Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study

Translation, Cross-Cultural Adaptation, and Validation of the Croatian Version of the Athlete Psychological Strain Questionnaire (APSQ)

The aim of this study is to translate, cross-culturally adapt, and validate the Croatian Athlete Psychological Strain Questionnaire (APSQ-Cro) as part of the Sport Mental Health Assessment Tool 1 (SMHAT-1) validation. We assessed the reliability and applicability of the APSQ-Cro among Croatian athletes. The international sports community is increasingly focused on mental health issues in athletes, highlighting the need for early detection tools like the Athlete Psychological Strain Questionnaire (APSQ) and SMHAT-1. We included 869 Croatian competing athletes across 54 sports who received a link to access the WEB-based questionnaire. The Croatian Olympic Board helped in distributing the questionnaires, aiming to reach as many and as diverse a group of registered competing athletes in Croatia as possible. Results showed a Cronbach's alpha of 0.75 for the entire questionnaire, indicating acceptable reliability. An exploratory strategy of factor analysis was used to determine the underlying structure of the APSQ-Cro. For this purpose, the Kaiser-Meyer-Olkin (KMO) test and Bartlett's test for sphericity were performed to ensure the suitability of the data. The KMO test ensured sampling adequacy, with a measure of 0.77 indicating suitability for factor analysis, while Bartlett's test confirmed significant correlations among variables (χ2 = 2779.155, df = 45, p < 0.001), validating the dataset's appropriateness for data reduction techniques. The factor analysis, together with the Cattell scree test and varimax rotation, resulted in a two-factor structure for the APSQ-Cro. Factor 1 included items related to internal psychological struggles, while Factor 2 included items related to external pressures from the athletic environment. These two factors explained 53% of the variability, with Cronbach's alphas of 0.75 and 0.88 for the respective factors. The APSQ-Cro is a valid and reliable tool for assessing distress in Croatian athletes. Croatian athletes' sporting experience will be improved with the broad adoption of the APSQ-Cro, which can help detect early signs of psychological distress and subsequently improve mental health outcomes.

High prevalence of harmful drinking habits and gambling among professional rugby players: mental health symptoms and lifestyle risks among New Zealand Super Rugby players-a cross-sectional survey

Objectives

Determining the prevalence of mental health and lifestyle risk factors (smoking, alcohol consumption, recreational drug use, gambling, family violence and anger management) in New Zealand (NZ) male professional rugby players.

Study design

Cross-sectional survey of mental health symptoms and lifestyle risk factors in male professional rugby players in NZ.

Methods

Players from all five NZ men's Super Rugby Franchises were invited to complete an online questionnaire (SportCHAT) measuring demographic status and mental health symptoms. Descriptive and interferential statistical analyses were used to identify the most prevalent mental health and lifestyle risk factors.

Results

105 players participated in the study (response rate 52.5%). 51.4% of players were either at moderate or high risk for alcohol-related harm (defined as potential health, social, legal or financial problems linked to alcohol consumption). In comparison, 4.8% reported recreational drug use and 5% reported smoking tobacco. Twenty players (19%) reported engaging in gambling, with five of these reporting problematic gambling. 21% of players reported symptoms of depression, but none reached the 'mild depression' threshold of the Patient Health Questionnaire for Depression. Younger players (aged 20-29) were more likely to report symptoms of depression than older players (aged 30-39). The prevalence of anxiety symptoms was 17.1%. 66.7% of these players reported minimal symptoms (GAD-7 score 0-4) and 33.3% reported mild symptoms (GAD-7 score 5-9). Family violence was reported by 2.9% of respondents, while 12.4% reported issues with anger management. There were no significant differences between ethnic groups.

Conclusion

There is a higher prevalence of alcohol misuse and gambling, but lower reported rates of depression and anxiety symptoms in this cohort when compared with the general population.

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population

BACKGROUND AND OBJECTIVE

Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population.

METHODS

A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools.

RESULTS

Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk.

CONCLUSION

This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors.

TRIAL REGISTRATION

PROSPERO Registration: CRD42023395990.

Health status of university football athletes through multidimensional screening

OBJECTIVE

Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated.

METHODS

Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties.

RESULTS

There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems.

CONCLUSION

More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations

Aim

This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide.

Methods

We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide.

Results

Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation.

Conclusion

The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.

