International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport

The journey to reporting child protection violations in sport: Stakeholder perspectives

Sport is a context within which human and children's rights should be respected, promoted, and protected. Yet, research and high-profile cases demonstrate that this is not always the case. To understand the existence (or not) of reporting mechanisms for child protection violations in sport, as well as how existing reporting and response systems operate, the authors, with the support of the Centre for Sport and Human Rights, conducted research on current abuse disclosure and reporting pathways in sport. The purpose was two-fold: to describe global child protection systems and reporting mechanisms, and to identify major areas of stakeholder concern, in terms of effective case resolution, healing, and children's experiences along reporting pathways in sport. Two sources of evidence were tapped. First, a rapid evidence assessment consisting of a literature review and an exploratory survey with 112 global stakeholders was conducted. Second, focus group interviews informed by the evidence assessment were held with nine athletes with lived experiences of abuse in youth sport and 13 global human and children's rights experts primarily working outside of sport. Through this emergent research, a 'pathway' or 'journey' to incident reporting in sport was developed, summarized as 5 'Rs': Readiness, Recognition, disclosure and Reporting, Response, and Remedy, which are similar but not identical to existing trauma frameworks. Each stage of the reporting journey appears to be influenced by a range of contextual, organizational, relational, and individual factors. All told, the disclosure of child protection violations in sport is a complex and dynamic process where myriad factors interact to influence outcomes, including healing. Key recommendations include: (a) establishing a global Safety Net Environment in sport practice with varying applications from region to region, (b) building bridges with specific partner organizations to enhance child protection and safeguarding work in sport and (c) bringing safeguarding to unregulated sporting environments.

A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden

Objectives

Little is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness.

Methods

A cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors.

Results

In total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001).

Conclusion

Anxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.

Implementation of the International Olympic Committee Sport Mental Health Assessment Tool 1: Screening for Mental Health Symptoms in a Canadian Multisport University Program

OBJECTIVE

To apply the International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) to determine the prevalence of mental health symptoms in a cohort of university student athletes over an academic year. A secondary objective was to explore the internal consistency of the screening tools from the SMHAT-1.

DESIGN

Cross-sectional design with 3 repeated measurements over an academic year.

SETTING

A large university multisport program.

PARTICIPANTS

Five hundred forty-two university-level student athletes from 17 sports.

INTERVENTION

N/A.

MAIN OUTCOME MEASURES

On 3 occasions, the participants completed the SMHAT-1, which consists of the Athlete Psychological Strain Questionnaire. If an athlete's score was above the threshold (≥17), the athlete completed step 2, consisting of (1) Generalized Anxiety Disorder-7; (2) Patient Health Questionnaire-9; (3) Athlete Sleep Screening Questionnaire; (4) Alcohol Use Disorders Identification Test Consumption; (5) Cutting Down, Annoyance by Criticism, Guilty Feeling, and Eye-openers Adapted to Include Drugs; and (6) Brief Eating Disorder in Athletes Questionnaire. Internal consistency of the SMHAT-1 was also measured.

RESULTS

Participants reported mental health symptoms with prevalence of 24% to 40% for distress, 15% to 30% for anxiety, 19% to 26% for depression, 23% to 39% for sleep disturbance, 49% to 55% for alcohol misuse, 5% to 10% for substance use, and 72% to 83% for disordered eating. Female athletes were more likely to suffer psychological strain, depression, and sleep disturbance; male athletes were more likely to report substance use.

CONCLUSIONS

The SMHAT-1 was feasible to implement with good internal consistency. University-level athletes suffer from a variety of mental health symptoms underscoring the necessity for team physicians to have the clinical competence to recognize and treat mental health symptoms.

What Contributes to Athlete Performance Health? A Concept Mapping Approach

BACKGROUND

In high-performance sport, athlete performance health encompasses a state of optimal physical, mental, and social wellbeing related to an athlete's sporting success. The aim of this study was to identify the priority areas for achieving athlete performance health in Australia's high-performance sport system (HPSS).

METHODS

Participants across five socioecological levels of Australia's HPSS were invited to contribute to this study. Concept mapping, a mixed-methods approach incorporating qualitative and quantitative data collection, was used. Participants brainstormed ideas for what athlete performance health requires, sorted the ideas into groups based on similar meaning and rated the importance, and ease of achieving each idea on a scale from 1 (not important/easiest to overcome) to 5 (extremely important/hardest to overcome).

RESULTS

Forty-nine participants generated 97 unique statements that were grouped into 12 clusters following multidimensional scaling and hierarchical cluster analysis. The three clusters with highest mean importance rating were (mean importance rating (1-5), mean ease of overcoming (1-5)): 'Behavioral competency' (4.37, 2.30); 'Collaboration and teamwork' (4.19, 2.65); 'Valuing athlete wellbeing' (4.17, 2.77). The 12 clusters were grouped into five overarching domains: Domain one-Performance health culture; Domain two-Integrated strategy; Domain three-Operational effectiveness; Domain four-Skilled people; Domain five-Leadership.

CONCLUSION

A diverse sample of key stakeholders from Australia's HPSS identified five overarching domains that contribute to athlete performance health. The themes that need to be addressed in a strategy to achieve athlete performance health in Australia's HPSS are 'Leadership', 'Skilled people', 'Performance health culture', 'Operational effectiveness', and 'Integrated strategy'.

