Housing Quality and Mental Health: the Association between Pest Infestation and Depressive Symptoms among Public Housing Residents

Abstract

Housing quality, which includes structural and environmental risks, has been associated with multiple physical health outcomes including injury and asthma. Cockroach and mouse infestations can be prime manifestations of diminished housing quality. While the respiratory health effects of pest infestation are well documented, little is known about the association between infestation and mental health outcomes. To address this gap in knowledge and given the potential to intervene to reduce pest infestation, we assessed the association between household pest infestation and symptoms of depression among public housing residents. We conducted a cross-sectional study in 16 Boston Housing Authority (BHA) developments from 2012 to 2014 in Boston, Massachusetts. Household units were randomly selected and one adult (n = 461) from each unit was surveyed about depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) Scale, and about pest infestation and management practices. In addition, a home inspection for pests was performed. General linear models were used to model the association between pest infestation and high depressive symptoms. After adjusting for important covariates, individuals who lived in homes with current cockroach infestation had almost three times the odds of experiencing high depressive symptoms (adjusted OR = 2.9, 95% CI 1.9-4.4) than those without infestation. Dual infestation (cockroach and mouse) was associated with over five times the odds (adjusted odds = 5.1, 95% CI 3.0-8.5) of experiencing high depressive symptoms. Using a robust measure of cockroach and mouse infestation, and a validated depression screener, we identified associations between current infestation and depressive symptoms. Although the temporal directionality of this association remains uncertain, these findings suggest that the health impact of poor housing conditions extend beyond physical health to include mental health. The study adds important information to the growing body of evidence that housing contributes to population health and improvements in population health may not be possible without addressing deficiencies in the housing infrastructure.

Keywords: Cockroach infestation; Depression; Housing quality; Integrated pest management; Mouse infestation; Public housing.

Fig. 1

This figure presents the criteria used to determine the three levels of pest management identified in this study: traditional pest management (PM), low integrated pest management (IPM), and high IPM. The six criteria were % of apartments receiving annual inspection, % of apartments with pests, % units with pests not followed up, 3-year average work order prevalence, pest contract lapse, and a combination of development participation in previous IPM pilot and presence of tenant coordinator. Of the 36 eligible developments, 12 developments were categorized into each intensity level, and from these 12, 6 were selected from each intensity level for inclusion in the study. Within each intensity level, 480 units were randomly selected. In the traditional PM, low IPM, and high IPM intensity levels, 161, 179, and 122 participants were enrolled, respectively. 1 A development with 3 or more criteria in one pest management intensity level was assigned to that level, 2 Fewer developments in the low IPM level were visited because the sample size was achieved prior to visiting 2 developments