Utility of the Counseling Center Assessment of Psychological Symptoms Screen in a Collegiate Athlete Population

CONTEXT

Mental health screening as a part of collegiate athletic preparticipation evaluations is becoming increasingly common, but effective and efficient screening depends on a screening tool that can accurately identify mental health symptoms and the need for mental health intervention.

DESIGN

Case-control study.

SETTING

Archival clinical records review.

PATIENTS OR OTHER PARTICIPANTS

Two cohorts of incoming National Collegiate Athletics Association Division I collegiate athletes (N = 353).

MAIN OUTCOME MEASURE(S)

Athletes completed the Counseling Center Assessment of Psychological Symptoms (CCAPS) Screen as a part of their preparticipation evaluation. These data were then matched with basic demographic data and mental health treatment history from clinical records, and the utility of the CCAPS Screen in determining a future or ongoing need for mental health services was analyzed.

RESULTS

Score differences for each of the 8 CCAPS Screen scales (Depression, Generalized Anxiety, Social Anxiety, Academic Distress, Eating Concerns, Frustration, Family Distress, and Alcohol Use) were found based on several demographic variables. Logistic regression analysis demonstrated that female sex, team sport participation, and the Generalized Anxiety scale score predicted future participation in mental health treatment. Decision tree testing of the CCAPS scales showed low utility in classifying those who received mental health treatment versus those who did not.

CONCLUSIONS

The CCAPS Screen did not appear to differentiate well between those who eventually received mental health services and those who did not. This should not be taken to mean that mental health screening is not useful but rather that a 1-time, state-based screening is not sufficient for athletes who experience intermittent but recurring stressors in a dynamic environment. A proposed model for improving the current standard of practice for mental health screening is provided as a focus of future research.

Sport and mental health performance optimization in an adolescent gymnast: A case evaluation

The Optimum Performance Program in Sports (TOPPS) is a multi-component, sport-specific Family Behavior Therapy that has demonstrated improved sport performance, relationships, and mental health outcomes in adult and adolescent athletes with, and without, diagnosed mental health disorders in clinical trials. The current case trial demonstrates successful implementation of a novel component of TOPPS (i.e., talk aloud optimal sport performance imagery leading to dream mapping) in a biracial Latina and White adolescent gymnast without a mental health diagnosis. The participant demonstrated significant improvements from baseline to both post-treatment and 3-month follow-up in severity of mental health functioning, factors interfering with sports performance, and her relationships with teammates, coaches, and family. Results suggest it may be possible to optimize mental health through sport performance optimization.

Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis

OBJECTIVE

To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight online databases (Embase, PsycINFO, SPORTDiscus, MEDLINE, Scopus, Cochrane CENTRAL, ProQuest Dissertations & Theses and Google Scholar), plus forward and backward searching from included studies and previous systematic reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they were randomised controlled trials (RCTs) that compared an MBP against a control, in current or former elite athletes.

RESULTS

Of 2386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBPs and 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g=-0.87, number of studies (n)=6, p=0.017, I ²=90) and stress (g=-0.91, n=5, p=0.012, I ²=74) and increasing psychological well-being (g=0.96, n=5, p=0.039., I ²=89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity.

CONCLUSION

MBPs improved several mental health outcomes. Given the moderate degree of evidence, high-quality, adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence and scalability within elite sport.

PROSPERO REGISTRATION NUMBER

CRD42020176654.

Symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada

The COVID-19 pandemic lockdown disrupted the university sports season and had negative consequences on the academic and personal life of university student-athletes, resulting in several psychological challenges. The goal of this study is to document the symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada. It aims to (a) assess the prevalence of mental illness symptoms (anxiety, depression, disordered eating, and dangerous drinking) among university student-athletes and (b) identify which sociodemographic and sports characteristics, pandemic impacts, and levels of perceived stress most influence these symptoms. A total of 424 university student-athletes completed an online survey, which included questions on mental illness and the impact of the pandemic lockdown. The results revealed a notable prevalence of the symptoms of mental illness; depressive symptoms are reported by 37.9% of the participants, anxiety symptoms by 24.9%, dangerous drinking symptoms by 10.1%, and disordered eating by 8.6%. In addition, being female [OR = 0.56, 95% CI (0.33, 0.95)] or a member of a visible minority group [OR = 2.63, 95% CI (1.02, 6.78)] are significantly associated with the presence of depressive symptoms. Low academic motivation has a significant negative influence on the presence of depressive [OR = 3.37, 95% CI (1.82, 6.25)] and anxiety symptoms [OR = 2.75, 95% CI (1.35, 5.62)]. However, the presence of perceived stress was strongly associated with depressive [OR = 7.07, 95% CI (3.26, 15.35)], anxiety [OR = 6.51, 95% CI (3.30, 12.84)], and dangerous drinking symptoms [OR = 5.74, 95% CI (2.51, 13.14)]. This study advocates for specific mental illness prevention and treatment resources tailored to the unique needs of university student-athletes. Accordingly, partnerships and practical interventions to support university student-athletes' mental health are presented.