A conceptual analysis of maltreatment in sports: A sport social work perspective

Maltreatment in sports is an epidemic and occurs in many relational forms such as physical, sexual, and emotional abuse or neglect. Maltreatment in sports also exists in forms of non-relational abuse and focuses on mezzo and macro forms of maltreatment such as systematic abuse, organizational abuse, and physiological abuse or neglect (e.g., exploitation and athlete trafficking). It is imperative to study the effects of maltreatment in sports as athletes can be the victims (survivors) as well as perpetrators of abuse. Recent research in the field of social work points to the benefits of Trauma-Informed Sports and Short Focused Brief Therapy (SFBT) as possible interventions. It is imperative for transferability in the field of maltreatment in sports, that practitioners define each form of abuse in the context of maltreatment and trauma. This commentary aims to discuss the different forms of maltreatment in sports that could affect athletes and provide discussion and insights into the void of research surrounding certain forms of non-relational abuse and the role trauma-informed therapies serve in promoting athlete wellbeing from a social work lens.

Sexual Harassment and Abuse among Young Elite Athletes, Recreational Athletes, and Reference Students: A Prospective Study

PURPOSE

This study aimed to examine the 12-month prevalence and 12-month prospective change in reported sexual harassment and abuse (SHA) victimization among young elite athletes, recreational athletes, and reference students in three different social settings and to identify the perpetrators.

METHODS

In total, 919 adolescents responded to an online questionnaire in 12th grade (T1) and 13th grade (T2). The sample consisted of elite athletes ( n = 482) and recreational athletes ( n = 233) attending Norwegian elite sport high schools ( n = 26), and reference students ( n = 200) attending ordinary high schools with no sport specialization ( n = 6). Data were analyzed using independent-sample t -test, Pearson χ 2 for independence/Fisher's exact test, McNemar test, and logistic regression analysis.

RESULTS

The total 12-month prevalence of SHA was 38.6% at T1 and 35.1% at T2. Most of the participants (74.6%-85.0%) reported no change in SHA from T1 to T2. The prevalence of SHA was higher for girls compared with boys, and elite athletes reported less SHA than recreational athletes and reference students, respectively. SHA occurred most often in a free time setting. Verbal sexual harassment, nonverbal sexual harassment, and physical SHA were reported by 24.6%, 27.0%, and 14.0%, respectively. Peers were reported as perpetrators by 83.1%, trainer/teacher/health personnel by 20.1%, and "other" perpetrators by 56.4%.

CONCLUSIONS

Because one in three elite athletes and nearly one in two recreational athletes and reference students, respectively, reported SHA victimization within a 12-month period, well-targeted preventive measures are needed for both young athletes and nonathletes.

Gender-specific psychosocial stressors influencing mental health among women elite and semielite athletes: a narrative review

Elite and semielite athletes commonly experience mental health concerns and disorders. Compared with men athletes, women athletes are at greater risk of a range of psychological stressors that contribute to health concerns and mental health disorders, which can impact their career satisfaction and longevity. In order to address and improve the mental health of women athletes, it is necessary to simultaneously tackle the gender specific psychosocial stressors that contribute to mental health outcomes. This narrative review examines the gender-specific stressors that affect mental health and well-being in women athletes, some of which are modifiable. Psychosocial stressors identified include exposure to violence, be it psychological, physical or sexual in nature, which can result in a myriad of acute and long-lasting symptoms; and inequities as reflected in pay disparities, under-representation in the media, fewer opportunities in leadership positions and implications associated with family planning and motherhood. Strategies to promote mental health in women athletes should be considered, and where possible, should proactively address gender-specific stressors likely to influence mental health in order to maximise positive outcomes in women athletes.

Parasport: Effects on Musculoskeletal Function and Injury Patterns

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Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation.

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Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity.

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Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment.

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Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.

Examining Pride Cups as a health promotion resource to address homophobia in Australian men's sport

Effective interventions are needed to stop homophobic behaviours in sport settings as these behaviours are associated with negative health and social outcomes for individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer or other diverse genders and sexualities. This paper reports the results of a quasi-experimental study commissioned by a public health agency to explore the benefits of a novel intervention that has been widely adopted by Australian community sport clubs. The 'Pride Cup' intervention includes education for club leaders, sport participants and the hosting of a rainbow-themed 'pride game'. Survey responses of male participants from six randomly selected sport clubs which had received the intervention (n = 148) were compared to responses (n = 137) from six randomly selected comparison clubs (Australian Football, cricket, field hockey, roller derby). Employing a post-test-only design, the study explored differences in homophobic attitudes, behaviours and individual efficacy to react negatively to homophobic behaviours. The study found significant differences (p < 0.001) in self-reported use of homophobic slurs (e.g. fag) in the last 2 weeks by participants in the treatment (11%) versus comparison (31.8%) clubs, and significant differences in the perceived use of these slurs by teammates (25.9% vs. 56.6%) or coaches (7.8% vs. 23.3%). There were also significant differences in efficacy scores, but no differences in homophobic attitudes. These results, combined with evidence of community-driven adoption, support the allocation of public health resources to conduct larger scale trials using pre/post designs to confirm these findings.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

'Knowing we have these rights does not always mean we feel free to use them': athletes' perceptions of their human rights in sport

Objectives

Modern sport safeguarding strategies include published global rights declarations that enshrine athletes' entitlements at the policy level. It is unclear how these documents translate to athletes' lived experiences. The study aimed to determine athletes' knowledge, attitudes and beliefs about their human rights in sports settings.

Setting

Web-based survey.

Participants

1159 athletes from 70 countries completed a validated web-based survey. Over half of participants (60.1%) were between 18 and 29 years, currently competing (67.1%), not members of players' unions (54.6%), elite (60.0%) and participating in individual (55.8%) non-contact (75.6%) Olympic (77.9%) sports. Gender distribution was equal.

Primary and secondary outcome measures

Participant demographics (eg, gender, age) and athletes' knowledge, attitudes and beliefs about their human rights in sports settings.

