Associations Between Bed Bugs and Mental Illness Among Emergency Department Patients

Background Bed bugs are common urban pests associated with stress, anxiety, depression, and some reports of suicidality. The emergency department (ED) treats patients with both acute mental illness and bed bug infestations. There have been few studies examining associations between bed bug infestations and mental illness. Methods A case-control study involving 332 adult ED patients infested with bed bugs and 4,952 uninfested control patients matched on sex, age (±1 year at the time of the ED visit), and the specific ED was completed. All clinic encounters occurred in northeast Ohio between February 1, 2011, and February 1, 2017, from a single health system. Univariable and multivariable regression analysis looked for associations between bed bug infestation and different psychiatric diagnoses and medications. Results Bed bug infested patients were more likely than uninfested patients to screen positive for an unsafe home and needing an abuse consult at ED triage (P≤.03 for both). ED psychiatric evaluations were not significantly more common among those with (2.4%) and without (1.3%) bed bugs (P=.14). Bed bug infested patients were significantly more likely to have an ED or inpatient diagnosis of alcohol abuse and psychosis (P≤.03 for both), but not for depression or suicidality. On univariable analysis, among ED patients not admitted to the hospital, bed bug infested patients were more likely to be diagnosed with psychosis or schizophrenia/schizoaffective disease (P≤.02) than uninfested patients. Among ED patients that received an ED or inpatient psychiatric evaluation and were admitted to the hospital, bed bug infested patients were significantly less likely to be diagnosed with depression and suicidality (P≤.03 for both). However, they were not significantly more likely to have insomnia or anxiety. Discussion Among ED patients, bed bug infestations were not associated with an ED or inpatient diagnosis of depression or suicidality. On univariable analysis, some mental health diagnoses such as anxiety and insomnia were more common among ED patients with bed bugs, but these associations were no longer significant on multivariable analysis. These associations likely reflect the complex relationships between socioeconomic factors, health disparities, mental illness, and having a bed bug infestation.