Mental health symptom burden in elite ice hockey players and its association with self-reported concussive events

BACKGROUND

Some studies suggest that elite athletes experience adverse mental health symptoms at rates commensurate with the general population, despite the well-established buffering effects of exercise. Within contact sports, such as ice-hockey, recurrent concussions may be a source of this discrepancy. We compared the point prevalence of various mental health outcomes with other athlete and general population samples, as well as investigated their relationship with concussive events.

METHODS

We surveyed 648 active ice hockey players from the top two men's tiers and the top women's tier in Swedish elite ice hockey on lifetime concussive events, hazardous alcohol use, problematic social media use, depression, anxiety, and burnout.

RESULTS

Hazardous alcohol use was more prevalent among male ice hockey players (29.5% AUDIT-C ≥ 6) compared to other athlete and general population samples, while other mental health symptoms were less common. Female ice hockey players reported higher hazardous alcohol consumption (36.4% AUDIT-C ≥ 4) than another athlete sample and more burnout (19.1%) than the general population. After adjusting for covariates, athletes with 3+ concussive events had 2.1 times the odds of elevated depressive symptoms and 3.5 times the odds of elevated burnout symptoms compared to those with no concussion history. Treating lifetime concussive events as a continuous predictor revealed positive correlations with all outcomes except for hazardous alcohol use.

CONCLUSIONS

Mental health outcome rates among active elite ice hockey athletes differ from those of other athlete and general population samples, whilst concussive events may be particularly linked to elevated symptoms of depression and burnout.

Adapting an evidence-supported optimization program for mental health and sport performance in collegiate athletes to fit youth from ethnic/racial minority and low-income neighborhoods: A National Institutes of Health stage model feasibility study

The current study addresses the need to empirically develop effective mental health interventions for youth from ethnic/racial minority and low-income neighborhoods. Using Stage Model evaluation methods supported by the National Institutes of Health in the US to address underutilization of mental healthcare among racial/ethnic minority youth, this feasibility study demonstrates empirical adaptation of an innovative sport-specific psychological intervention for use in youth from ethnic/racial minority and low-income neighborhoods. An international group of professionals familiar with sport performance and mental health intervention serving the target population experientially examined the adapted intervention protocols in workshops and provided feedback. Survey results indicated the professionals found the intervention components were easy to administer and likely to be safe, enjoyable, engaging and efficacious for youth mental health and sport performance. The protocols were revised based on feedback from these professionals and the intervention was examined in a case trial involving an Asian American youth who evidenced Social Anxiety Disorder. Case study results indicated the intervention could be implemented with integrity, and severity of psychiatric symptoms and factors interfering with sport performance decreased after intervention implementation. The participant's relationships with family, coaches and teammates were also improved.

The Efficacy of a Resilience Intervention Among Diverse, At-Risk, College Athletes: A Mixed-Methods Study

BACKGROUND: Adverse childhood experiences (ACEs) have been associated with psychological and physiological disease, and risky health behaviors. A person's ability to be resilient may protect them from these negative health outcomes, as resilience has been associated with increased emotional awareness, coping, belonging, and greater likelihood of good health and well-being. AIMS: The purpose of this pilot study was to assess the efficacy of a strengths-based resilience intervention to improve access to internal and external resources that effect perceptions of stress, resilience, emotional awareness, and belonging among student-athletes. METHODS: A mixed-methods design was used to examine variables of interest between intervention and control groups. A sample of 56 college athletes completed surveys and engaged in expressive writing during a 5-week resilience intervention. RESULTS: Self-report data indicated that student-athletes in the intervention group improved decision making, lowered perceived stress, and increased resilience compared with controls. Of note, participants with ACEs showed greater increments of positive change in emotional awareness scales than participants without ACEs. Descriptions of emotion management, authentic connections, and increased ability to request support from others were identified in the qualitative data. CONCLUSIONS: A strengths-based course designed to increase resilience-offered as academic and athletic stress is mounting-provided a unique opportunity to promote student-athlete success. Participants gained skills key to victory on and off the field, including health-promoting behaviors, a sense of belonging, persistence, and the ability to negotiate external resources.