Results

Most (78.5%) were unaware of any athletes' rights declarations. Gender influenced participants' confidence in acting on their rights in sport significantly. Males were more likely to accept pressure from coaches and teammates than females, but age affected how likely males were to accept this pressure. Paralympic athletes were less likely to agree that violence is acceptable in sports, compared with Olympic. Player union membership increased confidence in freely expressing one's opinion in sports settings. Athletes' rights-related awareness, knowledge and beliefs were disconnected.

Conclusions

Awareness raising is not enough to prevent human rights violations in sports. The cultural climate of the entire ecosystem must be targeted, using systems-level strategies to shift stakeholders' biases, beliefs and behaviours. This approach takes the onus of addressing abuse off athletes' shoulders and places accountability on sports organisations.

Child Sexual Abuse of Elite Athletes: Prevalence, Perceptions, and Mental Health

Despite a series of high-profile media reports of sexual abuse in sport over the past few years, little research has been done to explore the scope of the problem in the United States. The current article reports on prevalence of child sexual assault in elite athletes in the United States. Using a retrospective web survey, adults answered questions on their experiences in sport. Of the 473 elite athletes surveyed, 3.8% (n = 18) reported being sexual assaulted as a minor in the sporting context. Of those reporting assault, most (61%) reported being abused by an adult authority figure (usually a coach) and 44% reported being assaulted by a peer. Abused athletes were significantly more likely to report having been diagnosed with a mental disorder (Fisher's exact test; p < .001). The findings can be utilized to improve prevention and child protection measures and other safeguarding initiatives in sport.

Preventing sexual violence in sport: Determinants of positive coach-bystander behavior

Given their central role and position, coaches are instrumental in creating safe sport environments, especially in preventing sexual violence, but little is known about bystander behaviors, hampering the development of effective bystander programs in the context of sport. To identify determining characteristics of bystander behavior, 1,442 Belgian youth sport coaches completed an online questionnaire on bystander-related attitudes, norms, autonomy beliefs, and self-efficacy using two hypothetical scenarios of sexual violence in the sports club. Data were analyzed using confidence interval-based estimation of relevance (CIBER). A total of 127 coaches had witnessed sexual violence over the past year, most but not all intervened. Experiential attitude expectation, instrumental attitude evaluation, perceived referent behavior and approval, and subskill presence were positively associated with coaches' intention to intervene. Of the determinants of positive coach-bystander behavior, attitude and perceived norms proved key constituents for programs addressing sexual violence in youth sport. We conclude that interventions aiming at increasing positive affective consequences, reinforcing the sense of group membership, and strengthening the social norm of intervening in case of signs of sexual violence may be most influential to stimulate positive coach-bystander behavior.

The Role of Theory in the Prevention of Sexual Violence in Sport

Sexual violence (SV) remains at epidemic proportions in the U.S. and growing evidence demonstrates that youth and adults engaged in sport are at increased risk of victimization and perpetration of SV. Unfortunately, sport SV prevention strategies are rarely built on theory or theoretically grounded evidence, despite demonstrated effectiveness of such approaches. This study aimed to answer to questions: 1) Which theories are relevant to the development of effective SV prevention strategies in sport?; and 2) How has theory been incorporated into existing SV prevention literature on sport safety? A scoping review of the literature plus expert input identified 29 theories pertinent to SV prevention in sport. A systemized review of the literature regarding SV prevention in sport resulted in the identification and characterization of 41 published articles. Authors then examined theory's role in prevention literature. This study identified 29 theories pertinent to SV prevention in sports and applicable across the behavioral spectrum. Most theories were rooted in the Behavioral (41%), Situational (24%) or Social/Attitudinal (21%) areas. Less common were theories grounded in Feminist (14%) domains. Theories were predominantly focused at the individual (42%), organizational (29%), and interpersonal (18%) ecological levels. Of the 41 sport prevention articles, 33 (83%) referred to a theory either explicitly or implicitly. Though most theories have been incorporated into prevention efforts, closer examination indicates that the majority were descriptive, unlikely to use a sophisticated methodology (10%; e.g., experimental, quasi-experimental), and rarely intended to assess a specific prevention program/strategy or policy (21%). Strong theoretical foundations are available for SV prevention research focused on sports, and their application appears to show value across the developmental spectrum of athletes. There remains a need for greater focus on theory-driven research intended to develop prevention strategies and policies designed to enhance athlete safety.

Responding to Violence Against Women in Sport: Challenges Facing Sport Organizations in Victoria, Australia

Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

"Can You Deny Her That?" Processes of Governmentality and Socialization of Parents in Elite Women's Gymnastics

Abusive practices in elite women's artistic gymnastics (WAG) have been the focus of discussions about how to eliminate or reduce them. Both coaches and parents have been named as key actors in bringing about change. Our focus is on parents and their ability to safeguard their daughters in WAG. Parents are not independent actors, however, but are part of a larger web consisting of an entanglement of emotions and technologies and rationalities used by staff, other parents, and athletes, bounded by skill development plans and by coaching expertise and authority. This entanglement may limit the ability of parents to bring about change. We draw on a Deleuzian notion of assemblage, Foucauldian concepts of discourse and governmentality and Ahmed's assertion about the entanglement of discourses and emotions to explore how parents are disciplined into accepting dominant discursive practices of sport clubs for elite athletes. The data were drawn from a project called the Parental Awareness Program (PAP) that was designed to make parents aware of practices in competitive WAG that may not be in their child's best interest. Participants were parents of young gymnasts who had been identified as "talented" and who were members of an elite gymnastics club. The data analysis was based on focus group discussions with a total of 22 parents and semi-structured interviews with 8 parents. The results suggested that although parents problematized many practices during PAP, processes of governmentality involving an assemblage of discourses about coaching expertise, families, talent, enjoyment, long term skill development plans and its associated time demands, together ensured parental consent for dominant practices. The data suggested that a reduction of abusive practices lies in part in critical examinations of skill development plans that are presented as regimes of truth and are kept in place by emotions and the authority accorded to coaching expertise. These processes curtail parents in their ability to safeguard what is in the best pedagogical interest of their daughter.