Controlled Evaluation of a Sport-Specific Performance Optimization Program in a Biracial Black and White Athlete Diagnosed with Social Anxiety Disorder and Agoraphobia

There are a very limited number of sport-specific mental health and sport performance interventions available for athletes of color. This study examined The Optimum Performance Program in Sports (TOPPS) in a biracial adolescent athlete who was diagnosed with Agoraphobia and Social Anxiety Disorder. A multiple-baseline across behaviors case trial design was used to evaluate outcomes. A battery of psychological measures specific to mental health and sport performance was administered at baseline, post-intervention, and a 3-month follow-up. Social skill sets (i.e., positive assertion and negative assertion) were systematically targeted sequentially in a virtual format using HIPAA compliant video-conferencing technology to safeguard against contracting COVID-19. Results demonstrated improvement in negative and positive assertion skills when targeted by the intervention. Severity of concurrent symptoms associated with Social Anxiety Disorder and Agoraphobia Symptoms, general psychiatric functioning, relationships with coaches, teammates and family, and factors interfering with sports performance improved from pre- to post-intervention. These improvements were maintained at the 3-month follow-up. Athlete ratings indicated their satisfaction with TOPPS was high, and intervention components were implemented with high integrity.

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.

Compassionate Coach and Psychological Quality of Life in Portuguese Athletes: Effect of Mediating Variables

This study aimed to test a model that hypothesized that the compassionate coach, as perceived by the athletes, has an impact on athlete-related social safeness and psychological health, through shame and self-criticism. The sample comprised 270 Portuguese adult athletes, who practiced different competitive sports. The path analysis results confirmed the adequacy of the proposed model, which explained 45% of the psychological health’s variance. Results demonstrated that athletes who perceive their coaches as more compassionate tend to present higher levels of social safeness (feelings of belonging to the team) and of psychological health, through lower levels of shame and self-criticism. These novel findings suggest the importance of the adoption of supportive, warm, safe, and compassionate attitudes from coaches in athletes’ mental health. This study also offers important insights by suggesting that feelings of acceptance and connectedness in team relationships may be at the root of athletes’ emotional processes and well-being.

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes

Psychological interventions for child maltreatment have predominately been limited to family-supported, multi-component behavioral therapies. Although these comprehensive programs have resulted in positive outcomes, they are relatively costly and there is limited information available as to how the components of these programs influence treatment outcomes. In this study, the CBT components of an evidence-based treatment for child neglect and drug abuse (Family Behavior Therapy) were examined in regards to consumer preferences, consumer engagement and treatment outcomes. Thirty-five mothers identified for child neglect and drug abuse were administered various CBT components successively and cumulatively based on their preferences. Repeated measure ANOVAs indicated that participants chose to receive components that were specific to managing antecedents to drug abuse and child neglect most frequently, followed by parenting skills training, communication skills training, and job/financial skills training. No differences were found in treatment providers' ratings of the participants' engagement across intervention components throughout treatment. Participants rated the intervention components as similarly helpful. Partial correlations revealed that participants' ratings of helpfulness and provider ratings of participants' engagement were not associated with improved drug use outcomes at 6- and 10-months post baseline. Participants' ratings of helpfulness were associated with child maltreatment outcomes at 10-month post baseline, and provider ratings of participants' engagement were associated with child maltreatment outcomes at both 6- and 10-month post baseline. Participants identified for neglect not related to drug exposure in utero improved at a higher percentage than did participants identified for in utero drug exposure, and receiving behavioral intervention components more frequently led to greater percentages of participants improving in both drug use and child maltreatment outcomes.

