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

Do Sex and Gender Have Separate Identities?

The largely binary nature of biological sex and its conflation with the socially constructed concept of gender has created much strife in the last few years. The notion of gender identity and its differences and similarities with sex have fostered much scientific and legal confusion and disagreement. Settling the debate can have significant repercussions for science, medicine, legislation, and people's lives. The present review addresses this debate though different levels of analysis (i.e., genetic, anatomical, physiological, behavioral, and sociocultural), and their implications and interactions. We propose a rationale where both perspectives coexist, where diversity is the default, establishing a delimitation to the conflation between sex and gender, while acknowledging their interaction. Whereas sex in humans and other mammals is a biological reality that is largely binary and based on genes, chromosomes, anatomy, and physiology, gender is a sociocultural construct that is often, but not always, concordant with a person' sex, and can span a multitude of expressions.

Assessment of eating disorder symptoms, compulsive exercise, body dissatisfaction and depression in Swedish national team gymnasts, with a one-year follow-up

PURPOSE

The purpose of this study was to explore changes in symptoms of eating disorders, compulsive exercise, and depression, between two assessments 12 months apart, among elite gymnasts.

METHOD

Factors related to the development of mental health symptoms in male and female Swedish national team gymnasts were investigated using baseline and 1-year follow-up scores in two subscales of the Eating Disorders Inventory 3; drive for thinness and body dissatisfaction, two subscales of the Compulsive Exercise Test; avoidance and rule-driven behavior and exercise for weight control, and the Montgomery-Åsberg Depression Rating Scale-Self report (MADRS-S). Linear mixed models were used to investigate the influence of drive for thinness, exercise for weight control, avoidance and rule-driven behavior, and MADRS-S on body dissatisfaction.

RESULTS

Body dissatisfaction increased from baseline to the follow-up assessment, while drive for thinness and depression remained stable. Symptoms of eating disorders and depression were generally low in this group of elite gymnasts at both assessments. Drive for thinness, exercise for weight control, and symptoms of depression were associated with body dissatisfaction.

DISCUSSION

Our findings indicate that there were no significant changes over time in eating disorders and depression symptoms but significant associations with body dissatisfaction. Furthermore, we found independent effects of drive for thinness, exercise for weight control and symptoms of depression for body dissatisfaction.

Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes

OBJECTIVES

To co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being.

METHODS

40 Team USA female athletes across sports disciplines participated in an online, anonymous, modified Delphi survey by ranking topics on a Likert scale (1='strongly disagree' and 5='strongly agree') and providing qualitative justification regarding whether they believed having more information and research on each topic would support their athletic performance, health and well-being. After each Delphi round, quantitative rankings of topics and qualitative justifications were analysed, informing revisions to the list of topics for review in the subsequent round. Researchers provided athletes with a detailed report of findings and revisions following each round.

RESULTS

The final list contained 14 ranked topics. The top five were menstrual cycle symptoms (4.58±0.74), recovery (4.58±0.59), birth control (4.55±0.89), mental health (4.50±0.55) and fueling and the menstrual cycle (4.43±0.74). New topics originating from athletes included recovery, menstrual cycle symptoms, fueling and the menstrual cycle, mental health and sports performance, team dynamics, and institutionalised sexism.

CONCLUSION

This is the first study to co-construct a research and translational agenda with Team USA elite female athletes. The list of sports science research topics developed by focusing on elite female athletes' voices lays the foundation for future research and provides valuable insight into the specific needs of female athletes.

Creating optimally safe and enjoyable youth sporting experiences within the United Kingdom

Considering recent research and reports, much attention has been given to understanding and addressing issues of abuse in sport. Similarly, attention has been given to enhancing children's psychosocial experiences within sport. However, to-date, consideration of these two elements together, that is minimising abuse and enhancing enjoyment, has been minimal. Thus, the purpose of the current study was to explore perceptions of the process through which an optimally safe and enjoyable sporting experience can be created for young people. A Straussian grounded theory methodology was used to develop a substantive theory detailing the process through which an optimally safe and enjoyable sporting experience is created for young people in sport. Interviews were conducted with 19 young people, six parents, nine coaches, and five individuals in safeguarding roles. The interviews were analysed through open and axial coding, followed by theoretical integration. The resultant theory highlighted that establishing positive relationships between all young people and key individuals in a physically and developmentally safe environment was a fundamental requirement for fostering an optimally safe and enjoyable sporting experience. Achieving this required consideration of factors both in the immediate and broad sporting context. Specifically, support from sports organisations, access to continuing professional development opportunities, and a network of safeguarding experts are required in the broader environment. While within the immediate sporting environment, visibly displayed and appropriately implemented safeguarding policies and procedures; open, honest, and respectful interactions; shared goals and expectations between parents, coaches, and young people, and; trusting and supportive friendships with shared experiences are required.

The Safe Sport Allies bystander training: developing a multi-layered program for youth sport participants and their coaches to prevent harassment and abuse in local sport clubs

Harassment and abuse represent a pervasive and critical problem in sport with far-reaching consequences. Survivors' testimonials underscore the profound and enduring impact of these experiences at individual, interpersonal, organizational and community level. Many of their stories reveal painful inaction from responsible adults in the sport organization, aggravating the harm. Other contributing factors to the harm inflicted include a culture of silence, lack of knowledge and understanding of what constitutes abuse, unawareness of reporting and supporting mechanisms, and fear of potential consequences. While effective bystander interventions have been developed outside the sport context, particularly targeting students in higher education, such initiatives have yet to be extensively adapted and assessed within the sport context. To address this gap, the Safe Sport Allies Erasmus+ collaborative partnership relied on the intervention mapping approach as a guiding framework to systematically develop a bystander training program (i.e., Safe Sport Allies) to train youth sport participants and youth sport coaches to act as effective bystanders. The current paper describes the comprehensive development process and provides an overview of implementation and evaluation possibilities. Throughout the paper, it is explained how each step of the Intervention Mapping approach shaped the Safe Sport Allies bystander training program. The program development, and the developed plans for implementation and evaluation are presented, shedding light on challenges encountered. The bystander training program developed in this paper and the implementation and evaluation plans can serve as an outline to build future interventions within this critical domain of safeguarding in sport.

Clear Yet Crossed: Athletes' Retrospective Reports of Coach Violence

AIMS

This study aimed at examining coach-athlete violence based on the retrospective reports of adults who had been athletes as children and adolescents; predict variables that contribute to the existence of such violence; describe difficulties that the participants encountered as young athletes following such violence; and reveal the outcomes of such violence on their emotions and behaviors, in the past and present.

