Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England

Abstract

ObjectiveTo investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England.MethodsA 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.ResultsOverall, 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).ConclusionsFor 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.

Insomnia and its associated factors in incarcerated adults: A cross‐sectional study

“…To the best of our knowledge, the present study is the first to estimate the overall prevalence and correlates of insomnia in male prison inmates in Taiwan using a highly‐sensitive instrument. The prevalence of insomnia in the present study was 26.9%, which was higher than that of the adult population in the community (5–15%) (Buysse et al, ; Cao et al, ), but considerably lower than the result in a female prison population in the USA (61.6%) (Dewa et al, ). This discrepancy could be attributed to sex and the measurement tools and definitions of insomnia used in various studies.…”

“…People with more medical problems typically rate their perceived health status relatively low (Wu et al, ). Moreover, prisoners with a history of physical ill health have been reported to experience more insomnia (Dewa et al, ).…”

“…An earlier study revealed that the prevalence of insomnia was approximately 44% in a Swiss prison (Elger, ). However, a recent study estimated that the prevalence of insomnia (61.6%) was higher in adult prisoners in England than in the general population (Dewa, Hassan, Shaw, & Senior, ). These studies demonstrated that prisoners were more likely to suffer insomnia than the non‐incarcerated population (Dewa et al, ; Morin & Benca, ).…”

“…Prisoners must not only navigate complicated relationships with other inmates and prison staff but also endure the overcrowded environment (WHO Regional Office for Europe, ). These stressful situations in the prison environment cause various negative effects on mental and physical health (WHO Regional Office for Europe, ), which in turn cause sleep problems (Dewa et al, ). Furthermore, prisons are part of communities.…”

Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study

“…This included a systematic integrative review of published literature on insomnia in prison3; learning from a questionnaire survey and in-depth qualitative interviews with prison health and discipline staff and prisoners about the current treatment of insomnia (L Dewa, unpublished data, 2016)14; and a prevalence study of rates of short-term and long-term insomnia in a sample of English prisons 5. The preliminary pathway then went through an initial review by a convenience sample of academic sleep researchers, prison staff and prisoners.…”