Safeguarding Reimagined: Centering Athletes' Rights and Repositioning Para Sport to Chart a New Path

Objectives

Para sport has much to teach the broader sports world about safeguarding and athlete protections. By centering athletes' human rights and underlining the rights-based philosophical underpinnings of the Paralympic Movement, we outline how sport can be safer to all players, coaches, and other participants.

Methods

We address global Human Rights conventions and their application to Para and non-disabled sport. Safe Sport is positioned as a matter of human rights. The nature of interpersonal violence that human beings experience within and outside sport is discussed. The intersectionality of vulnerable identities (related to gender, sexuality, disability, ethnicity, etc.) is reviewed in some detail.

Results

Rights violations in Para and non-disabled sport illustrate both individual and organizational vulnerabilities. Individual- and organizational-level drivers of abuse, as well as various modes and types of abuse observed in Para sport, are relevant in all sport settings and should be centered in global sport safeguarding work. The rights-based core of Para and similar sports movements, exemplifies this.

Conclusion

From a Para-informed vantage point, we issue a call to action, where interpersonal violence in sport is reduced by leveraging relevant elements of the Paralympic Movement. This call asks all sport participants to reject a purely capitalist approach to sport and follow a Para sport paradigm; which embodies human achievement (including sporting success), reflects human rights and inherent human dignity, and requires a higher standard of behaviour.

Sexual Assault Prevention With Student-Athletes: Exploring Perceptions of the Campus Climate and Awareness of Sexual Assault Policies and Resources

Increasing awareness of school sexual assault policies and resources is a central component of sexual assault prevention. Research suggests that the state of the campus climate impacts an individual's level of awareness, particularly for at-risk groups like student-athletes. The purpose of this study was to examine how macro factors such as participation in sexual assault prevention, perceptions of the institutional response to addressing sexual assault, and perceptions of campus staff (i.e., campus police, athletic staff, and administration) are associated with awareness of sexual assault policies and resources. Student-athletes at five National Collegiate Athletic Association (NCAA) schools participated in a web-based survey to assess their perceptions of the campus climate and awareness of sexual assault policies and resources. The results from an ordinary least squares multiple regression model revealed that past participation in sexual assault prevention, more positive perceptions of the institutional response, and more positive perceptions of campus police and administration were associated with a greater awareness of sexual assault policies and resources while controlling for race, ethnicity, and gender. Perceptions of athletic staff was not significantly related to awareness of policies and resources. These findings demonstrate that delivering consistent messaging and engaging campus staff in sexual assault prevention provides a foundation for building a positive campus climate which, in turn, may reduce campus sexual assault.

SafeSport: Perceptions of Harassment and Abuse From Elite Youth Athletes at the Winter Youth Olympic Games, Lausanne 2020

OBJECTIVE

To analyze the Winter Youth Olympic Games (YOG) 2020 athletes' understanding and perceptions of harassment and abuse in sport and their knowledge of reporting mechanisms.

DESIGN

A cohort study.

SETTING

The Winter YOG2020 in Lausanne, Switzerland.

PARTICIPANTS

Accredited athletes at the YOG2020.

INTERVENTION

An athlete safeguarding educational program was delivered at the YOG2020. Participating athletes were encouraged to answer a survey embedded in the safeguarding educational materials during the YOG.

MAIN OUTCOME MEASURES

Perception of occurrence of harassment and abuse as well as knowledge of the term "safe sport" and reporting mechanisms.

RESULTS

The survey response rate of athletes attending the Safe Sport Booth was 69%. When asked to define Safe Sport, 10% of athletes at the YOG2020 correctly identified a sport environment free from harassment and abuse, 20% identified fair play/antidoping, and 19% safety. When presented with the definition of harassment and abuse, 30.4% expressed surprise, in contrast to 46% in the summer YOG2018. A third (32%) reported that harassment and abuse was either "likely" or "very likely" present in their sport, which was similar to the YOG2018 (34%). The group of athletes not knowing where to go to report harassment and abuse was greater than in the YOG2018 (26% vs 11%). There were no differences in responses between competitive sex (boys' vs girls' events) or type of sport (team vs individual).

CONCLUSIONS

Outcomes of this study, such as the development of youth-friendly terminology and emphasizing mechanisms for reporting of harassment and abuse, should inform the development of safeguarding educational materials for youth athletes.

Extreme weight control behaviors among adolescent athletes: Links with weight-related maltreatment from parents and coaches and sport ethic norms

The use of extreme weight-control behaviors is prevalent among adolescent athletes and may result from individual and sport-specific factors. Weight-related maltreatment from coaches and parents, and conformity to sport ethic norms have recently been linked to the use of extreme weight-control behaviors. This study aims to investigate the role of sport ethic norms and weight-related maltreatment from coaches and parents in the use of extreme weight-control behaviors among adolescent athletes. A sample of 999 French-Canadian athletes aged 14-17 years competing in a variety of sports completed an online survey assessing extreme weight-control behaviors, weight-related maltreatment from coaches and parents, and conformity to sport ethic norms. A total of 16.9% of the adolescent athletes reported having adopted extreme weight-control behaviors during their athletic careers. Extreme weight-control behaviors were significantly more prevalent among girls (19.75% vs 9.7% in boys) and weight-class-sport athletes (44%). In addition, 7.4% of the sample experienced at least one type of weight-related maltreatment by coaches or parents. Sex, weight-related neglect by coaches and parents, and weight-related psychological violence by coaches explained 24.4% of extreme weight-control behaviors variance. Indeed, participants who engaged in extreme weight-control behaviors experienced significantly more violence than the other participants did. In contrast, no differences were observed between people who engaged in extreme weight-control behaviors and those who did not due to conformity to sport ethic norms.