Empirical Development of a Screening Method to Assist Mental Health Referrals in Collegiate Athletes

The conspicuous absence of validated screening measures specific to mental health symptomology in collegiate athletes has negatively affected clinical practice in this population. Therefore, this study was performed to develop a sport specific measure to optimally identify collegiate athletes who are particularly likely to benefit from mental health programming. Participants were 289 collegiate-athletes who were assessed for mental health symptomology using the Global Severity Index of Symptom Checklist-90-Revised (GSI), factors that interfere with sport performance using the Problems in Sport Competition Scale (PSCS) and Problems in Sport Training Scale (PSTS), and motivation to pursue professional counseling using the Desire to Pursue Sport Psychology Scale (DSPS). As hypothesized, a hierarchical multiple regression analysis indicated that PSCS, PSTS and DSPS scores significantly predicted GSI scores, controlling gender and sport status (NCAA, club, intramural). Receiver operating characteristic (ROC) analysis indicated that high-risk athletes (GSI T-scores ≥ 60) could be correctly classified by PSTS and PSCS scores. Results suggest the PSCS and PSTS may assist identification of collegiate athletes who are especially appropriate for mental health programs. These scales additionally identify factors directly relevant to athletes’ sport performance.

Controlled Evaluation of an Optimization Approach to Mental Health and Sport Performance

Athletes experience unique stressors that have been indicated to compromise their mental wellness and sport performance, yet they underutilize mental health services. Indeed, very few mental health interventions for athletes have been developed to fit sport culture, and well-controlled mental health outcome research in athlete populations is warranted. In this randomized controlled trial, a sport specific optimization approach to concurrent mental health and sport performance (The Optimum Performance Program in Sports; TOPPS) was examined. Seventy-four collegiate athletes (NCAA = 42; club = 11; intramural = 21) formally assessed for mental health diagnostic severity were randomly assigned to TOPPS or campus counseling/psychological services as usual (SAU) after baseline. Dependent measures assessed general mental health, mood, mental health factors affecting sport performance in training, competition and life outside of sports, days using substances, sexual risk behaviors, happiness in relationships, relationships affecting sport performance, and contributions of relationship to sport performance. Intent to treat repeated measures analyses indicated that participants in TOPPS consistently demonstrated better outcomes than SAU up to 8-months post-randomization and for mental health/substance use measures, particularly when diagnostic criteria were most severe. Recommendations are provided in light of the results to assist sport-specific mental health intervention development and implementation within athlete populations.

A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials

BACKGROUND

The aim of the current study was to conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. The second aim was to review the study quality and to report on the validity of measures that were used to determine the effectiveness of programs.

METHODS

Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: PsycINFO, MEDLINE (OVID interface), Scopus, Cochrane, CINAHL and SPORTDiscus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools.

RESULTS

Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes was used to assess indices of mental health awareness and well-being. Mental health referral efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias.

CONCLUSIONS

Further, well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply the psychological theory of behaviour change when developing and evaluating complex interventions.

TRIAL REGISTRATION

PROSPERO CRD42016040178.

Ethical issues in sport psychology

The field of sport psychology is dynamic and growing. To continue building credibility with the public and allied professionals, effective and ethical practice is crucial. Advances in technology have allowed sport psychology professionals to consult with athletes from a distance, but practitioners must be mindful of their competency to use technology, confidentiality concerns, and the suitability of technology for their clients. Movement toward defining competency and clarifying issues of title usage are additional areas in which the field is gaining momentum. Recent attention has also been drawn to the topics of professional development and cultural competency. With the unique settings in which applied sport psychology practice takes place, attention to multiple relationships is another key ethical issue.

Mental Health and Sport Performance Programming in Athletes Who Present Without Pathology: A Case Examination Supporting Optimization

Athletes are exposed to unique stressors that often negatively impact the way they think, behave, and feel in athletic, academic, and social domains. The Optimum Performance Program in Sports (TOPPS), an adaptation of Family Behavior Therapy, is an innovative approach to optimization science that has demonstrated positive outcomes in student-athletes evidencing substance use disorders. However, this approach has yet to be evaluated in athletes who are interested in optimizing their mental health and sport performance, but have no indication of pathology. We describe the administration of TOPPS in a female student-athlete who presented for intervention with no assessed mental health pathology. Although experimental methodology was uncontrolled, many of the methodological features in this examination were advanced. Treatment integrity was reliably assessed and the athlete demonstrated significant improvements in psychometrically validated measurements of mental health and sport performance from baseline to 5-months post-treatment, including psychiatric domains (somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and psychoticism), relationships with teammates, family members, coaches, and peers, and measures of sport performance. Future directions are reported in light of the results.

