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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. A