Factors that influence mental health and well-being of high-performance athletes from Olympic or Paralympic sport who have transitioned out of national-level or international-level sport: a mixed methods approach

Transitioning out of elite sports can be a challenging time for athletes. To illuminate the gaps and opportunities in existing support systems and better understand which initiatives may have the greatest benefit in supporting athletes to transition out of elite sport, this study examined the lived experience of retired elite Australian athletes. Using a sequential mixed-methods approach, quantitative data were collected via a self-report online survey, while qualitative data were collected via semistructured interviews. In total 102 retired high-performance athletes (M=27.35, SD=7.25 years) who competed in an Olympic or Paralympic recognised sport at the national and/or international-level participated in the online survey, providing data across domains of well-being and athletic retirement. Eleven survey respondents opted in for the semistructured interview (M=28.9, SD=6.9 years) providing in-depth responses on their retirement experiences. Using partial least squares structural equation modelling (PLS-SEM), latent variables were identified from the survey data and associations between retirement support, retirement difficulties, retirement experiences, well-being and mental health were determined. Interview data were thematically analysed. The structural model had good predictive validity for all nine latent variables, describing positive and negative associations of retirement experiences, mental health and well-being. Building an identity outside of sport, planning for retirement, and having adaptive coping strategies positively impacted retirement experiences. Feeling behind in a life stage and an abrupt loss of athletic identity had a negative impact on retirement experiences. Implications for sports policymakers are discussed, including support strategies that could better assist athletes in successfully transitioning from elite sports.

Mental health literacy, mental health experiences and help-seeking behaviours of Chinese elite athletes: a qualitative study

Introduction

Elite athletes' help-seeking on mental health might be influenced by their mental health literacy (MHL) and mental health experiences. The current study aimed to explore the MHL, experiences and help-seeking behaviours among elite athletes using a qualitative approach.

Methods

Face-to-face semi-structured interviews were conducted among 20 Chinese elite athletes, 12 coaches, and 5 team officials. Interview data was analyzed using content analysis.

Results

Seven main themes emerged from the analysis. The current study revealed that Chinese elite athletes suffered from various mental health issues and athletes' MHL levels, help-seeking attitudes and intentions, Chinese sports environments, and Chinese cultural background could impact their help-seeking behaviours.

Conclusion

Support for Chinese elite athletes' mental health and help-seeking requires improvement.

Unmasking mental health symptoms in female professional football players: a 12-month follow-up study

Objective

To calculate the prevalence rates of mental health symptoms among female professional football players over a 12-month period and to explore the associations of severe injury and related surgery with mental health symptoms among female professional footballers.

Methods

An observational prospective cohort study was conducted over a 12-month follow-up period by distributing an electronic questionnaire three times. The questionnaire was based on validated screening tools for assessing mental health symptoms.

Results

A total of 74 female professional football players participated in this study. Mental health symptoms ranged from 1% for substance misuse to 65% for sport-psychological distress at baseline, from 6% for anxiety to 53% for sport-psychological distress 6 months postbaseline and from 3% for substance misuse to 55% for sport-psychological distress 12 months postbaseline. The prevalence of disordered eating remained between 15% and 20% over the 12-month period. Only one of the associations was statistically significant. Female professional football players were nearly twice as likely to report sport-related psychological distress following every surgery.

Conclusions

The substantial prevalence of mental health symptoms among female professional football players emphasises the need for increased attention, awareness and interventions. Additionally, female professional football players are nearly twice as likely to report sport-related psychological distress after each surgery. Sports medicine physicians and mental health professionals working in female football should provide standard care, which involves identifying, monitoring and implementing tailored interventions for mental health symptoms.

Basic psychological need satisfaction of collegiate athletes: the unique and interactive effects of team identification and LMX quality

Purpose

The present study sought to understand the relationships between team identification, leader-member exchange (LMX) quality, and the basic psychological need satisfaction of collegiate athletes, as well as the moderating role of coach-athlete LMX quality.

Methods

Self-reported data from 319 collegiate athletes were analyzed using SPSS version 29. The relationships between the study variables were tested by moderation analysis using PROCESS macro model 1.

Results

Regression analyses showed team identification to be positively related to the satisfaction of the needs for competence and relatedness, while LMX quality was positively related to the satisfaction of the needs for competence and autonomy. Furthermore, moderation analyses showed that LMX quality positively moderated the relationship between team identification and the satisfaction of the needs for competence and relatedness.

Conclusion

The results of this study highlight the important role that team identification and LMX quality play in the satisfaction of the basic psychological needs of collegiate athletes. The implications of these results for the optimal functioning of collegiate athletes are discussed.

