Addressing mental health through sport: a review of sporting organizations' websites

Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project

BACKGROUND

Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions.

OBJECTIVE

The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program.

METHODS

A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence.

RESULTS

Participant recruitment will commence in September 2023. The full project will be completed by March 2027.

CONCLUSIONS

With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49670.

The Effectiveness of Online Mental Health First Aid Training in Community Rugby: A Mixed-Methods Approach

Mental Health First Aid (MHFA) training exists to improve supportive behaviours towards peers, increase mental health literacy, and reduce stigma. Community sport clubs have potential to successfully deliver mental health programs. This study investigated the effectiveness of online MHFA training undertaken by members of the rugby community and evaluated the feasibility and usefulness of the online delivery mode and users' engagement with it. A mixed-methods approach was used to provide depth of understanding through qualitative analysis, combined with quantitative outcomes. Online surveys examining participants' knowledge and perceptions were administered pre- and post-MHFA training. Significant improvements (p < 0.05) across all assessed domains were observed post- compared to pre-MHFA training. A large effect size was identified in relation to advice giving and sign and symptom identification. A moderate effect size pre- to post-improvement was identified for users' perceptions of therapy's effectiveness, the ability of people with severe mental health conditions to recover, and benefit of a healthcare professional. Participants endorsed the MHFA program to improve mental health literacy, advance non-technical skills, and improve confidence. MHFA training can increase the awareness and knowledge of mental health issues in key individuals in community sport clubs and enable them to aid people with mental health concerns. Online MHFA training is associated with improved mental health literacy and may be a suitable and economically sustainable model for community sport.

Mental health promotion in youth sporting clubs: predictors of stakeholder participation

BACKGROUND

Young people are disproportionately affected by poor mental health. Youth sport settings hold immense potential to improve the mental health outcomes of this demographic. Efforts to leverage youth sport settings to promote mental health are limited by the lack of knowledge pertaining to engagement with mental health interventions in these settings. Therefore, this study aimed to examine the willingness of youth sporting club stakeholders (e.g., sportspersons, coaches, support staff, parents/guardians) to engage in mental health initiatives conducted by sporting clubs and ascertain possible determinants of engagement.

METHODS

This study used an observational cross-sectional design. Participants completed an online survey assessing likelihood of supporting a mental health campaign, mental health literacy (help-seeking, inclusive attitudes), and perceived club support. Perceptions pertaining to the importance of youth mental health and sporting clubs supporting youth mental health were also assessed.

RESULTS

The survey was completed by 275 stakeholders of youth sporting clubs in Australia (Mage = 40.2 ± 15.8 years, 60.3% female). The findings indicated that stakeholders were willing to participate in mental health initiatives in youth sport clubs. A linear regression analysis indicated that the significant predictors of stakeholders supporting such initiatives were older age (> 25-50 and > 50 years; β = 0.15, p = .033, β = 0.19, p = .005, respectively), along with perceived importance of youth mental health (β = 0.24, p = .003) and sporting clubs supporting youth mental health (β = 0.22, p = .004).

CONCLUSION

Youth sport settings have the capacity to improve the provision of mental health support among young people. There is a need for tailored approaches to enhance the engagement with, and effectiveness of, mental health resources in sport contexts.

Protocol for national mental health guidelines for community sport in Australia

Organised sports are the most common settings for sports participation. Despite a range of documented benefits from participation, these positive outcomes are not always guaranteed. Emotional distress from pressure and injuries can mean some participants experience negative outcomes. To ensure organised sports are well equipped to promote the mental health of their members, evidence-based guidelines for them are required. Using a Community-Based Participatory Research framework, mental health guidelines for community sport will be developed. In Phase One, community sport stakeholders will participate in focus groups. The aim is to understand their preferences of the content, purpose and scope of the guidelines. In Phase Two, an e-Delphi study will be conducted with experts in mental health and sport in Australia to gather recommendations on the purpose and scope of the guidelines. In Phase Three, a national consensus meeting with an Expert Guideline Development Committee will be held to draft the guidelines. In Phase Four, follow-up focus groups will be held with community sport stakeholders to understand the usability and acceptability of the draft guidelines. In Phase Five, a second e-Delphi study will be conducted to provide feedback on the revised guidelines after community stakeholder review. In Phase Six, implementation case studies will assess the implementation of the guidelines in community sport clubs. These mental health guidelines will answer an urgent call for action by experts. The guidelines will be based on sector needs and preferences, be acceptable and useable, and be able to be implemented by community sport clubs globally by 2025.