METHODOLOGY

The applied mixed methods comprised quantitative self-reporting questionnaires and qualitative interviews. The former included 440 participants (mean age 27.6) who had trained for at least one year in a sports union youth department; the latter included 14 participants (aged 23-37). These competitive athletes came from eight branches of sports. The interviews were analyzed based on the Narrative Approach.

RESULTS

According to the quantitative study, all participants had experienced coach violence at least once during their career, mainly psychological violence and neglect, followed by physical violence. Sexual violence was least reported. The age of their retirement from sports and the number of coaches that they had had were significant predictors of violence. Thematic analysis of the qualitative interviews resulted in six types of coach-athlete violence: (1) psychological violence; (2) verbal violence; (3) starvation and food fattening; (4) non-proportional punishing; (5) physical violence; and (6) sexual violence.

CONCLUSIONS

It is vital that coach-athlete violence is addressed in public discourse, that the topic of young athletes' safety is introduced into coaching education, and that a position holder is nominated to be in charge of such safety in all sports organizations.

IOC Olympian Health Cohort: a study protocol for a 15-year, prospective, Olympian health study across Summer and Winter Olympic sports

Prevention of sports injury and illness and protection of athlete health are key mandates of the IOC. Methodological limitations in Olympic Games surveillance and retired Olympian studies mean there are gaps in the available evidence on Olympian health and the varied challenges occurring at different stages throughout an athlete's career. This (protocol) paper describes the methods for implementation of the IOC Olympian Health Cohort. The study aims to establish a longitudinal cohort of current Olympians and follow them prospectively (around 15 years) throughout their Olympic careers and retirement. The study will use participants who have completed self-report questionnaires. Olympians will be recruited after each Summer and Winter Olympic Games, and all National Olympic Committee (NOC) athletes aged 16 years or older are eligible. The first phase included the Tokyo 2020/2021 and Beijing 2022 Olympians, with the study promoted via IOC platforms, Athlete365 and NOCs. Questionnaires include baseline demographics, sports exposure and history of injuries and illnesses impacting the athlete's ability to continue to train and/or compete for at least 2 weeks. Questions also address retirement from sports, musculoskeletal, mental and general health, and quality of life measures. This protocol describes the methods for the 15-year global IOC Olympian Health Cohort Study, from participant recruitment to the development and distribution of the study questionnaire. This protocol will be updated to report future changes in the study's conduct or questionnaire content. These data will help identify risk factors and inform risk-reduction strategies. The ultimate goal is to protect the health of all athletes during their careers and retirement.

Athletic identity affects prevalence and disclosure of emotional abuse in Finnish athletes

The present study offers novel insight into the topic of experienced and observed emotional abuse by researching factors that affect athletes' responses to emotional abuse by coaches. The research aimed to explore three main questions: (1) whether athletic identity was associated with the prevalence of emotionally abusive coaching practices, and (2) disclosure of emotional abuse, and (3) whether demographic variations existed in the frequency of emotional abuse, athletic identity, and disclosure of the abuse. Study participants who filled in an anonymous digital survey consisted of athletes from elite to leisure levels living in Finland (N = 3687, aged 12-80, gender 61% female, 37.7% male, 0.8% other genders). The research findings highlighted three key insights. Firstly, Pearson correlations revealed that a salient athletic identity was related to a higher prevalence of emotional abuse. Secondly, ANOVA/Kruskal-Wallis tests between-groups indicated that particularly children were susceptible to the abuse. Thirdly, a mediation analysis showed that self-identity (aspect of athletic identity) influenced the relationship between experienced emotional abuse and disclosure, by reducing disclosure. As a result, holistic identity development is recommended for athletes and particularly children in sports.

Ethical Risks of Systematic Menstrual Tracking in Sport

In this article it will be concluded that systematic menstrual tracking in women's sport has the potential to cause harm to athletes. Since the ruling of Dobbs v. Jackson Women's Health Organization (2022) in the United States, concerns regarding menstrual health tracking have arisen. Research suggests that the menstrual tracking of female athletes presents potential risks to "women's autonomy, privacy, and safety in sport" (Casto 2022, 1725). At present, the repercussions of systematic menstrual tracking are particularly under-scrutinized, and this paper seeks to combine novel research in the sport sciences with present ethical debates in the philosophy of sports. Utilizing Beauvoir's feminist philosophy (2011), this paper argues that systematic menstrual tracking may contribute to the wider system of women's oppression by exploiting female athletes, as well as enabling the internalization of submissive behaviour in cultures where athletes are expected to comply unquestioningly. Five policy recommendations are made concerning autonomy, informed consent, education, safeguarding and data access. The overall findings of this paper propose that a more in-depth understanding of the links between data, privacy, and the menstrual cycle are required by sports organizations and governing bodies if athletes are to be protected in a future where systematic menstrual tracking is inevitable.

The role, readiness to change and training needs of the Athlete Health and Performance team members to safeguard athletes from interpersonal violence in sport: a mini review

Safeguarding athletes from interpersonal violence (IV) in sport is an important topic of concern. Athlete Health and Performance (AHP) team members working with athletes have a professional, ethical, and moral duty to protect the health of athletes, prevent IV, and intervene when it occurs. However, little is known on their respective roles regarding IV in sport and their needs to fulfill their responsibility of safeguarding athletes. The aim of this review is to synthesize knowledge about the roles, readiness to change and training needs of AHP team members to navigate IV in sport. A total of 43 articles are included in the review. Results show that all AHP team members have a role to play in safeguarding athletes and should therefore be trained in the area of IV in sport. Overall, very little research has directly assessed AHP team members' needs to positively foster safety and eliminate IV in sport. There are common training needs for all types of AHP team members such as the ability to recognize signs and symptoms of IV in sport. However, there are also specific needs based on the role of the AHP team members such as ways of facilitating behavioural change for sport managers. Findings from this review are mostly experts' recommendations and should therefore be interpreted as such. The results of the review can guide the development of future research and recommendations.

High time to enhance dancer welfare: a call to action to improve safeguarding and abuse prevention in dance

While there is a lack of research into abuse in elite dance, numerous allegations of emotional, sexual and physical abuse of dancers can be found anecdotally in the media, legal convictions and personal accounts. As more dancers speak out, the scale of the problem within preprofessional schools and professional companies is becoming apparent. Accordingly, effective safeguarding mechanisms for preventing, identifying and reporting abuse are urgently needed. This viewpoint is intended to raise health professionals' awareness of factors contributing to abusive practices found in dance environments and the potential clinical implications of abuse to dancers' health and well-being. We also call for research and policy engagement on safeguarding and abuse prevention designed and implemented in partnership with stakeholders, aiming to promote safe and positive dance environments for all.