Barriers To and Attitudes Toward Seeking Mental Health Services Among Collegiate Marching Band Artists

CONTEXT

Marching band (MB) artists experience stressors influencing their physical, mental, and emotional health warranting medical support, and they face challenges similar to those of other college students and athletes. Mental health illnesses exist in collegiate and MB settings, but barriers affect access to treatment.

OBJECTIVES

To examine MB artists' perceived barriers to and attitudes toward seeking care from mental health professionals. The secondary aim was to explore barriers to and attitudes about seeking mental health counseling between genders and history of pursuing mental health counseling.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 534 MB artists (women = 312, men = 222; age = 19.7 ± 1.4 years).

MAIN OUTCOME MEASURE(S)

Participants completed surveys on demographics and past medical history along with the Barriers to Help Seeking Checklist, the Attitudes Toward Seeking Professional Psychological Help-Short Form Scale (ATSPPH-SF), and the Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics were calculated to assess demographic data. Cross-tabulations and χ2 statistics were used to evaluate individual barriers (Barriers to Help Seeking Checklist) between genders. Scales were scored 1 to 7 and 10 to 30 on the MHSAS and ATSPPH-SF, respectively. A 1-way analysis of variance measured differences in the total mean score on the ATSPPH-SF between genders.

RESULTS

The highest barrier reported was lack of time to seek services (69.1%; n = 369), followed by 47.6% (n = 254) for services not available during my free time. Average scores were 4.0 ± 0.4 on the MHSAS (indicating neutral attitudes toward seeking help) and 17.97 ± 5.48 on the ATSPPH-SF (indicating slightly positive attitudes to seeking help). No differences were seen for the total mean scores on the MHSAS and ATSPPH-SF between genders.

CONCLUSIONS

Marching band artists' barriers to and attitudes toward mental health care influenced their ability to seek care in times of need and demonstrated some similarities to those of collegiate athletes. Awareness of the obstacles MB artists face in receiving mental health care will assist health care providers in advocating for improved care in this setting.

Variables e instrumentos para evaluar la salud mental en nadadores de competición: una revisión narrativa

Background

Mental health issues are becoming increasingly prevalent among elite athletes, and during the Tokyo 2020 Olympic Games, this issue became a pressing concern. In particular, several athletes complained about their mental health in relation to the highly demanding demands of their sport. High-performance swimming exposes athletes to a variety of stressors due to the physical, technical and mental demands of the sport. The study has carried out a narrative review of the main variables related to mental health, their dimensions and evaluations in competitive swimmers.

Methods

Clearly planned and ordered potential studies were identified using combined search methods. The search was carried out in different bibliographic databases (Dialnet, Web of Science and Scopus) between 1990 and 2023. Google Scholar was used to manually search the reference lists of the retrieved studies to identify potentially eligible studies that were not included in the electronic searches. The studies were examined from three different perspectives. Firstly, the methodology, sample, swimming categories and their relationship with mental health were analysed. Secondly, the variables related to mental health symptoms and disorders. Finally, the main mental health analysis tools and the conclusions of the studies.

Results

The concept of mental health in competitive swimmers needs to be clarified in the scientific literature, as different variables have been analysed and multiple instruments have been used with small samples of swimmers, without any intervention and prevention protocol. In addition, the bodies and institutions involved should work in an interdisciplinary and collaborative manner, establishing specific programmes to ensure effective prevention and care.

Conclusions

Studies are needed to fill this gap and it is necessary to work under the same consensus and in collaboration with specified technical teams. In order to monitor, evaluate and provide services through detection tests and support to swimmers in their training and competitions.

Impacts of the Early COVID-19 Pandemic on Depressive Symptoms and Mental Health Among Student-Athletes

Objective

Social distancing protocols due to the COVID-19 pandemic resulted in premature ending of athletic seasons and cancellation of upcoming seasons, placing significant stress on young athletes. Inability to play or forced early retirement has significant consequences on athlete's mental health, as demonstrated by an extensive body of injury literature. We hypothesize that premature suspension and cancellation of athletic events due to the COVID-19 pandemic leads to higher incidence of depressive symptoms among high-school and collegiate athletes. Further, athletes who strongly derive their sense of self-worth centered around athletics would have higher rates of depressive symptoms.

