Higher Frequency of Psychiatric Morbidity in Patients with Bacterial Infection of the Skin and Subcutaneous Tissue versus Cutaneous Neoplasms: Results from a Nationally Representative Sample from the United States

Abstract

Background: Poor hygiene and nutrition and resultant compromised immune status in some psychiatric patients can increase susceptibility to bacterial skin infections. Objective: We examined the frequency of ICD9-CM psychiatric disorders (codes 290–319) in bacterial skin infections (ICD9-CM codes 680–686) ( N = 18,734) versus malignant and benign cutaneous neoplasms (ICD9-CM codes 172, 173, 232, 216) ( N = 8,376), conditions that would be expected to cause psychological distress for the patient. Methods: Logistic regression analysis was conducted controlling for age, sex, race, diabetes, obesity, and the use of antineoplastic and immunosuppressant medications. Results: Skin infections were more commonly (odds ratio = 3.03, 95% CI 1.58–5.82) associated with a psychiatric disorder; the most frequent diagnoses were substance dependence and abuse (19.5%), depressive disorder (19.0%), attention-deficit disorder (14.4%), and anxiety disorders (11.6%). Conclusion: In contrast to cutaneous neoplasms, bacterial skin infections were three times as likely to be associated with a psychiatric disorder. Psychiatric comorbidity should be ruled out as a factor in patients with intractable skin infections.