Suicide in National Collegiate Athletic Association athletes: a 20-year analysis

OBJECTIVES

To determine the incidence rate of suicide from 2002 to 2022 among athletes from the National Collegiate Athletic Association (NCAA) and assess for potential differences by, sex, race, division and sport.

METHODS

NCAA athlete deaths over a 20-year period from 2002 to 2022 were identified. Poisson regression models were built to assess changes in incidence rates over time. Linear and quadratic fits between year and suicide incidence for males and females were evaluated.

RESULTS

Of 1102 total deaths, 128 (11.6%) deaths by suicide were reported (male n=98, female n=30). The overall incidence was 1:71 145 athlete-years (AYs). Over the last decade, suicide was the second most common cause of death after accidents. The proportion of deaths by suicide doubled from the first 10 years (7.6%) to the second 10 years (15.3%). The suicide incidence rate for males increased linearly (5-year incidence rate ratio 1.32 (95% CI 1.14 to 1.53)), whereas a quadratic association was identified among female athletes (p=0.002), with the incidence rate reaching its lowest point in females in 2010-2011 and increasing thereafter. Male cross-country athletes had the highest suicide incidence rate (1:29 815 AYs) and Division I and II athletes had a higher suicide incidence rate than Division III athletes. No significant differences in suicide incidence rates by sex, race or sport were identified.

CONCLUSION

Deaths by suicide among NCAA athletes increased in both males and females throughout the 20-year study period, and suicide is now the second most common cause of death in this population. Greater suicide prevention efforts geared towards NCAA athletes are warranted.

Female blind baseball players against gender discrimination: the "red diamonds" experience

Background

Sport has the well-known power of improving body awareness, self-esteem, and social interaction, thus promoting quality of life and psychophysical wellbeing. Specifically referring to adapted disciplines, habitual practice often becomes an effective integration and self-efficacy booster. Among disabilities, visual impairment deeply alters body image perception, autonomy, and environmental/social interaction heavily reducing sport or leisure involvement opportunities. In particular, visually impaired women represent one of the most vulnerable categories to gender and disability discrimination. Moreover, even when congenitally sightless, they perceive social pressure of mainstream beauty ideals, mostly spread by media, comparable to their sighted peers. On these premises and the previously demonstrated psychophysical benefits of Italian blind baseball practice on this target population, the present study aimed to deepen the social and educative potentialities of such adapted sport applying a more sociological research approach.

Methods

The "red diamonds" event, namely, the first ever female blind baseball match, was the setting for the administration of our structured online survey. In detail, our survey comprised different evaluation tools such as the 18-item Psychological Well-Being Scale, the 12-item Short Form questionnaire, the Dresden Body Image questionnaire, the Rosenberg Self-Esteem Scale, and sociological model designed questions. Quality of life, psychological wellbeing, self-esteem, body image, and perceived female sport psychological violence were investigated in the whole women sample (n = 33) voluntarily adhering to the game.

Results

Survey results revealed no statistically significant differences between visually impaired players (n = 13; mean age: 32.84 ± 12.05 years) and sighted on-field subjects (i.e., coaches, assistants, and referees; n = 20; mean age: 47.15 ± 12.31 years) in almost all the inquired variables, thus remarking the social and functional benefits of adapted sport through the "dual embodiment" and empowerment phenomenon.

Conclusions

Given that the event was inspired by and performed on the World Day against women violence, our study deepened not only the topic of disability discrimination but also the currently alarming gender-related one. In such a context, the present research might provide interesting cues for further investigations on disability and gender disparities in sports, hence spreading interest in this under-investigated field. In perspective, the "red diamonds" experience could also contribute to inspiring and progressively developing educative tools against any kind of discrimination by promoting integration and social growth through regular sports practice.

Breaking the silence: Phenomenological unveiling of the hidden impact of abuse on Iranian athletes

Abuse is a social concern in all life affairs including sports. This qualitative phenomenological study aimed to explore the lived experience of Iranian athletes who had been abused in sports. The participants were six athletes who had experienced abuse in sports. Due to the sensitivity of the issue, they were selected through the purposeful snowball sampling method. The results of the research showed seven main themes in the Iranian athletes' experience of abuse in sports: (1) stigma, (2) suppressed hatred and anger, (3) psychological pendulum of continuing and abandoning sport, (4) trampled emotions, (5) ambiguity and imposed harassment, (6) victimhood, and (7) feelings of self-blame. Our findings indicate that abuse among athletes is a multifaceted issue that can take different angles. A better understanding of abuse in sports can help prevent and manage this phenomenon.

Women's Experiences of Gender-Based Interpersonal Violence in Sport: A Qualitative Meta-Synthesis

Violence against women in sport is pervasive. Prevalence rates of interpersonal violence range from 26% to 74% across psychological, physical, and sexual violence. This review synthesizes adult women's experiences of gender-based interpersonal violence in sport. A systematic review of qualitative studies was conducted. Five databases were searched, including CINAHL, Web of Science, SPORTDiscus, PsycINFO, and Sociological Abstracts. In total, 1,617 records were retrieved and screened. Twenty-five records representing 24 studies were eligible for inclusion. Following a meta-ethnographic approach, both authors synthesized first- (participants) and second-(researcher) order constructs to create a new interpretation (third-order construct) beyond the individual studies reviewed. A feminist socio-ecological lens was applied. Five themes were constructed: women's safety work, the normalization of abusive behaviors in the sports context, sport family violence, organizational impotence and hostility, and women's status in a patriarchal system. Women's experiences of abuse are mapped within and across the individual, relational, organizational, and cultural levels of the socio-ecological model, with (lack of) power being a central factor within each level as well as flowing between the levels. A fifth socio-ecological level was developed pertaining to the unique context of sport-that of the sport family. This sits between the relational and organizational levels of the model and covers both intense familial relationships and patriarchal familial organizational structures in sport that facilitate and silence the abuse. Sporting bodies must co-design interventions encompassing all socio-ecological levels to address gender-based violence in sport.