Methods

High school and collegiate athletes were evaluated for depressive symptoms, emotional health and athletic identity measures through validated assessment instruments from May 2020 through July 2020. The Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test (PROMIS-10 Depression CAT), Veterans RAND-12 (VR-12), which comprises both a physical and mental health component, and Athletic Identity Measurement Scale (AIMS) were utilized.

Results

Mental health assessments were completed by 515 athletes (52.4% male, 47.6% female; .84.5% collegiate, 15.5% high school). Female athletes scored significantly worse than males on VR-12 mental health assessments, as well as PROMIS-10 Depression scores; however, males scored significantly lower than females on VR-12 physical health assessments, irrespective of education level. Athletes who had strong associations with athletics as central to their personal identity exhibited worse psychologic impact on VR-12 mental health and PROMIS-10 Depression measures and female athletes in this cohort reported greater depressive symptoms than males.

Conclusion

Social distancing protocols due to the COVID-19 pandemic have limited athlete's ability to participate in sports at the training and competition level. Higher rates of depressive symptoms in high school and college athletes have resulted among female athletes and those who identify strongly as an athlete.

Athlete Mental Health and Wellbeing During the Transition into Elite Sport: Strategies to Prepare the System

The transition into elite-level sport can expose young athletes to risk factors for mental ill-health, including increased performance expectations, stressors associated with becoming increasingly public figures, and changes in lifestyle demands, such as diet, training loads and sleep. Successful integration into elite-level sport requires athletes to quickly adapt to these newfound challenges and the norms and culture of the new sport setting, while developing relationships with teammates, coaches, and support staff. Despite these demands, the mental health experiences of athletes transitioning into elite-level sport have been largely neglected in sport psychology literature. This is reflected in the dearth of programs for supporting mental health during this career phase, particularly relative to retirement transition programs. In this article, we offer a preliminary framework for supporting athletes' mental health during the transition into elite-level sport. This framework is based on holistic, developmental, and ecological perspectives. Our framework outlines a range of recommendations for promoting mental health and preventing mental ill-health, including individual-level, relational, sport-level, and sociocultural-level strategies. Key recommendations include preparing athletes for the challenges they are likely to face throughout their athletic careers, highlighting athletes' competence earlier in their careers, developing supportive relationships in the sport setting, and fostering psychologically safe sporting cultures. Supporting mental health from earlier in the athletic career is likely to promote athletes' overall wellbeing, support enjoyment and retention in sport, and encourage help-seeking.

Athlete mental health help-seeking: A systematic review and meta-analysis of rates, barriers and facilitators

Athletes are vulnerable to a range of mental health symptoms, in part due to stressors within the sport environment. An early intervention framework suggests the benefits of routine screening and referral for mental health, however, greater understanding around athlete help-seeking is needed to support referral uptake. This review examined rates of formal help-seeking behaviour as well as barriers and facilitators to help-seeking in sport settings. Relevant studies were retrieved from SportDiscus, PubMed and PsycInfo, with unpublished studies identified through contacting authors. Help-seeking rates were meta-analysed and barriers and facilitators were meta-synthesised. Twenty-two studies were included. Help-seeking rates were reported in 11 studies (N = 3415) and the pooled proportion of help-seeking was 22.4 % (95 % CI 16.2-30.2, I2 = 95.7 %). Barriers were reported in 13 studies and facilitators in six, highlighting a range of sporting-specific factors, such as stigma in relation to athlete identity and sport culture, fear of deselection, and concerns around confidentiality in sport settings, in addition to lack of awareness, low mental health literacy, and negative attitudes to services. Normalising experiences of mental health in sport settings, including through role models, was a key facilitator to help-seeking. Results provide implications for sport organisations to promote help-seeking and athlete mental health, such as through the use of role models, ensuring clarity around confidentiality, stigma reduction interventions, and fostering team cultures that promote mental health. Findings also support the value of sport staff in facilitating help-seeking, and organisational culture changes to foster wellbeing.

Mental Health Among Elite Youth Athletes: A Narrative Overview to Advance Research and Practice

CONTEXT

Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs).

EVIDENCE ACQUISITION

A narrative overview of the literature combined with the clinical and research expertise of the authors.

STUDY DESIGN

Narrative overview.

LEVEL OF EVIDENCE

Level 5.

RESULTS

EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility.

CONCLUSION

A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes "youth" and "elite" in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport.

SORT

Level C.

