title: Anxiety and associated factors among prisoners in North West of Amhara Regional State, Ethiopia.
abstract: BACKGROUND
  Mental illnesses are more common among the prison population than the general public. However, little attention is given to mental health service in low and middle income countries in general. The problem is more so for prisoners where the overall health care is poor. Therefore, the aim of this study was to assess the prevalence of anxiety and the associated factors among prisoners of North West Amhara, Ethiopia.
  
  
  METHODS
  Institutional based cross-sectional study was employed from February to March 2015 by taking a sample of 700 prisoners. Simple random sampling method was employed to select three prisons out of 10 prisons found in the North West Amhara region. Generalized Anxiety Disorder 7-item (GAD-7) scale was used to assess prisoners' anxiety status. The receiver- operator characteristic (ROC) curve was used to determine the cutoff point with high sensitivity and specificity. Structured and pretested interviewer administered questionnaire was used for data collection. Data were checked, coded and entered into Epi Info version 7 and analyzed using R version 3.2.0. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with anxiety. Odds ratio with its 95 % confidence interval was used as a measure of association. Akaike's Information's Criterion (AIC) was used to check model fitness.
  
  
  RESULTS
  A total of 649 prisoners were included in the analysis making the response rate 92.5 %. The prevalence of Anxiety was found to be 36.1 % (95 % CI: 32.7, 39.9). The odds of Anxiety was 2.49(95 % CI: 1.38, 4.55) times higher among prisoners who used to be unhappy in their life before imprisonment. Moreover, smokers were 2.6 (AOR = 2.6, 95 % CI: 1.08, 6.6) times more likely to have anxiety compared with non smokers. However, the odds of the odds of anxiety was 89% lower among Debre-Tabor prisoners (AOR = 0.11, 95 % CI: 0.06, 0.20) and 57 % lower among Gondar prisoners (AOR = 0.43, 95 % CI: 0.28, 0.67).
  
  
  CONCLUSIONS
  The prevalence of anxiety is found to be very high among prisoners in North West Ethiopia. Anxiety was associated with current smoking and having had a dissatisfying life. Screening prisoners for common mental disorders and integrated health care is necessary.
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of public Health, University of Gondar, Gondar, Ethiopia. Fekten@yahoo.com.
authors.forename: Abel Fekadu
authors.initials: AF
authors.lastname: Dadi
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of public Health, University of Gondar, Gondar, Ethiopia.
authors.forename: Berihun Assefa
authors.initials: BA
authors.lastname: Dachew
authors.affiliation: Department of Public Health, College of health sciences, Arsi University, Arsi, Ethiopia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Kisi
authors.affiliation: Department of Psychiatry, School of Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Nigussie
authors.initials: N
authors.lastname: Yigzaw
authors.affiliation: Department of Health Education and Behavioral Science, Institute of public Health, University of Gondar, Gondar, Ethiopia.
authors.forename: Telake
authors.initials: T
authors.lastname: Azale
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: Anxiety; Cross-sectional study; Prisoner