Safeguarding strategies in athletes with intellectual disabilities: A narrative review

Compared to their non-disabled peers, athletes with disabilities are at an increased risk of interpersonal violence in sport. Athletes with intellectual disabilities specifically may face compounded risk due to impaired communication and social challenges. Despite the inherent risk of interpersonal violence in athletes with intellectual disabilities, there is a paucity of literature focused on safeguarding strategies in this population, and no global consensus prevention guidelines exist. The goal of this review was to synthesize the literature on interpersonal violence in athletes with intellectual disabilities and propose an evidence-informed safeguarding framework. Future research and practice should emphasize tailored training on appropriate athlete-protection strategies and ways to recognize and respond to suspicions of abuse in this population. Given the benefits of sports participation for persons with intellectual disabilities, implementation of fit-for-purpose safeguarding strategies would help address any elevated risk of interpersonal violence. Formal monitoring and evaluation of these initiatives can help minimize interpersonal violence.

Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than 'wear a mask', different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

Sexual Harassment/Abuse Policies in U.S. Youth Sport Programs

Sport governing bodies, such as the International Olympic Committee, have recommended youth sport organizations develop policies, procedures, and/or ethical guidelines to prevent and respond to sexual harassment and abuse (SHA) experienced by young athletes. To our knowledge, no studies have investigated SHA policies or procedures in U.S. youth sport programs. The purpose of this exploratory study was to examine U.S. youth sport programs' policies regarding SHA. The results are based on a cross-sectional survey completed by youth sport coaches (n = 200) from various organizations (e.g., public recreation organizations, private nonprofit organizations, and interscholastic sports). Findings suggest that most organizations have several SHA policies, such as education and training requirements, written policies and codes of conduct regarding coach-athlete sexual relationships, and formal complaint and disclosure procedures for investigating SHA. A bivariate analysis suggests that the presence of several SHA policies was associated with an increased number of self-reported SHA incidents. Moreover, youth sport programs located in urban areas had a greater extent of SHA policies compared to those located in suburban or rural areas. These results are discussed with respect to the potential relationships between the presence of policies and increased cases of SHA. Also, we discussed advocating for equitable resources among youth sport programs regardless of geographic and/or demographic factors. Future research should identify social and cultural barriers that inhibit the successful implementation of SHA policies. While developing and implementing SHA policies is a step in the right direction, it may not be used as the only means to address this complex, systematic, and structural issue.

Development and initial validation of the perceived instrumental effects of violence in sport scale

Introduction

A growing body of research is looking into risk factors for interpersonal violence (IV) in sport. This research suggests the existence of several important risk factors, especially organizational and social factors. One of these factors is the beliefs regarding instrumental effects of violence. Coaches may want to drive performance, deter failure, test resilience and commitment, develop toughness, assure interpersonal control, and promote internal competition. In sum, available evidence suggests the risk of IV increases when coaches believe in the effectiveness of strategies involving IV to enhance athlete performance or perceive external approval for these practices.

Methods

The studies presented in this article seeks to develop and validate the Perceived Instrumental Effects of Violence in Sport (PIEVS) Scale in order to measure those beliefs in coaches. In study 1, item generation, expert consultation, cognitive interviews, pilot test and item reduction phases led to 25 items for the PIEVS around six dimensions. In study 2, exploratory factor analysis (EFA) was conducted with 690 coaches in order to determine the PIEVS factorial structure and the convergent and divergent validity of the scale was tested (long and short form).

Results

Our results suggested a one-factor solution for the PIEVS (25 items). This one-factor model provided an excellent fit to the data and a very good internal consistency. The PIEVS and empowering motivational climate were negatively correlated, which supported divergent validity as expected. The PIEVS was positively correlated with the disempowering motivational climate and with sport ethic norms, which supported convergent validity as expected.

Discussion

These findings provide preliminary evidence for the appropriateness of the PIEVS Scale to measure perceived instrumental effects of violence in coaches.

The role of the six factors model of athletic mental energy in mediating athletes' well-being in competitive sports

In the realm of high-performance sports, athletes often prioritize success at the expense of their well-being. Consequently, sports psychology researchers are now focusing on creating psychological profiles for athletes that can forecast their performance while safeguarding their overall well-being. A recent development in this field is the concept of athletic mental energy (AME), which has been associated with both sporting success and positive emotions. Therefore, the aim of this study was to explore if AME in athletes can mediate this directly observed relationship between performance and psychological well-being. For stronger predictive validity these relationships were examined across two studies with each involving distinct sets of participants engaged in various sports disciplines, including football, cricket, basketball, archery, and more. The self-report measures of sports performance, athletic mental energy (AME), and psychological well-being (PWB) were administered post-competition on the local, regional, state, national, international, and professional level athletes of age 18 and above. Our study found that both, the affective and cognitive components of AME mediated the athletes' performance and psychological well-being relationship. Interestingly, the study found no significant gender differences in AME and PWB scores. While family structures didn't yield significant variations in AME scores, there were some descriptive distinctions in PWB scores across different family structures. Our research offers preliminary evidence suggesting that AME can play a pivotal role in preserving athletes' psychological well-being following competitive events.

Effects of inpatient treatment on compulsive exercise in adults with longstanding eating disorders: Secondary analysis from a randomized controlled trial with 12-month follow-up

PURPOSE

This study aimed to examine changes in compulsive exercise among adults with eating disorders (ED) admitted for inpatient treatment in a randomized controlled trial comparing cognitive behavioral therapy (CBT) and compassion-focused therapy (CFT) and whether such changes were influenced by treatment condition, childhood trauma, or level of compulsive exercise.

METHOD

A total of 130 adults admitted to inpatient treatment for EDs mean (SD) age 30.9 (9.7) years, mean illness duration 14.2 (8.9) years, were randomized to receive CBT or CFT and analyzed using multilevel modeling. Assessments included Eating Disorders Examination - Interview, Compulsive Exercise Test and Childhood Trauma Questionnaire.

RESULTS

Mean total CET score at baseline was 14.7 (4.0) with no difference between the treatment groups. A total of 63 (48.5%) had CET score ≥ 15, indicating clinical levels. There was an overall time effect on reduction in CET total and all CET subscale scores except Lack of enjoyment, and CFT provided greater reduction compared to CBT on the CET subscale Mood improvements. Patients with clinical CET score levels showed greater reduction on CET total and the subscales Avoidance, Weight, and Rigidity across time compared to persons with non-clinical CET score. Childhood trauma did not predict changes in CET total or subscale scores.

DISCUSSION

Both CBT and CFT improve overall compulsive exercise. The greater effect of CFT than CBT on exercise as a maladaptive mood regulator calls for further research on how affective oriented psychotherapies can not only reduce compulsive exercise but also promote functional exercise among persons with EDs.