Empowered, Yet Vulnerable: Motives for Sport Participation, Health Correlates, and Experience of Sexual Harassment in Female Combat-Sport Athletes

Background: To explore motives for combat sport participation, weight regulation practices, symptoms of low energy availability (LEA), disordered eating (DE) or eating disorders (ED), and any experiences with sexual harassment (SH) among female combat-sport athletes. Methods: In total, 29 athletes were recruited by social media and in clubs. Participants responded to a questionnaire on health behavior and mental health and completed diet registration and a DXA-scan. Results: Most athletes started combat sports to feel empowered and experienced an inclusive milieu, but the frequency of health issues was high. A total of 21−67% had symptoms of ED, suffered from injuries, had low site-specific BMD, and/or symptoms of LEA. Athletes had insufficient intake of energy and nutrients, and <50% received any dietary information or guidance from their clubs. Most athletes complied with favorable weight-loss strategies; still, >20% used unfavorable methods and rapid weight-loss periods. A total of 70% of the athletes had experienced SH, of which 41% experienced SH within the combat-sport context. Conclusion: Combat sport offers an inclusive milieu, which may increase women’s health and confidence; still, our results indicates a need for actions to safeguard female combat-sport athletes’ mental and physical health, implying a cultural change within the community of combat sport and a need for increased health and nutrition literacy.

From Silence to Speaking Up About Sexual Violence in Greece: Olympic Journeys in a Culture That Neglects Safety

The present study scrutinizes the role of societal culture in cases of sexual violence in Greek sport, as presented in the media after a two times Olympic medalist of Greece fired up the “‘me too’ Movement” in the country. Specifically, data for this study consisted of 36 media articles (14 international in the English language and 22 national in the Greek language), reporting multiple cases of sexual abuse and harassment in Greek sport and were published between January 2021 and January 2022. We drew on the cultural praxis heuristic to explore how the cultural setting operates as an underlying factor in priming athletes for harassment and abuse and in oppressing them into not speaking up. Our thematic analysis of media data revealed two overarching themes, namely, keeping the home intact and failed negotiations with power. Based on these findings, we discuss how subtle manifestations of patriarchy and collectivism perpetuate sexualized violence in Greek sport as they promote a climate of silence, prevent safeguarding, maintain underreporting of sexual violence, and delayed the arrival of the #metoo. We conclude that under the current circumstances, change seems to be a threat to all involved in Greek sport, yet for different reasons. For the coaches, sport officials, stakeholders, state system, change would require them to relinquish male powers and authority, find new meaning of what it means to be and do as a man, and allow women to be seen as counterparts. For the female athletes-survivors, it would require them to prioritize the self and their self-care and let go of the in-group loyalty and subordination learned and exhibited from infancy. We also contend that mere translations of international and regional safeguarding guidelines and toolkits cannot foster awareness raising, nor the implementation of measures within cultural settings that divert from the Global North. If we care to combat the universal phenomenon of sexualized violence in sport, a glocal approach is needed, where local socio-cultural factors are acknowledged, their role is addressed, and violence is understood within its context.

‘Safe Sport Is Not for Everyone’: Equity-Deserving Athletes’ Perspectives of, Experiences and Recommendations for Safe Sport

There is a growing concern that the voices of athletes, and in particular, athletes from equity-deserving groups, are unaccounted for in the development and advancement of Safe Sport initiatives. The lack of consideration of the needs and experiences of diverse groups is concerning, given the existing literature outside the context of sport indicating that equity-deserving individuals experience more violence. As such, the following study sought to understand how equity-deserving athletes interpret and experience Safe Sport. Grounded within an interpretive phenomenological analysis, semi-structured interviews were used to understand how athletes with marginalised identities conceptualise and experience Safe Sport. Seven participants, including two Black male athletes, two White, gay male athletes, one Middle Eastern female athlete, one White, female athlete with a physical disability and one White, non-binary, queer, athlete with a physical disability, were asked to conceptualise and describe their experiences of Safe Sport. The findings revealed these athletes perceived Safe Sport as an unrealistic and unattainable ideal that cannot fully be experienced by those from equity-deserving groups. This interpretation was reinforced by reported experiences of discriminatory comments, discriminatory behaviours and systemic barriers, perpetrated by coaches, teammates, and resulting from structural aspects of sport. The findings draw on the human rights literature to suggest integrating principles of equity, diversity and inclusion are fundamental to safeguarding equity-deserving athletes.

