Prevalence, types and possible causes of insomnia in a Swiss remand prison

Study objectives: To determine the prevalence of insomnia complaints and possible causes among prisoners. Design: Prospective study of medical consultations during 1 year ( questionnaire A) to identify reasons for consultation and diagnoses. After this year we compared the medical records ( questionnaire B) of 112 non-substance misusing (NSM) insomniac prisoners identified through questionnaire A with the records of 103 NSM prisoners without insomnia complaint. Setting: Outpatient service of the remand prison in Geneva, Switzerland. Patients: 995 prisoners. Interventions: None. Measurements and results: The general practitioners returned completed questionnaires A for 92% (n = 2772) of the consultations ( 995 patients). Using questionnaire A and B, we identified 112 NSM insomnia patients. Among these, chronic forms of insomnia were more common than transitory insomnia (< 3 weeks). The most frequently reported reason for insomnia was anxiety related to incarceration. A higher percentage of the 112 insomnia patients than of the 103 non-insomnia patients had a history of medical and psychiatric illness, suffered from anxiety or depression in prison, and received prescriptions of psychotropic and analgesic medications. After the study of the records, we estimated the overall prevalence of insomnia at 44.3% of the 995 patients of whom 51% (n = 223) were drug misusers. Conclusions: Our results confirm that insomnia is a frequent complaint among prisoner patients and that at least half of insomnia patients are substance misusers. In NSM patients, insomnia does not seem to be an only transitory problem of adaptation to incarceration, but a more chronic problem lasting more than 3 weeks, related to a higher degree of medical and psychological problems before and during incarceration.