Insomnia in primary care—a study from India T S Jaisoorya a, ⁎, Ajit Bhalchandra Dahale b , Kumar G Sunil c , L Manoj d , GR Gokul e , K Thennarassu f a Associate Professor of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India, 560 029 b Assistant Professor of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India, 560 029 c State Programme Manager, National Health Mission (Kerala), Thiruvanthupuram, India d District Programme Manager (Alappuzha), National Health Mission (Kerala), India e State Mission Director, National Health Mission (Kerala), Thiruvanthupuram, India f Professor of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India, 560 029 abstract article info Article history: Received 16 August 2017 Received in revised form 6 November 2017 Accepted 8 November 2017 Available online xxxx Keywords: Insomnia Primary care Correlates India Objectives: To study the prevalence and clinical correlates of insomnia among a sample of primary care attendees, in the state of Kerala, India. Design: Cross-sectional survey. Setting: Primary care. Participants: 7017 adult patients [18–60 years] attending 71 primary health centers selected by cluster random sampling. Measurements: Patients were assessed for insomnia using the Insomnia Severity Index. In addition to self- reported socio-demographic and chronic medical illness details, structured instruments were used to assess for mental disorders, disability and life satisfaction. Results: Subclinical insomnia and clinical insomnia were reported by 17.7% and 4.7% subjects, respectively. Subjects with subclinical and clinical insomnia when compared to those without insomnia had higher odds of having older age, female gender, urban background, lower education, chronic medical and mental disorders, greater disability and poor life satisfaction. Subjects with clinical insomnia when compared to the subclinical group had higher odds of having older age, urban background, lower education, mental disorders and greater disability. Among mental disorders, depressive disorder was correlated with both clinical and subclinical insomnia. Conclusions: Clinical and subclinical insomnia is common among primary care attendees and both are associated with significant morbidity. This study highlights that it is a major public health concern, albeit neglected, which needs to be dealt as a priority. © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved. Introduction Insomnia is the most common sleep disorder in clinical practice. Subjects with chronic insomnia have a poor quality of life, reduced work productivity including absenteeism, increased risk of accidents, higher healthcare utilization and increased mortality risk. 1,2 Older age, female gender, being separated/divorced/widowed, lower education and lower income are reported to be associated with insomnia. 3–7 Insomnia and psychiatric illnesses frequently co-occur. 8,9 Chronic medical conditions also increase the risk for developing insomnia. 10 Correlates of subjects who have subclinical sleep disturbances remain under-studied though there is evidence from other neuropsychiatric disorders like depression that even sub-threshold conditions can be impairing. 11 Occasional or transient sleep disturbances are extremely common in the community with third of the population experiencing it any given time. 12 The prevalence rates of insomnia in the general popula- tion vary widely, from 6% to 33%. 4 A higher prevalence of insomnia has been reported from primary care settings with rates varying be- tween 10–69%. 13–15 Indian studies reporting on insomnia are sparse. Existing Indian studies are single center small studies reporting prev- alence rates of 15–45%. 16–18 Though the varying rates could be partly accounted by methodological differences, international studies using similar methodology, have reported variation in the geographic dis- tribution of insomnia. 4,19 The major studies in primary care from var- ious countries and indexed studies to date from India are summarized in Table 1. Sleep Health xxx (2017) xxx–xxx ⁎ Corresponding author. Tel.: +91 9495600084 (Mobile); fax: +91 80 26562121. E-mail address: tsjaisoorya@gmail.com (T.S. Jaisoorya). Contents lists available at ScienceDirect Sleep Health Journal of the National Sleep Foundation journal homepage: sleephealthjournal.org Please cite this article as: Jaisoorya TS, et al, Insomnia in primary care—a study from India, Sleep Health (2017), https://doi.org/10.1016/ j.sleh.2017.11.001 https://doi.org/10.1016/j.sleh.2017.11.001 2352-7218/© 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.