"I Gave Up Football and I Had No Intention of Ever Going Back": Retrospective Experiences of Victims of Bullying in Youth Sport

Bullying is a global issue that, beyond school, is present in different social contexts, such as sport environments. The main objective of this study was to get to know the experiences of victims of bullying in sport throughout their youth sport training. Semi-structured interviews to four Spanish women and seven Spanish men were carried out, within an age range of 17–27 (M_age = 21 years, SD = 3.69). The following main themes were established by means of a hierarchical content analysis: (a) “bullying characterization,” (b) “dealing with bullying,” and (c) “consequences of bullying.” The results show the presence of physical, verbal and social bullying in the sport context, with the changing room being the space where this type of behavior is most frequently developed. Most victims show an internal attribution (self-blame) for the bullying event, related to their motor skills and their personal physical and psychological characteristics. Double victimization can be observed, at the sport club and at the educational center. Passive strategies are used to deal with the situation, while little support is shown by sport agents (teammates and coaches). The victims, as a consequence of the bullying experience, suffer from short and long-term negative effects on a psychosocial level. The study highlights the necessity to design and implement programs focused on the prevention, detection and intervention of bullying for sport organizations, bearing in mind all the agents that make them up (coaches, management teams, families, and players). Furthermore, the importance of promoting the creation of safe sport environments, free from any kind of violence, is emphasized.

From Policy to Practice: Measures Against Sexual Abuse by Swedish Sports Federations

The sport movement must protect children and young athletes from all forms of abuse. However, research points to a disconnect between policy and implementation of policy against sexual abuse. No studies have investigated measures against sexual abuse in Swedish sport. The purpose of this study was to explore measures against sexual abuse in the 10 largest sports federations (SFs) for child and youth sport in Sweden. The study draws on interviews with representatives (n = 18) of the SFs and on a review of SFs' website content regarding sexual abuse and safe sport. Results show that the SFs have taken few or no measures against sexual abuse. Measures for safe sports vary in existence, development, and organization between the SFs, and many SFs are in the early stages of safe sport measures and practice. Although the SF representatives emphasize that sexual abuse is unacceptable, a conflict between making it visible or invisible emerges and creates a gap between policy and practice. Reproducing a culture of silence around sexual abuse in sports seems advantageously for SFs. Social and organizational factors that can debilitate safe sport measures and facilitate sexual abuse in sport are discussed.

Beneath the Surface: Mental Health and Harassment and Abuse of Athletes Participating in the FINA (Aquatics) World Championships, 2019

OBJECTIVE

To assess the mental health and experience of sport-related harassment and abuse of elite aquatic athletes and to analyze it in relation to gender and discipline.

DESIGN

Cross-sectional study using an anonymous survey.

SETTING

The FINA World Championships 2019.

PARTICIPANTS

Registered athletes in the disciplines of swimming, diving, high diving, water polo, artistic swimming, and open water swimming.

INTERVENTIONS

Athletes completed an online or paper-based questionnaire.

MAIN OUTCOME MEASURES

The main outcome measures included screening for depression (10-item version of the Center for Epidemiological Studies Depression Scale revised), eating disorders (Brief Eating Disorders in Athletes Questionnaire), the subjective need for psychotherapeutic support, and the experience of sport-related harassment and/or abuse.

RESULTS

A quarter (24.6%) of the 377 responding athletes were classified as depressed and 2.5% as having an eating disorder. More than 40% of the athletes stated that they wanted or needed psychotherapeutic support. Fifty-one athletes (14.9%) had experienced harassment/abuse in sport themselves, and 31 (9%) had witnessed it in another athlete. The experiences of harassment and abuse ranged from unwanted comments about body or appearance (40.2%) to rewards in sport for sexual favors (2.5%) and rape (0.3%). Athletes who had experienced harassment/abuse in sport themselves had higher average scores for depression and eating disorders, and more of them felt they needed psychotherapeutic support. Up to a third would not talk or report to anybody if they saw or experienced harassment/abuse, and less than 20% would talk to an official for help.

CONCLUSION

Targeted initiatives are required to address mental health issues and harassment and abuse in sport in the FINA aquatic disciplines.

Effective engagement of survivors of harassment and abuse in sport in athlete safeguarding initiatives: a review and a conceptual framework

Sport, as a microcosm of society, is not immune to the abuse of its stakeholders. Attention to abuse in sport has recently become a priority for sport organisations following several high-profile cases of athlete abuse from different sports around the world. Resulting from this increased awareness, many sport organisations have commenced work in the field of athlete safeguarding including the development of policy, educational programmes, reporting pathways, investigation mechanisms and research initiatives. One mechanism adopted by many sport organisations to support their safeguarding efforts is the engagement of survivors of abuse in sport: typically, as guest speakers at conferences or educational events. Unfortunately, many sport organisations do not have the knowledge or trauma-informed expertise to engage survivors safely and effectively; and in doing so, may unintentionally retraumatise the survivor if erroneous methods of engagement are employed. For some survivors, this experience may compound the original harms, and thus it also represents an area of vulnerability for the organising entity. The purpose of this paper is to explore the rationale for partnering with survivors of abuse in sport in safeguarding initiatives and to propose a living conceptual framework to support effective and safe survivor engagement in safeguarding initiatives. We will explore the underpinning scientific background, as well as the 'why', and 'how' of survivor engagement to inform sport organisations, research scientists, policy-makers, conference organisers, safeguarding officers, sport medicine clinicians and survivors themselves.

Optimizing Health and Athletic Performance for Women

PURPOSE OF REVIEW

The exponential growth of women participating in competitive sports throughout the years was made possible through several initiatives by the International Olympic Committee and the passage and implementation of Title IX as a federal law in the United States. However, this positive trend towards gender equity in sports has not transpired for women in medicine, especially in fields that care for elite athletes. This current review will discuss specific areas that can be tailored to help female athletes prevent injuries and optimize their athletic performance. We will also highlight how increased female team physician representation in sports may help optimize care for female athletes.

RECENT FINDINGS

Female athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.