A Systems Theory of Mental Health in Recreational Sport

The focus on mental health outcomes in sport, including the ways in which mental health can be protected and promoted, has become a major international priority for all sports, including the recreational sports system. The aim of this paper is to outline a systems theory of mental health care and promotion that is specific to needs of the recreational sport system so that context-specific, effective policies, interventions, and models of care can be articulated and tested. Based on general systems theory, we offer a preliminary theory and accompanying postulates that outline the general principles that explain mental health in recreational sports. Namely: one of the purposes of the recreational sport system is to protect and promote the mental health of all involved; the recreational sport system is comprised of components (individuals, groups, organisations, communities, society); the role and function of those components vary by context; the purpose of the system is achieved through coordinated and reciprocal relationships between its components; and, the system should be regulated from within to ensure that mental health is protected and promoted. We have also outlined the ways in which the subcomponents of the system interact, their potential influence on mental health in recreational sports, and the ways in which they may be regulated. This information provides a theoretical foundation upon which research, programming, and policy can be based to protect and promote the mental health of all involved in recreational sports.

A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours

AIM

The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours.

METHODS

A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations.

RESULTS

One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion.

CONCLUSIONS

Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.

Profiles of mental health help seeking among Australian adolescent males

INTRODUCTION

Adolescent males are at increased risk of mental illness and are reluctant to engage in treatment. This study aims to identify subgroups of help-seeking intentions among a sample of Australian male adolescents.

METHODS

A sample of 1038 male adolescent sport participants in Australia (age M = 14.69 years, SD = 1.35) reported help-seeking intentions from ten sources and from 'no one'. Latent profile analysis was conducted based on these 11 items. Identified profiles were then compared across mental health measures.

RESULTS

Four latent profiles were identified: Low general help-seekers (10.5%), Moderate general help-seekers (46.8%), High general help-seekers (25.5%), High family and friends help-seekers (17.2%). Low, Moderate, and High general help-seekers had uniformly low, moderate, and high intentions to seek help from all sources, respectively. High family and friends help-seekers reported high endorsement of intentions to seek help from intimate partners, friends, parents, and other relatives, but low intentions for other sources. Low general help-seekers had lower intentions to seek help from parents compared to all other profiles. They also had significantly lower perceived family support and higher psychological distress.

CONCLUSIONS

Low general help-seekers were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Their distinct profile offers potential to identify this high-risk group through the use of ratings on the parent help-seeking intentions item. Further research should investigate the predictive utility of this item on help-seeking and mental health, and should consider the influence of masculinity and previous experiences of help-seeking.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.

Tackling Mental Health in Youth Sporting Programs: A Pilot Study of a Holistic Program

Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys' anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys' access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys.

An Intervention for Mental Health Literacy and Resilience in Organized Sports

PURPOSE

In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants.

METHODS

The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes' psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mean differences on the primary and secondary outcomes were analyzed using linear mixed models, adjusted for clustering at club level, participant age, and socioeconomic status.

RESULTS

Significant positive group-time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group-time interaction for the secondary outcome of well-being. There were no group-time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress.

CONCLUSIONS

Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.

Determining the role of sport coaches in promoting athlete mental health: a narrative review and Delphi approach

Background

Coaches have the potential to support athlete mental wellness, but many are unsure what to do and concerned they may unintentionally engage in behaviours that negatively impact their athletes. Education has the potential to help coaches engage in primary, secondary and tertiary preventive behaviours related to athlete mental health; however, there exists no empirical or consensus basis for specifying the target behaviours that should be included in such education.