PUBLIC SIGNIFICANCE STATEMENT

Understanding and addressing compulsive exercise in adults with eating disorders is crucial. This study comparing cognitive-behavioral therapy and compassion-focused therapy shows both improve compulsive exercise. Importantly, compassion-focused therapy has a greater impact as an emotion-focused regulator. This emphasizes the need for further exploration into how emotion-focused therapies can reduce compulsive exercise and promote healthier, functional physical activity for individuals with eating disorders.

Mental Health in Elite Coaches

CONTEXT

Coaches play an important role in promoting mental health in elite sports. However, they themselves are exposed to risks affecting their mental health, and their fears and worries are often overlooked. Moreover, it remains unclear how coaches' mental health affects their athletes' mental health.

OBJECTIVE

To create a compilation of the literature on (1) elite coaches' mental health and (2) how coaches' mental health influences elite athletes' mental health. Building on this, recommendations for improving coaches' psychological well-being should be elaborated upon and discussed.

DATA SOURCES

A literature search was conducted up to November 30, 2021, using the following databases: PubMed, PsycINFO, Scopus, Web of Science, and SportDiscus.

STUDY SELECTION

Studies reporting elite coaches' mental health symptoms and disorders and the influence of elite coaches' mental health on elite athletes' mental health were included.

STUDY DESIGN

Scoping review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data regarding elite coaches' mental health, as well as their influence on athletes' mental health and performance, were included in a descriptive analysis. The PRISMA guidelines were used to guide this review.

RESULTS

Little research has been done on elite coaches' mental health disorders, although studies confirm that they do experience, for example, symptoms of burnout, anxiety, and depression. The influence of coaches' mental health on their athletes is underinvestigated, with research focused mainly on the influence of coaches' stress.

CONCLUSION

Knowledge about coaches' mental health is still limited. Coaches' poor mental health diminishes coaching performance and might impair athletes' mental health. Coaches should receive more support, including sports psychiatric care and education on the importance of mental health. This could improve the mental health of both coaches and athletes, and positively affect athlete performance.

Societal discrimination and mental health among transgender athletes: a systematic review and Meta-analysis

BACKGROUND

Discrimination and inequality have been identified as significant problems faced by transgender individuals in sports participation. However, uncertainties remain regarding the effectiveness of interventions aimed at promoting equality.

OBJECTIVES

This systematic review and meta-analysis aimed to examine the experiences of transgender athletes in sports, focusing on mental health issues and factors contributing to inequality among transgender and other sexual minorities.

METHODS

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched 10 electronic databases, including PubMed, Google Scholar, and Web of Science, to identify eligible studies published between 2005 and 2022. The search yielded 1430 articles, of which only 12 studies met the inclusion criteria for this review.

RESULTS

The meta-analysis of the 12 studies included in this review revealed that transgender athletes faced social discrimination and inequality in sports participation, resulting in mental health problems and higher rates of suicide. From a cohort of 21,565 participants in the studies, 7152 (33%) were subjected to discrimination in sports participation and healthcare, with a rate of 0.61 (95% confidence interval [CI]: 0.35, 0.81). However, transgender athletes who felt welcomed and embraced by their respective teams accounted for 0.39 (95% CI: 0.19, 0.65). These results indicated significant differences between how transgender athletes are treated in healthcare settings and when participating in sports.

CONCLUSION

The study findings underscore the need for policies, cultural research, and interventions to address discrimination and inequality faced by transgender athletes in sports participation. Promoting equality and safeguarding the rights of transgender athletes can mitigate the risk of mental health problems and increase physical activity among sexual minorities.

Experiences of Interpersonal Violence in Sport and Perceived Coaching Style Among College Athletes

Importance

Concern about interpersonal violence (IV) in sport is increasing, yet its implications remain poorly understood, particularly among currently competing college athletes.

Objective

To document the self-reported prevalence of IV in college sports; identify associated risk factors; examine potential consequences associated with athletes' psychosocial well-being, emotional connection to their sport, and willingness to seek help; and explore the associations between IV reporting and perceived variations in coaching styles.

Design, Setting, and Participants

This survey study analyzes results of the 2021 to 2022 National Collegiate Athletic Association (NCAA) myPlaybook survey, which was administered from July to December 2021 to 123 colleges and universities across the US. Participants were NCAA athletes aged 18 to 25 years who were current players on an NCAA-sanctioned team.

Exposures

Self-reported demographic characteristics (eg, athlete gender identity and sexual orientation) and perceived differences in supportive vs abusive coaching styles (eg, athlete autonomy, team culture, and extent of abusive supervision).

Main Outcomes and Measures

The primary outcome was self-reported experiences of IV in sport during the college sports career of currently competing college athletes. Types of IV considered were physical abuse, financial abuse, sexual abuse, psychological or emotional abuse, and neglect or abandonment. Outcomes potentially affected by IV were assessed with 4 questionnaires.

Results

A total of 4119 athletes (mean [SD] age, 19.3 [1.5] years; 2302 males [55.9%]) completed the survey (response rate, 21.2%). One in 10 athletes (404 of 4119 [9.8%]) reported experiencing at least 1 type of IV during their college sports career, of whom two-thirds (267 [6.5%]) experienced IV within the past 6 weeks. On multivariable analysis, female gender identity (odds ratio [OR], 2.14; 95% CI, 1.46-3.13), nonheterosexual sexual orientation (OR, 1.56; 95% CI, 1.01-2.42), increasing age beyond 18 years (OR, 1.13; 95% CI, 1.01-1.30), increasing year of NCAA eligibility beyond the first year (OR, 1.19; 95% CI, 1.02-1.39), and participation in select sports (eg, volleyball: OR, 2.77 [95% CI, 1.34-5.72]; ice hockey: OR, 2.86 [95% CI, 1.17-6.95]) were independently associated with IV. When exposed to IV, college athletes reported experiencing consistently worse psychosocial outcomes, including increased burnout (mean difference on a 5-point Likert scale, 0.75; 95% CI, 0.63-0.86; P < .001) and an expressed desire to consider quitting their sport (mean difference, 0.81; 95% CI, 0.70-0.92; P < .001). They were not, however, less willing to seek help. Differences in coaching style were associated with differences in IV reporting. In risk-adjusted linear regression models, having a more supportive coach was associated with a 7.4 (95% CI, 6.4-8.4) absolute percentage point decrease in athletes' probability of reporting experiencing IV. In contrast, having a more abusive coach was associated with up to a 15.4 (95% CI, 13.8-17.1) absolute percentage point increase in athletes' probability of reporting experiencing IV.