Youth Athletes' Perception of Existence and Prevalence of Aggression and Interpersonal Violence and Their Forms in Serbia

Aggression and interpersonal violence (IV) against children and youth are issues in contemporary society. The current study reports on the youth athletes' perception of the aggression and IV prevalence and its manifestation forms in a Serbian context. The sample included athletes (N = 2091) between the age of 11 and 18 years. Data were collected through an ad-hoc questionnaire created by the authors. Respondents' answers to introductory questions about the frequency of IV indicated its absence (78.1%). However, the answers to the questions about specific forms of violent peer behavior indicated forms as well as the time and place where IV most often occurs. They underlined that IV takes place mainly after training or competition and during sports camps; and that the dressing room is the most favorable place for these behaviors. They also confirmed that the most prevalent subtypes of IV are psychological (roughly 40%) and physical (approximately 30%). The respondents' opinions and experiences about IV (psychological, physical, sexual) revealed that factors such as gender, location, and parents' education level may influence the IV manifestation. Highlighting the prevalence and the most frequently manifesting types of aggression and IV could help in awareness-raising of these social issues.

Para athletes' perceptions of abuse: a qualitative study across three lower resourced countries

OBJECTIVES

Interpersonal violence is an increasingly recognised risk of sport participation and causally linked to negative physical and mental health outcomes. Para athletes from low- and middle-income countries may be at highest risk of physical, psychological, sexual and neglect-related violence due to various factors; however, their perceptions of these abusive behaviours are unknown. This study examined the perceptions and experiences of abuse in para athletes from three lower resourced countries: Ghana, India and Brazil.

METHODS

Qualitative data from semistructured focus group interviews conducted with 26 individuals were collected to explore characteristics of abuse observed, navigated and experienced by para athletes. The framework method for multidisciplinary qualitative research guided data analysis.

RESULTS

Athletes identified a wide range of abusive behaviours they experienced within and outside of sport, including psychological, emotional, physical, sexual and neglect-related violence, which operated on both interpersonal and systemic levels. Most athletes described three less easily recognised forms of abuse in greater detail and more frequently than others: financial abuse, neglect and disability stigma.

CONCLUSION

It is important to hear directly from athletes with diverse experiences and backgrounds and to integrate their insights and priorities into sport safeguarding policies, programmes and interventions. Understanding the requirements and challenges of para athletes and para sport is needed to achieve safe, equitable and inclusive sport. As new insights from diverse sport settings are added to the evidence base, globally balanced, athlete-generated and locally relevant preventative strategies can better protect all athletes.

A survey of elite and pre-elite athletes' perceptions of key support, lifestyle and performance factors

Background

Success at the elite level in sport is often attributed to physical prowess, technical skill, and mental attitude. However, underpinning these factors are various lifestyle, support and social factors that may contribute to successful performance, but which may be absent from athlete development programs.

Methods

An online survey was used to investigate athlete perceptions of lifestyle practices and support services amongst 135 Australian Olympic, Paralympic, National, and state-level athletes across 25 Olympic sports.

Results

International athletes perceived psychological skills and attributes, along with strong interpersonal relationships as vital to their success, and they also rated ‘Recovery practices’ as very important and made extensive use of available support services. These athletes also indicated that they would have liked access to these services earlier in their careers, a wish that was reiterated by the sub-elite athletes. Furthermore, athletes wanted greater knowledge, mentoring, and autonomy earlier in their careers, and the importance of ‘athlete wellbeing’ as well as ‘athletic performance’ was evident in a number of contexts.

Conclusions

An athlete development system into which these are included may assist in generating an environment that facilitates athlete success, repeated podium performances, retain athletes in high-performance sport for longer, encourage human-flourishing, wellbeing and smooth transitions for retiring athletes.

Mental Health Symptoms of Amateur Association Football Referees: A Cross-Sectional Study

Although referees who officiate in the amateur football leagues are exposed to various stressors that can negatively affect their mental health (MH), little is known about their MH symptoms. The purpose of the study was to evaluate MH symptoms of referees who officiate in the Turkish amateur football leagues. An online survey was sent to all referees in the Turkish amateur football leagues (n = 4,900) incorporating standardized scales assessing depression, anxiety, and stress. A total of 1,279 referees participated in the study. Female referees reported higher depression (p < .01) and anxiety (p = .02) scores than males. Younger referees (23–27 years) reported higher depression (p = .01) and anxiety (p < .01) scores than older (>38 years) referees. Results showed that symptoms of depression, anxiety, and stress scores were associated with marital status (being single), lower incomes, severe sports injury history, and inadequate social support. In light of these results, MH assessments should be undertaken to detect which referees are at greater risk of MH problems and facilitate appropriate and timely MH interventions. Further study is needed to inform MH risk reduction strategies and/or programming.

Violence and Abuse in Competitive Sports

Violence and abuse in competitive sports, such as physical and emotional abuse, physical and emotional neglect and sexual abuse, affect children, adolescents and adults alike and lead to severe physical, psychological and social consequences. In current medical and educational care concepts of athletes, there is a lack of consistent integration of sports/psychiatric, clinical psychological and psychotherapeutic, developmental pediatric and developmental psychological expertise. Problem areas arise from fine lines between harassment, non-physical and physical violence. The present position paper includes recommendations for the development of a concept for the protection of mental health in competitive sports and for coping with mental stress and psychological disorders by qualified medical experts in mental health, i.e., child, adolescent and adult psychiatrists with specific expertise in competitive sports: sports psychiatrists. According to the recommendations, experts should also have and further develop competence in other fields, especially in ethics, child protection, protection against violence and abuse in competitive sports, awareness of and dealing with transgression of boundaries, knowledge about child development, and transparency in training structures and relationships.

