Journal of Urban Health

, Volume 95, Issue 5, pp 691–702 | Cite as

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

  • Snehal N. ShahEmail author
  • Alan Fossa
  • Abigail S. Steiner
  • John Kane
  • Jonathan I. Levy
  • Gary Adamkiewicz
  • Willie Mae Bennett-Fripp
  • Margaret Reid


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.


Depression Housing quality Public housing Cockroach infestation Mouse infestation Integrated pest management 



This article is based on work funded by United States Department of Housing and Urban Development under Award No. HUD MALHH0193-09. Its contents are solely the responsibility of the authors and do not represent the official views of the U.S. Department of Housing and Urban Development. We would like to thank all the Boston Housing Authority residents who participated in this study. In addition, we thank Peter J. Ashley, Director of the Policy and Standards Division of HUD’s Office of Lead Hazard Control and Healthy Homes, for his support of this work.

Compliance with Ethical Standards

Ethical Approval

The study was reviewed and approved by the Boston University Medical Campus Institutional Review Board. Informed consent was obtained from all participants in the original data collection stages.


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Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  1. 1.Research and Evaluation OfficeBoston Public Health CommissionBostonUSA
  2. 2.Department of PediatricsBoston University School of MedicineBostonUSA
  3. 3.Boston Children’s Hospital BostonUSA
  4. 4.Tufts University School of MedicineBostonUSA
  5. 5.Operations, Boston Housing AuthorityBostonUSA
  6. 6.Department of Environmental HealthBoston University School of Public HealthBostonUSA
  7. 7.Department of Environmental Health, Landmark CenterHarvard T.H. Chan School of Public HealthBostonUSA
  8. 8.Committee for Boston Public Housing, Inc.RoxburyUSA
  9. 9.Division of Healthy Homes and Community SupportBoston Public Health CommissionBostonUSA

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