Conclusions and Relevance

Results of this survey study suggest that IV is associated with marked changes in the psychosocial health and emotional well-being of college athletes, particularly those who identify as female and with nonheterosexual sexual orientations. Variations in coaching style have the potential to alter these associations. Ongoing efforts are needed to leverage the unique position that coaches hold to help reduce IV and create safe places where all college athletes can thrive.

Athlete Maltreatment in Sport

The celebrated side of sports is the high-intensity display of athleticism and competition that draws spectators to the stands, televisions, and streaming services. That version of sports is presented as the hotly contested, highly sought-after glory that the competitors sacrifice their time and bodies to pursue. The competitive passion for sport can be observed at every level of sport: from youth sports leagues to elite and professional sports competitions. This chapter will peel back the layers of sports to expose the elements that are not glamorous or celebrated. It will explore the staggering costs under the surface: to athletes, members of the athlete's entourage, and teammates when maltreatment occurs. It will also outline the role of the team physician in providing a safe clinical environment and tools to navigate disclosure and beyond.

A moderated mediation analysis on the influence of social support and cognitive flexibility in predicting mental wellbeing in elite sport

The purpose of this study was to examine the mechanism by which social support influences mental wellbeing. Using the thriving through relationships model to provide a theoretical underpinning, cognitive flexibility was hypothesised as a mediator. Additionally, the research examined the consistency of this pathway between elite athletes, retired athletes, and non-athletes. Survey responses from a sample of 247 participants (n = 49 elite athletes, n = 61 retired athletes, n = 137 convenience sample; of which 127 (51.4%) were males were included in the analysis. Initial mediation analysis revealed a significant indirect pathway from social support to mental wellbeing through cognitive flexibility. Moderated mediation analysis revealed this pathway was significant for retired athletes and the convenience sample, but not for elite athletes. Results provide additional insight into the mechanisms by which social support influences wellbeing. Cognitive flexibility interventions may not be as effective for elite athletes.

Anxiety Disorders in Athletes

Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and harassment and abuse in sport. Anxiety may negatively impact sport performance. Specific types of anxiety may have unique presentations in athletes. It is important to rule out general medical and substance-related causes of anxiety symptoms. Psychotherapy and pharmacology treatment options should be considered, bearing in mind athletes' environmental circumstances and physiologies.

Risk factors for sexual harassment and abuse victimization among adolescent athletes and non-athletes: A one-year follow-up study

BACKGROUND

The association between SHA and negative mental health increases the need to understand risk factors for SHA victimization, which is important for future development of prevention programs.

OBJECTIVE

To examine which combinations of demographic- and mental health factors were associated with subsequent SHA victimization, and the prevalence of elite athletes, recreational athletes, and reference students who experienced sexual revictimization.

PARTICIPANTS AND SETTING

Norwegian elite athletes and recreational athletes attending sport high schools, and reference students attending non-sport high schools (mean age: 17.1 years) were eligible for participation.

METHODS

The participants answered an online questionnaire at two measurement points one year apart, T1 and T2 (n = 1139, 51.1 % girls). After testing for measurement invariance, data were analyzed with Classification and Regression Tree analysis (CRT) using demographic- and mental health variables from T1 as independent variables, and SHA at T2 as outcome.

RESULTS

The combination of being a girl with high level of symptoms of eating disorders and other psychological symptoms was associated with subsequent reporting of SHA. Among the students with lifetime experience of SHA at T1 (n = 533, 58.3 %), 49.5 % reported revictimization at T2 (60.9 % girls, 32.2 % boys, p ≤ .001). The prevalence of SHA revictimization was lower among elite athletes (44.3 %) compared with recreational athletes (49.1 %) and reference students (59.4 %, p = .019).

CONCLUSION

The combination of female gender and mental health symptoms are risk factors for subsequent SHA victimization. These findings, and the high prevalence of SHA revictimization is important knowledge for developing preventive programs targeting elite athletes, recreational athletes, and reference students.

Management of Mental Health Challenges in Athletes: Screening, Pharmacology, and Behavioral Approaches

Athletes are incredibly motivated and perpetually pursuing dominance in skill, strength, endurance, and execution-often while balancing many additional responsibilities. Despite the appearance of living fun, luxurious, care-free lifestyles, they are vulnerable to exceptional stressors and the same mental health challenges as the general population. The use of screening tools and assessment guided by a biopsychosocial framework can assist in understanding the factors that contribute to the athlete's mental health status. This can facilitate the development of a targeted management approach to mental health challenges.

Depressive Disorders in Athletes

Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tools have been developed specifically for athletes such as the Sport Mental Health Assessment Tool (SMHAT). The management of the depressed athlete should involve an individualized approach, with methods such as counseling, interpersonal therapy, or cognitive behavioral therapy being used. Some may require antidepressant medication. Depressive disorders are also linked to sucidality in athletes, and the team physician and sporting organisation should have a crisis management plan in place for mental health emergencies. Tackling the stigma that remains in sport is a key part to improving mental wellbeing for all athletes.

Using a socioecological approach to explore healthy lifestyle in elite sport: a qualitative study of French athletes', coaches', and managers' perspectives

Elite athletes are continually subjected to a range of constraints specific to high performance, and these can have a negative impact on their health. Although many studies have explored the individual factors related to risky behaviours and disorders in elite sport contexts, few have focused on health promotion. Consequently, the interpersonal, institutional, and policy factors of the health-related behaviours of elite athletes are still poorly explored. Based on the socioecological model, this study aimed to identify the factors involved in the health-related lifestyle of elite athletes. Semi-structured interviews were conducted with 45 participants: athletes (N = 32), their coaches (N = 6) and the managers of elite sport centres (N = 7). Both deductive and inductive thematic analyses were performed. Our results highlight the views of the actors. Regarding intrapersonal factors, resilience qualities and health literacy appeared as key factors in influencing the health-related lifestyle of elite athletes. At the interpersonal level, parents and coaches emerged as the main sources of educational support. Regarding institutional factors, the health policies of the elite sport centres were key factors in supporting the athletes' healthy lifestyle. These results encourage the development of health promotion programs at different levels of intervention.

Mental health symptoms and correlates among amateur football players: a cross-sectional study

The objective of this study was to evaluate mental health problems reported by Turkish amateur football players. A total of 4516 Turkish amateur football players were invited to complete an anonymous online survey including demographic and COVID-19 pandemic related questions, the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, and Athlete Psychological Strain Questionnaire. A total of 1263 players participated in the study (27.9% response rate). Single players reported higher depression and anxiety scores than married players. Higher depression, anxiety, and athletes-specific stress scores were reported by players with an annual income <$5,000 and those reporting an income loss >75% during the COVID-19 pandemic. Players with a sports injury history, psychiatric illness, sleep problems, and perceived inadequate social and/or organizational support reported poorer indices relative to their counterparts. Implementation of mental health screening among amateur football players may assist in detecting vulnerabilities and initiating appropriate timely intervention.