Discussing prevalence, impacts, and treatment of substance use disorders in athletes

The consumption of alcohol, tobacco, and other drugs has become a concern in high-performance athletes. Professional athletes are more exposed to drugs than the general population. Although some drugs are unquestionably detrimental to performance, several studies have nevertheless shown evidence of increased consumption of these substances within this sub-population. This review aimed to elucidate alcohol, tobacco, cocaine, cannabis, and opioid use among high-performance athletes, discussing the prevalence of substance use, its impacts, and alternatives to treatment in this special population. Unfortunately, no clinical trials for the treatment of substance use disorders were carried out with this specific sub-population. Therefore, the strategies adopted for the general population should be adapted to high-performance athletes. Psychological, psychosocial, psychoeducational, cognitive-behavioural, motivational interviewing approaches can be implemented. As regards pharmacological treatment, medications used in the treatment of alcohol and tobacco dependence, such as naltrexone, disulfiram, acamprosate, varenicline, bupropion, and nicotine replacement treatment can be used without problems. However, some medications used in cocaine and opioid dependence treatment, such as moldafinil and methadone, are prohibited by doping enforcement agencies. Professionals involved with athletes should be aware of the signs and symptoms of the acute effects of substances so as to enable an early identification of substance abuse problems, especially during training periods.

Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review

BACKGROUND

Elevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours.

METHODS

A review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrollment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively.

RESULTS

The title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect.

CONCLUSIONS

A limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014001739.

A Systematic Case Examination of The Optimum Performance Program in Sports in a Combat Sport Athlete

The integration of athletics into higher education enriches the experience of student-athletes, and the advantages are both immediate and lifelong. However, it is well-documented that athletes experience unique stressors, and a deficiency exists of evidence-supported programs to concurrently promote goal achievement in mental health and sport performance. Therefore, this case examination reviews efficacious implementation of The Optimum Performance Program in Sports (TOPPS) in a collegiate combat sport athlete evidencing alcohol dependence and concurrent elevations in mental health symptoms. An AB experimental design with follow-up assessments was utilized to determine the influence of intervention on the participant’s substance use, mental health, HIV/sexually transmitted infection (STI) risk behavior (i.e., unsafe sexual practices), relationships, and factors identified to interfere with sport performance. Unique to existing campus counseling programs, TOPPS incorporated significant other support to assist in goal accomplishment. The intervention program included innovative components that were built upon evidence-supported Family Behavior Therapy protocols, including Cultural Enlightenment, Dynamic Goals and Rewards, Performance Planning, Environmental Control, Self-Control, Reciprocity Awareness, and Positive Request. Intervention components were evaluated to be reliably implemented. The participant reported substantial improvements in mental health and reduced substance use from baseline to post-intervention assessment, and these improvements were sustained at 1- and 3-month follow-up assessments. Future directions in performance programming with student-athletes are discussed in light of the results including the incorporation of significant others in the intervention plan.

Piloting A Family-Supported Approach to Concurrently Optimize Mental Health and Sport Performance in Athletes

Participation in sports offers exceptional pro-social opportunities. However, sport participation also contributes to uniquely experienced stressors that may interfere with athletes’ achievement in sports and mental health. In this study, we describe the initial process of empirically developing The Optimum Performance Program in Sports (TOPPS). We first review the need to adapt evidence-based behavioral interventions to optimize mental health in athletes. We then review the innovative features of TOPPS and report the results of our initial piloting of TOPPS in a series of case trials. Throughout this developmental process, we underscore our methods of addressing obstacles (e.g., stigma) that appear to have influenced the conspicuous absence of performance programming specific to mental health optimization in athletes. Recommendations are offered in light of the results.