[Violence and Abuse in Competitive Sports]

Violence and Abuse in Competitive Sports Abstract. Violence and abuse in competitive sports, such as physical and emotional abuse, physical and emotional neglect and sexual abuse, affect children, adolescents and adults alike and lead to severe physical, psychological and social consequences. In current medical and educational care concepts of athletes, there is a lack of consistent integration of sports/psychiatric, clinical psychological and psychotherapeutic, developmental pediatric and developmental psychological expertise. Problem areas arise from fine lines between harassment, non-physical and physical violence. The present position paper includes recommendations for the development of a concept for the protection of mental health in competitive sports and for coping with mental stress and psychological disorders by qualified medical experts in mental health, i.e., child, adolescent and adult psychiatrists with specific expertise in competitive sports: sports psychiatrists. According to the recommendations, experts should also have and further develop competence in other fields, especially in ethics, child protection, protection against violence and abuse in competitive sports, awareness of and dealing with transgression of boundaries, knowledge about child development, and transparency in training structures and relationships.

The Three-Level Curriculum Sports Psychiatry and an Evaluation of the First Course "Basic Health Care in Sports Psychiatry"

Due to scientific progress and diversification in medicine and psychiatry, there is a need for specialization in sports psychiatry. Therefore, the SSSPP has been developing a curriculum on sports psychiatry. Different backgrounds and approaches within the above-mentioned areas are presented here since they have influenced the development of the three-level curriculum. The structure of the three-level curriculum, which contains theory, practical experience, and supervision, encompassing 80 hours of additional training, will also be explained. Within this curriculum, basic knowledge in sports medicine, sports psychology, sports science, and applied sports theory will also be taught. Other subjects include sports and exercise on mental disorders, mental disorders in competitive sports, sports as a coping strategy, and other contents. Moreover, different contents and key topics of the curriculum's three levels will be presented.

The Mental Health of Athletes: Recreational to Elite

ABSTRACT

Athletes at all levels of competition are susceptible to mental health symptoms and disorders, and this has been a topic of increased research attention in recent years. The most common such conditions will be highlighted in this article, with a clinical focus on unique aspects of presentation, diagnosis, and management among athletes. Conditions addressed include depression, anxiety and related disorders, eating disorders, sleep concerns, attention-deficit/hyperactivity disorder, bipolar and psychotic disorders, and substance use disorders and behavioral addictions. Athletes experience particular physiologic and psychosocial demands that impact how they present symptomatically and how treatment modalities, including psychotherapy and pharmacologic treatments, impact them.

Athlete Preparticipation Physical Evaluation

Preparticipation evaluations (PPE) are both a traditional and legal requirement by many governing bodies for sport. The ideal goal of the PPE is safe participation in sport for athletes. This article provides an overview of common PPE elements and current best practice recommendations. Descriptions of every possible examination are published elsewhere and are beyond the intent of this article. Additional considerations for transgender, masters athletes, and Special Olympians are also outside the scope of this review, but are well covered in The Preparticipation Physical Evaluation, fifth edition monograph.

Development and validation of the athletes' rights survey

A recognised imbalance of power exists between athletes and sporting institutions. Recent cases of systemic athlete abuse demonstrate the relationship between power disparities and harassment and abuse in sport. Embedding human rights principles into sporting institutions is a critical step towards preventing harassment and abuse in sport. In 2017, the World Players Association (WPA) launched the Universal Declaration of Player Rights. A year later, the International Olympic Committee (IOC) developed their Athletes’ Rights and Responsibilities Declaration. These two documents codify benchmarks ‘for international sporting organisations to meet their obligations to protect, respect and guarantee the fundamental rights of players’. This paper is the first project exploring athletes’ knowledge, understanding and awareness of rights in the sports context. This study presents the development and validation of a survey investigating athletes’ knowledge of these declarations, associated attitudes/beliefs and understanding of how these rights can be enacted in practice. The survey includes 10 statements of athlete rights based on the WPA and IOC declarations. Face validation was assessed by distributing the survey to 10 athletes and conducting qualitative interviews with a subgroup of four athletes. The survey was reworked into 13 statements, and the tool was validated with 611 responses through confirmatory factor analysis. Key findings include a weak correlation between athletes’ knowledge and their attitudes/beliefs, and challenges with the interpretation of words such as ‘pressure,’ ‘violence,’ ‘harassment’ and ‘intimidation.’ This validation puts forward the first survey instrument to directly test athletes’ knowledge, attitudes and beliefs about rights in sport.

Search for Spiritual Assistance in Religious Organizations: What Are the Motives of Persons Who Have Experienced Destructive Relationships at Work?

Religious assistance is an effective tool in helping the victims of violence, but so far, it has not been investigated that what promotes the persons aggrieved in the workplace to seek such assistance. Therefore, this study aimed to identify the motives of persons who have experienced destructive relationships, which inspire the search for spiritual assistance in religious organizations, seeking to develop the provision of such service. After the analysis of the scientific literature, a questionnaire “Motives of Persons Aggrieved at Work for Seeking Spiritual Assistance (MP-SSA-40)” was developed and validated. In this study, a survey was conducted on 463 persons working in Lithuanian organizations using the questionnaire survey method. The correlation and regression analyses were performed. The study has shown that the religiosity of the victim is not the only condition for seeking spiritual assistance. Significant factors are the congruence of values borne by the person and the religious organization, the motives arising from the relation with the person providing assistance, and the motives determined by circumstances that create an important contextual background. The established trends show that by solving work-related problems and problems of interpersonal relationships of assistance providers, obstacles hindering the implementation of intrinsic motives of the victim to apply for spiritual assistance to the religious organization, providing it can be removed. The value of the article is demonstrated by the fact that it fills the existing gaps of knowledge about the motives of victims of destructive relationships at work, seeking religious spiritual assistance. In addition, a new and reliable instrument to measure such motives is proposed.