Assessing the links between Internalizing Symptoms and Treatment Motivation in Incarcerated Juveniles

Abstract

The assessment of internalizing symptoms among incarcerated juveniles is limited. Untreated internalizing symptoms can lead to both problems within the facility as well as a higher likelihood of recidivism. However, more research is needed to understand how specific types of symptoms experienced (i.e., depressive vs. anxiety symptoms) are associated with treatment motivation (i.e., problem recognition and treatment readiness) to inform treatment approaches. Alexithymia (i.e., difficulties communicating emotions) is prevalent in incarcerated juveniles and may contribute to the links between internalizing symptoms and treatment motivation. Accordingly, this study evaluated associations between internalizing symptoms and treatment motivation, including the influence of alexithymia, among detained youth. The study used data from 111 detained juveniles who responded to surveys assessing levels of internalizing symptoms, alexithymia, and treatment motivation. An Exploratory Factor Analysis was conducted on all items of the PROMIS Anxiety scale (Ader, 2007) and SMFQ (Short Mood and Feelings Questionnaire; Angold et al., 1995) and revealed that the items measure two separate constructs (i.e., anxiety and depression, respectively) rather than shared negative affectivity in the population. Additionally, Confirmatory Factor Analyses on the PROMIS and SMFQ revealed that unifactorial models of depression and anxiety were maintained in incarcerated juveniles. Path models suggested that higher levels of depression, higher levels of anxiety, and higher levels of alexithymia were linked to higher levels of problem recognition when internalizing symptoms were assessed both simultaneously and separately. While higher levels of depressive and anxiety symptoms were linked to higher levels of treatment readiness when assessed in separate models, no variable was uniquely associated with treatment readiness when internalizing symptoms were assessed simultaneously. Further, alexithymia did not moderate any of the associations examined. Findings suggest that anxiety and depressive symptoms are both more strongly linked to problem recognition than treatment motivation. Implications for facility staff and clinicians are discussed.