Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 2;22(1):53.
doi: 10.1186/s12916-024-03269-3.

Association between drinking water quality and mental health and the modifying role of diet: a prospective cohort study

Shuduo Zhou #  1   2 , Mintao Su #  1 , Peng Shen #  3 , Zongming Yang  4 , Pengfei Chai  3 , Shengzhi Sun  5 , Hongbo Lin  3 , Liming Shui  6 , Na Zhang  7 , Ming Xu  1   2 , Zhi-Jie Zheng  1   2 , Jianbing Wang  8   9 , Zhenyu Zhang  10   11   12 , Kun Chen  13   14
Affiliations

Association between drinking water quality and mental health and the modifying role of diet: a prospective cohort study

Shuduo Zhou et al. BMC Med. .

Abstract

Background: Environmental factors play an important role in developing mental disorders. This study aimed to investigate the associations of metal and nonmetal elements in drinking water with the risk of depression and anxiety and to assess whether diets modulate these associations.

Methods: We conducted a prospective cohort study including 24,285 participants free from depression and anxiety from the Yinzhou Cohort study in the 2016-2021 period. The exposures were measured by multiplying metal and nonmetal element concentrations in local pipeline terminal tap water samples and total daily drinking water intakes. Cox regression models adjusted for multi-level covariates were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95%CIs).

Results: During an average follow-up period of 4.72 and 4.68 years, 773 and 1334 cases of depression and anxiety were identified, respectively. A 1 standard deviation (SD) increase in manganese exposure reduced the incidence of depression by 8% (HR 0.92, 95%CI 0.88 to 0.97). In contrast, with a 1 SD increase in copper and cadmium exposure, the incidence of depression increased by 6% (HR 1.06, 95%CI 1.01 to 1.11) and 8% (HR 1.08, 95%CI 1.00 to 1.17), respectively. The incidence of anxiety increased by 39% (HR 1.39, 95%CI 1.20 to 1.62), 33% (HR 1.33, 95%CI 1.03 to 1.71), and 14% (HR 1.14, 95%CI 1.03 to 1.25) respectively for a 1 SD increase in manganese, iron, and selenium exposure. Diets have a moderating effect on the associations of metal and nonmetal elements with the risk of anxiety. Stronger associations were observed in older, low-income groups and low-education groups.

Conclusions: We found significant associations between exposure to metal and nonmetal elements and depression and anxiety. Diets regulated the associations to some extent.

Keywords: Anxiety; Cohort study; Depression; Drinking water; Metals element; Nonmetals element.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population
Fig. 2
Fig. 2
Prospective association between long-term exposure to metal and nonmetal elements and risk of depression and anxiety onset. Model adjusted for age; education; BMI; annual household income; current smoking status; current alcohol consumption status; current tea consumption; medical history of stroke, diabetes, hypertension, cancer, and dyslipidemia; current vegetable consumption; current fruit consumption; current seafood consumption; current freshwater product consumption; current marine product consumption; current meat consumption; current red meat consumption; and current white meat consumption
Fig. 3
Fig. 3
The moderating effect of food consumption on the prospective associations between metal and nonmetal elements and mental diseases. A Depression. B Anxiety. Model adjusted for age; education; BMI; annual household income; current smoking status; current alcohol consumption status; current tea consumption; medical history of stroke, diabetes, hypertension, cancer, and dyslipidemia; current vegetable consumption; current fruit consumption; current seafood consumption; current freshwater product consumption; current marine product consumption; current meat consumption; current red meat consumption; and current white meat consumption
See this image and copyright information in PMC

References

    1. GBD 2019 Mental Disorders Collaborators Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137–150. doi: 10.1016/S2215-0366(21)00395-3. - DOI - PMC - PubMed
    1. Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. EClinicalMedicine. 2022;54:101675. doi: 10.1016/j.eclinm.2022.101675. - DOI - PMC - PubMed
    1. COVID-19 Mental Disorders Collaborators Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398(10312):1700–1712. doi: 10.1016/S0140-6736(21)02143-7. - DOI - PMC - PubMed
    1. Mahmud S, Hossain S, Muyeed A, Islam MM, Mohsin M. The global prevalence of depression, anxiety, stress, and insomnia and its changes among health professionals during COVID-19 pandemic: a rapid systematic review and meta-analysis. Heliyon. 2021;7(7):e07393. doi: 10.1016/j.heliyon.2021.e07393. - DOI - PMC - PubMed
    1. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17(3):327–335. doi: 10.31887/DCNS.2015.17.3/bbandelow. - DOI - PMC - PubMed