title: Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England.
abstract: OBJECTIVE
  To investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England.
  
  
  METHODS
  A cross-sectional study of 237 prisoners aged 18-72 years, across two male prisons and one female prison in North England. We used the Sleep Condition Indicator to measure probable DSM-V insomnia disorder (ID) and the Pittsburgh Sleep Quality Index to examine sleep quality. Multiple demographic, sleep, clinical and forensic self-reported measures were recorded to identify any associations with insomnia.
  
  
  RESULTS
  Overall, the prevalence of possible DSM-V ID was 61.6% (95% CI, 55.5%-67.8%). Subjective poor sleep quality was reported by 88.2% (95% CI, 84.1%-92.3%). Seven in ten (70.6%) female prisoners had possible DSM-V ID (95% CI, 64.8%-76.4%). Multivariable logistic regression analysis, adjusting for gender and age, indicated odds of having possible ID in prison were increased for the following factors: history of physical ill-health (OR = 3.62, 95% CI, 1.31-9.98); suicidality (OR = 2.79, 95% CI, 1.01.7.66), previously asked for help for insomnia (OR = 2.58, 95% CI, 1.21-5.47), depression (OR = 2.06, 95% CI 1.31-3.24), greater endorsement of dysfunctional beliefs about sleep (OR = 1.50, 95% CI, 1.21-1.87), poor sleep hygiene (OR = 1.11, 95% CI, 1.04-1.19), and problematic prison environment (eg, noise, light or temperature) (OR = 1.07, 95% CI, 1.02-1.12).
  
  
  CONCLUSIONS
  For the first time we have established the prevalence and associated factors of insomnia in a large sample of adult English prisoners. ID and poor sleep quality are common, especially in female prisoners. These findings emphasize/amplify the need for dedicated treatment pathways to improve screening, assessment and treatment of insomnia in prison.
authors.affiliation: NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK. Electronic address: l.dewa@imperial.ac.uk.
authors.forename: Lindsay H
authors.initials: LH
authors.lastname: Dewa
authors.affiliation: Division of Imaging, Informatics and Data Sciences, The University of Manchester, Manchester, UK.
authors.forename: Lamiece
authors.initials: L
authors.lastname: Hassan
authors.affiliation: Division of Psychology and Mental Health, The University of Manchester, UK.
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Shaw
authors.affiliation: Division of Psychology and Mental Health, The University of Manchester, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Senior
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000523:psychology*; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Insomnia; Prevalence; Prisons; Risk factors; Sleep