alet al. 2005 Aug. Suicide risk in patients treated with lithium. . 2005 Aug. Suicide risk in patients treated with lithium. Arch Gen Psychiatry. Arch Gen Psychiatry. (8):860-6(8):860-6..

9)9) Moscicki EK. 1997 Sep. Identification of suicide risk factors using Moscicki EK. 1997 Sep. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am 20(3):499-517.epidemiologic studies. Psychiatr Clin North Am 20(3):499-517.

10)10) Muller-Oerlinghausen B Muller-Oerlinghausen B et alet al. 2005. The impact of lithium long-term . 2005. The impact of lithium long-term medication on suicidal behavior and mortality of bipolar patients.medication on suicidal behavior and mortality of bipolar patients. Arch Arch Suicide Res.Suicide Res. 9(3):307-19. 9(3):307-19.

11)11) Schrauzer GN, Shrestha KP. 1990. Lithium in drinking water and the Schrauzer GN, Shrestha KP. 1990. Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions. incidences of crimes, suicides, and arrests related to drug addictions. Biol Biol Trace El ResTrace El Res 25: 105–113. 25: 105–113.

12)12) Scharuzer GN. Lithium. 2002. Occurrence, Dietary Intakes, Nutritional Scharuzer GN. Lithium. 2002. Occurrence, Dietary Intakes, Nutritional Essentiality. Essentiality. Journal of the American College of Nutrition.Journal of the American College of Nutrition. Vol. 21, No. 1, Vol. 21, No. 1, 14-21 14-21

13)13) Stack S, Wasserman I. 2005. Race and method of suicide: culture and Stack S, Wasserman I. 2005. Race and method of suicide: culture and opportunity. opportunity. Arch Suicide Res. Arch Suicide Res. 9(1):57-68. 9(1):57-68.

14)14) Suicide and Crisis Center. Suicide and Crisis Center. Suicide Facts and Statistics. Suicide Facts and Statistics. Available at: Available at: <http://www.sccenter.org/facts.html>. Accessed October 21, 2005. <http://www.sccenter.org/facts.html>. Accessed October 21, 2005.

15)15) Texas Water Development Board. Updated Water-Quality Evaluation of Texas Water Development Board. Updated Water-Quality Evaluation of the Ogallala Aquifer Including Selected Metallic and Non-Metallic Inorganic the Ogallala Aquifer Including Selected Metallic and Non-Metallic Inorganic Constituents. Constituents. Available at: Available at: <http://www.twdb.state.tx.us/publications/reports/GroundWaterReports/<http://www.twdb.state.tx.us/publications/reports/GroundWaterReports/HydrologicAtlases/HA-10.pdf.> Accessed October 21, 2005.HydrologicAtlases/HA-10.pdf.> Accessed October 21, 2005.