Objective

The aim of this research was to review extant literature about the role of sport coaches in mental health prevention and promotion, and obtain expert consensus about useful, appropriate and feasible coach behaviours.

Design

Modified Delphi methodology with exploration (ie, narrative review) and evaluation phase.

Data sources

Twenty-one articles from PubMed, PsycINFO and ProQuest, and grey literature published by prominent sport organisations.

Eligibility criteria for selecting studies

All studies were English-language articles that focused on the role of coaches as they relate to (1) culture setting in sport, (2) addressing athlete mental health and (3) providing ongoing support to athletes with mental health concerns. No study design, publication date limits or sport characteristics were applied.

Results

The coach's role should include fostering team cultures that support athlete mental health, encouraging care-seeking and supporting athletes currently receiving mental healthcare.

Summary/Conclusion

The behaviours specified herein have implications for coach education programme development. This study is the first to use a structured Delphi process to develop specific recommendations about the role coaches can play in supporting athlete mental health.

Addressing mental health in elite athletes as a vehicle for early detection and intervention in the general community

Recent scientific literature in addition to increased media attention has highlighted the important role of mental health in elite athletes. Often defined by terms such as "mental toughness", athletes are now becoming more open to discussing the role of anxiety, depression and other psychologically distressing processes that are intertwined with their time both during and after elite sport. In line with this, recent international position statements regarding the mental health of athletes have been released. The current New Hypothesis article follows on from these statements and proposes that further work must be performed to better understand this aspect of elite sport in addition to developing sport-specific interventions for athletes, their families, and support staff. Furthermore, we propose that by better understanding and treating the mental health of elite athletes a follow-on effect may occur, whereby help-seeking in the general community will increase. In particular, young adults who were previously hesitant to seek help may take strength from this shift, maximizing the success of early intervention occurring.

Mental Health and Organized Youth Sport

Mental health is one of the most prominent global burdens of disease among young people, while organized youth sport is one of the most popular activities for children and adolescents worldwide. Organized sport can be an engaging vehicle for the promotion of mental health, but participation also brings several meaningful risks and detriments for young people’s mental health. This paper contains a review of the evidence underpinning the relationships between sport participation and mental health during childhood and adolescence and also outlines the key areas of risk for mental health problems. Relevant theoretical frameworks are discussed, as are the key concepts underpinning 2 exemplar sport-based interventions to promote mental health and reduce the risk of mental health problems. Recommendations for best practice in organized youth sport are not available. However, relevant frameworks are outlined, from which administrators, coaches, and athletes can base the design and delivery of sport programs to be consistent with relevant theoretical and philosophical approaches such as the athlete-centered approach to youth sports.

Health Promotion Interventions in Sports Clubs: Can We Talk About a Setting-Based Approach? A Systematic Mapping Review

Many researchers and authorities have recognized the important role that sports clubs can play in public health. In spite of attempts to create a theoretical framework in the early 2000s, a thorough understanding of sports clubs as a setting for health promotion (HP) is lacking. Despite calls for more effective, sustainable, and theoretically grounded interventions, previous literature reviews have identified no controlled studies assessing HP interventions in sports clubs. This systematic mapping review details how the settings-based approach is applied through HP interventions in sports clubs and highlights facilitators and barriers for sports clubs to become health-promoting settings. In addition, the mapped facilitators and barriers have been used to reformulate previous guidelines of HP in sports clubs. Seven databases were searched for empirical research published between 1986 and 2017. Fifty-eight studies were included, principally coming from Australia and Europe, describing 33 unique interventions, which targeted mostly male participants in team sports. The settings-based approach was not yet applied in sports clubs, as more than half of the interventions implemented in sports club targeted only one level of the socio-ecological model, as well as focused only on study participants rather than the club overall. Based on empirical data, the analysis of facilitators and barriers helped develop revised guidelines for sports clubs to implement settings-based HP. This will be particularly useful when implementing HP initiatives to aid in the development of sports clubs working with a whole setting approach.