Teammate influences, psychological well-being, and athletes' eating and exercise psychopathology: A moderated mediation analysis

OBJECTIVE

Positive and negative influences from teammates (e.g., supportive teammate friendships, modelling of teammates' disordered eating) have been associated with athletes' eating/exercise psychopathology. However, research is yet to explore how an athlete's psychological well-being and gender may impact upon these relationships. This study aimed to explore whether psychological well-being mediates the relationship between teammate influences and eating/exercise psychopathology, and to determine whether gender moderates the significant mediation effects identified.

METHOD

Athletes (N = 195, mean age 18.35 years, n = 110 female, n = 81 lean sport athletes) completed a survey three times over an 8-month period exploring teammate influences, psychological well-being (self-esteem, anxiety, depression) and eating/exercise psychopathology. Mediation and moderated-mediation analyses were conducted.

RESULTS

Higher levels of anxiety significantly mediated the positive relationships between bulimia modelling and teammate pressure with eating and exercise psychopathology. Higher levels of depression significantly mediated the positive relationship between teammate pressure and body dissatisfaction, and the negative relationship between supportive friendships and body dissatisfaction. Higher levels of self-esteem mediated both inverse relationships between supportive friendships and a lower drive for thinness (fully) and body dissatisfaction (partially). Gender did not significantly moderate any mediation relationships.

DISCUSSION

Male and female athletes with poor psychological well-being (i.e., high levels of anxiety or depression) are more susceptible to negative teammate influences, while athletes with good psychological well-being (i.e., high self-esteem) reap the protective benefits of supportive teammate friendships. Understanding the circumstances under which teammates are influential is vital for the development of targeted intervention and prevention strategies to reduce athlete eating and exercise psychopathology.

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

The current 'state of play' in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete's mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete's overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete's mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Effects of a Mental Health Intervention in Athletes: Applying Self-Determination Theory

Introduction: Many sport associations have responded to mental health issues in sport through the inclusion of self-management programs, such as mindfulness training, which may improve well-being through increasing one's competence in self-regulating stressors. Yet, the mechanisms accounting such changes lack a theoretical basis, particularly in athletes. Aim: To determine the effect of a mental health intervention comprising a mindfulness program for promoting well-being, reducing stress, and increasing competence in mental health self-management. This is the first study among athletes to test the mechanisms of change in a mindfulness program using Self-Determination Theory (SDT). Methods: A 2 (groups) × 2 (time-point) non-randomized controlled trial was conducted, and between-groups baseline differences were firstly assessed. Two competing regression models assessing singular and serial indirect mediating mechanisms were conducted, in which mindfulness (Model 1) and competence satisfaction (Model 2) were both tested as primary and secondary mediators predicting change scores in stress and well-being. Demographic variables (i.e., gender, age) were controlled for in the analyses. Results: Two hundred and thirty-eight student athletes (mean age = 20.47 years, SD = 3.30, 57.6% = males) participated, with 108 in the intervention group who received an instructional workshop, and a home-directed mindfulness program comprising daily meditation sessions. No baseline differences were found between intervention and control groups. In Model 1, mindfulness was not directly enhanced by the intervention, subsequently resulting in no indirect effects on competence, stress and well-being. In Model 2, the intervention was directly related to positive changes in competence (β = 0.39, p < 0.05), subsequently resulting in indirect effects on mindfulness awareness (β = 0.07, p < 0.05), stress (β = -0.06, p < 0.05), and well-being (β = 0.05, p < 0.05). In addition, serial indirect effects for the intervention on stress were present through competence and mindfulness awareness in sequence (β = -0.02, p < 0.05), and; on well-being through competence, mindfulness awareness, and stress in sequence (β = 0.01, p < 0.05; R 2 = 0.54). Conclusion: Mindfulness-based mental health interventions may be effective at reducing stress and promoting well-being in athletes, with the caveat that attention is given to the inclusion of mental health competence promotion in program design. However, it remains unclear whether increasing mindfulness itself can exert additional salutary effects. Our findings have an important bearing on how mindfulness programs are developed within athlete mental health interventions.

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.