Alcohol Use, Rape Myth Acceptance, Rape Empathy, and Sexual Assault History Influence the Believability of a Hypothetical Victim's Report of Sexual Assault

College sexual assault is a common problem, and survivors often do not report their experience to college campus officials or law enforcement for fear of not being believed. This study examined how contextual factors such as alcohol use and whether the perpetrator was described as a student-athlete or student, and rater characteristics, such as the history of sexual assault and attitudes toward rape, influenced college students' perceptions of the believability of a hypothetical victim's sexual assault account. In all, 449 (N = 449) undergraduates read a vignette describing a hypothetical sexual assault and were assigned randomly to one of four conditions with varying contextual features: college athlete-no alcohol, college athlete-alcohol, college student-no alcohol, or college student-alcohol. They then rated how much they believed the victim in the vignette had been raped (0 [not at all] to 100 [completely]). The presence of alcohol use in the vignette was associated with lower ratings of believability, and participants who were higher in rape myth acceptance and lower in rape empathy rated the hypothetical victim's rape account as less believable. In addition, women who had been raped previously rated the victim in the vignette as more believable than women with no history of sexual assault. Implications for how college campuses might respond more effectively to reported sexual assaults are discussed.

Sexual harassment and abuse; disclosure and awareness of report- and support resources in Norwegian sport- and non-sport high schools: a prospective exploratory study

Purpose

To examine high school students' disclosure of sexual harassment and abuse (SHA), and awareness of reporting systems and support mechanisms in school among students, leaders, and coaches.

Method

Norwegian 17-year-old high school elite athletes (n = 630), recreational athletes (n = 307), and reference students (n = 263) responded to an online questionnaire at two measurement points, 1 year apart (T1 and T2). Leaders and coaches (n = 249) at the participating high schools responded to an adapted version of the questionnaire at T1. Data were analyzed using ANOVA or Welch test, Pearson Chi-Square test, and McNemar test.

Results

In total, 11.4 and 34.0% of the adolescents were aware of reporting systems and support mechanisms, respectively, in their schools. Nearly all the leaders, and half of the coaches were aware of these resources. Among the adolescents with lifetime experience of SHA, 20.1% had disclosed their experiences to someone. Girls disclosed more frequently than boys. The elite- and recreational athletes disclosed less often compared with the reference students. A negative change from T1 to T2 was found in disclosure of SHA and awareness of support mechanisms. At T2, 6.5% of the adolescents reported that their school had implemented measures against SHA during the last 12 months.

Conclusion

The results emphasize a need for institutional effort to improve information about available report- and support resources and increase the relevance of use of such systems for adolescents.

Empowering and disempowering climate and experiences of psychological violence in artistic gymnastics

In light of the continuing debate about coach-perpetrated violence and the maltreatment of athletes in the elite sports context, empowering and ethical approaches to coaching need to be investigated and proposed as evidence-based effective alternatives. This study aims to investigate the associations between motivational coaching climates and athletes’ experiences of psychological violence, as well as their effects on well-being. Using an anonymous cross-sectional online survey, artistic gymnasts’ perceptions of empowering and disempowering coach-created motivational climates, experiences of psychological violence in sport, well-being, and depressive symptoms were recorded quantitatively. Results indicate that a more disempowering climate predicts psychological violence, while an empowering climate was not a significant predictor. Regarding mental health outcomes, an effect of psychological violence on depressive symptoms and well-being was found, but no effect was found for the disempowering climate. Explorative analysis suggested that psychological violence mediates the relationship between disempowering coaching and mental health outcomes. Based on these findings, coach education should focus on prevention of psychological violence and minimization of disempowering climates. Further research should investigate the relations and effects of psychological violence and coaching climates more thoroughly, including the role of an empowering climate as a potential beneficiary alternative coaching method.

Experiences of LGBTQ student-athletes in college sports: A meta-ethnography

This study aimed to explore and describe the experiences of LGBTQ student-athletes to identify ways in which athletic staff, coaches, and others can support LGBTQ youth's safe participation in sports. Guided by the preferred reporting items for systematic reviews (PRISMA) and eMERGe reporting guidance. We conducted a meta-ethnography to synthesize qualitative research focused on student-athletes' experiences. Fourteen studies were included in the meta-ethnography published between 1973 and 2022. Four themes were identified: (1) experiences of discrimination and violence; (2) perceived stigma; (3) internalized prejudice; and (4) coping and team support, and they were used to generate a line of argument model, which explains the stress process of LGBTQ student-athletes in the sports. LGBTQ student-athletes experience persistent discrimination in college sports, which poses a significant risk to their mental health. Meanwhile, this study identified that qualitative research on LGBTQ youth sports participation is lacking in many regions of the world and lacks knowledge of the sports participation experience of bisexual, gay, and transgender students. These findings revealed a way for research on LGBTQ-related issues and future policy and practice on LGBTQ youth-related issues in sports.

Profiles of Teenage Athletes' Exposure to Violence in Sport: An Analysis of Their Sport Practice, Athletic Behaviors, and Mental Health

Violence in sport is a major social issue generating great interest in research over the last 10 years. Studies to date highlight various forms and manifestations of violence in the lives of teenagers practicing individual or team sports, in competitive and recreational contexts. Although allegations of sexual violence involving coaches most often reach media attention, psychological and physical violence involving teammates, parents, and coaches are also prevalent. While profiles of offenders in the sport context have contributed to a better understanding of the issue, similar profiles need to be elaborated for young victims to delineate varying degrees of risk, adaptation, and needs. Latent class analyses were conducted to empirically identify different patterns of exposure to violence in sport from a sample of 1057 athletes aged 14-17 years. Teenagers participated in an online survey assessing their experiences of violence using the Violence Toward Athletes Questionnaire. Results highlighted three different profiles of victimization in the sport context: (a) a non-victimized profile constituting only 37% of the sample; (b) a profile representing 52% of the sample that is mainly exposed to psychological violence by teammates, coaches, and parents; and (c) a "poly-victimized" profile, representing 10% of the sample, that is exposed to all forms of violence at the hands of various perpetrators (teammates, coaches, and parents). The identified profiles were compared according to different indicators of sport practice, athletic behaviors, and mental health. This study delineates the influence of single and multiple forms of violence and its compound consequences on mental health and sport-related behaviors, thus portraying various degrees of need for tailored prevention and intervention measures.

Youth Sport Coaches' Perceptions of Sexually Inappropriate Behaviors and Intimate Coach-Athlete Relationships

Although sexual harassment and abuse in youth sport have received increasing research attention worldwide, less is known about youth coaches' perceptions of sexually inappropriate behaviors and intimate relationships with athletes. The purpose of this exploratory study was to examine youth sport coaches' perceptions of behaviors that can lead to potential sexual harassment and abuse, as well as to understand how coaches perceive coach-athlete sexual relationships. A cross-sectional survey was completed by 200 male coaches from various U.S. youth sport programs. Overall, a majority of coaches indicated behaviors associated with sexist comments and verbal/physical advances as sexually inappropriate. There was, however, a lack of consensus regarding what constitutes sexually inappropriate behaviors when the behavior was instruction-related/contextually dependent. Results were mixed regarding the perceptions of coach-athlete sexual relationships, with a notable number of coaches agreeing that sexual intimacies with young athletes (17 years or younger) are not always harmful and should not be prohibited. Based on a regression analysis, white coaches were more likely to exhibit negative perceptions about coach-athlete sexual relationships compared to ethnically diverse coaches. Overall, these findings warrant the development or reevaluation of policies and interventions aimed at preventing sexual harassment and abuse in the youth sport environment. Continued research is needed to better understand youth sport coaches as the perpetrators of sexual harassment and abuse.

Canadian Academy of Sport and Exercise Medicine Position Paper: The Clinician's Role in Addressing and Preventing Maltreatment in Sport-10-year Anniversary

ABSTRACT

In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care.

Effectiveness of an educational intervention targeting homophobic language use by young male athletes: a cluster randomised controlled trial

OBJECTIVE

Homophobic language is common in male sport and associated with negative physical and mental health outcomes for all sport participants, but particularly for gay or bisexual youth populations. Evidence-based interventions are needed to reduce such language and mitigate harm. This study evaluated the effectiveness of a short social-cognitive educational intervention delivered by professional rugby union players in youth sport.

METHODS

In a two-arm, cluster randomised controlled trial, 13 Australian youth rugby teams from 9 clubs (N=167, ages 16-20, mean 17.9) were randomised into intervention or control groups. Professional rugby players delivered the intervention in-person. Frequency of homophobic language use was measured 2 weeks before and 2 weeks after the intervention. Hypothesised factors underpinning homophobic language were also measured, including descriptive (other people use), prescriptive and proscriptive injunctive norms (approval/disapproval by others), and attitudes towards the acceptability of homophobic language.

RESULTS

At baseline, 49.1% of participants self-reported using homophobic language in the past 2 weeks and 72.7% reported teammates using homophobic language. Significant relationships were found between this behaviour and the hypothesised factors targeted by the intervention. However, generalised estimating equations found the intervention did not significantly reduce homophobic language, or alter the associated norms and attitudes, relative to controls.

CONCLUSION

Use of professional rugby athletes to deliver education on homophobic language was not effective. Other approaches to reduce homophobic language (and other forms of discrimination) such as peer-to-peer education, and enforcement of policies prohibiting specific language by coaches, should be explored.

Psychological, Physical, and Sexual Violence Against Children in Australian Community Sport: Frequency, Perpetrator, and Victim Characteristics

Childhood sport participation is associated with physical, social, and mental health benefits, which are more likely to be realized if the sport environment is safe. However, our understanding of children's experience of psychological, physical, and sexual violence in community sport in Australia is limited. The aims of this study were to provide preliminary evidence on the extent of experiences of violence during childhood participation in Australian community sport and to identify common perpetrators of and risk factors for violence. The Violence Towards Athletes Questionnaire (VTAQ) was administered online to a convenience sample of Australian adults (>18 years), retrospectively reporting experiences of violence during childhood community sport. Frequencies of experience of violence were calculated and Chi-square tests were conducted to determine differences between genders. In total, there were 886 respondents included in the analysis. Most survey respondents were women (63%) and about a third were men (35%). About 82% of respondents experienced violence in sport as a child. Psychological violence was most prevalent (76%), followed by physical (66%) and sexual (38%) violence. Peers perpetrated the highest rates of psychological violence (69%), and the rates of physical and psychological violence by coaches (both >50%) were also high. Age, sexual orientation, disability, and hours of weekly sport participation as a child were all associated with childhood experience of violence in sport. The rates of interpersonal violence against children in sport were high. This novel data on perpetrators of the violence and the risk factors for experiencing violence provides further context to inform safeguarding strategies in sport. A national prevalence study is recommended to advance our understanding of the childhood experiences of violence in Australian sport.

Beyond the medals: a cross-sectional study exploring retired elite female athletes' health

Objectives

Little is known about the impact of elite sport participation on long-term athlete health. We aimed to: (1) describe musculoskeletal, mental health, reproductive/endocrine and cardiovascular characteristics in retired elite female athletes and compare to the general population and (2) explore athletes' perceptions of their elite sport participation and its impact on health.

Methods

A 136-item online questionnaire was disseminated to Canadian elite female rowing and rugby athletes >18 years old, >2 years retired from elite competition. Matched general population data were obtained from Statistics Canada when available.

Results

Seventy-four (24% response rate) athletes (average age 45 (±9) years; retired 15 (±9) years) completed the questionnaire (30 rowing, 44 rugby athletes). During their career, 63 athletes (85%) experienced a hip/groin, knee, foot/ankle injury, or low back pain, with 42 (67%) reporting ongoing symptoms. Athletes 35-54 years reported worse knee symptoms and quality of life compared with the general population (symptom: p=0.197; d=1.15 [0.66, 1.63]; quality of life: p=0.312 d=1.03 [0.54, 1.51]) while other hip, knee and foot/ankle outcome scores were similar. Retired athletes had lower odds of anxiety (OR=0.155 [95% CI0.062 to 0.384]), greater lifetime/ever odds of amenorrhea (OR=6.10 [95%CI 2.67 to 13.96]) and gave birth when older (p<0.05). Fifty-nine (79%) recalled witnessing or experiencing at least one form of harassment/abuse during their career. Sixty athletes (81%) rated their current health as above average or excellent and 61 (82%) would compete at the same level again if given the choice.

Conclusion

These novel insights can inform future preventative efforts to promote positive elite sport-related outcomes for current, former and future female athletes.

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.