Australian elite sport coaches' mental health literacy of eating disorders, orthorexia, and muscle dysmorphia in athletes: A qualitative study

Athletes have an increased risk of developing eating disorders (EDs) compared to non-athletes. Coaches are in a unique position to identify symptoms and promote timely support; however, research has not yet explored coaches' mental health literacy about DSM-5 EDs and related orthorexia and muscle dysmorphia conditions in elite athletes. Eighteen Australian elite sport coaches from aesthetic, weight-class, and endurance sports participated in individual semi-structured interviews to investigate their mental health literacy of EDs and related conditions. Four themes emerged from the data. Theme 1 (knowledge of EDs and related conditions) highlighted coaches' awareness of maladaptive perfectionism as a key risk factor, limited awareness of EDs without observable weight loss, and conceptualisation of EDs as a nutritional issue. Theme 2 (facilitators to managing EDs) highlighted the helpfulness of building trust with athletes, accessing support staff, emphasising body functionality, and lived experience. Theme 3 (barriers to managing EDs) highlighted coaches' challenges with communicating about body image, responding to denial, and funding constraints. Theme 4 (future ED education and training) highlighted coaches' desire for in-person, interactive training and to support junior-level coaches. These findings may assist in developing tailored educational resources to improve coaches' ability to identify and manage eating-related concerns in athletes.

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.

How Mental Health Affects Injury Risk and Outcomes in Athletes

CONTEXT

The importance of mental health among athletes is becoming more recognized and valued. Athletes experience symptoms of depression, anxiety, and related mental health disorders at rates similar to those of the general population, but because athletes face unique cultural and environmental pressures, such disorders are exacerbated in the context of an injury. Furthermore, we review the less well-known evidence that mental health disorders in athletes are associated with an increased risk of injury. We discuss the increasing awareness of the deficiencies in mental health support for athletes, which has been especially highlighted during the COVID-19 pandemic as well as in prominent professional and Olympic athletes, and describe both internal and external barriers to appropriate care.

EVIDENCE ACQUISITION

We searched PubMed for pertinent peer-reviewed studies.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

There is a known psychological response to injury that can prolong recovery from musculoskeletal injury; conversely, mental health disorders in athletes are not only associated with an increased injury risk but also portend poorer outcomes subsequently, including prolonged recovery times, increased rates of injury recurrence, decreased rates of return to sport, and reduced performance upon return. Because of inherent barriers to appropriate care of athletes, including identification, stigma, and resource availability, there are currently various ongoing efforts nationally to create and implement initiatives regarding athlete mental health screening, support systems, and directed interventions to address the inextricably linked physical and mental health of athletes.

CONCLUSION

Athletic injury negatively impacts the mental health of athletes. Likewise, mental health can and does influence athletic performance and is also intimately tied to the risk of athletic injury, thus creating a complex cycle with inability to separate physical and mental health.

Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships

OBJECTIVE

To assess health problems and training environment of female golfers participating in the 2022 World Amateur Team Championships (WATC) and to compare golfers (a) with and without health problems prior the WATC and (b) living and training in countries ranking in the upper versus lower 50% of the team results at the 2022 WATC.

DESIGN

Cross-sectional cohort study using an anonymous questionnaire.

SETTING

International Golf Federation WATC.

PARTICIPANTS

One hundred sixty-two female golfers from 56 countries.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Golfers' answers on the presence and characteristics of health problems, their training environment, and to the Oslo Sport Trauma Research Centre Questionnaire.

RESULTS

Almost all golfers (n = 162; 96%) answered the questionnaire. In the 4 weeks before the WATC, 101 golfers (63.1%) experienced 186 musculoskeletal complaints, mainly at the lumbar spine/lower back, wrist, or shoulder. Just half of the golfers (50.6%) performed injury prevention exercises always or often. More than a third (37.4%) of the golfers reported illness complaints and 32.5% mental health problems in the 4 weeks preceding the WATC. General anxiety, performance anxiety, and low mood/depression were the most frequent mental health problems. Golfers with injury complaints rated their daily training environment poorer. Golfers ranking in the lower 50% at the WATC had significantly less support staff, rated their training environment poorer, and had a higher prevalence of illness complaints and mental health problems.

CONCLUSIONS

Effective illness and injury prevention programs should be implemented and better access to education and health support in the daily training environment provided.

Mindfulness and impulsive behavior: exploring the mediating roles of self-reflection and coping effectiveness among high-level athletes in Central China

Introduction

In the highly competitive field of sports, impulsive behavior by athletes not only threatens personal and team harmony but also poses significant risks to their careers and public image. Despite these behaviors often becoming the focus of public attention, their underlying causes and prevention strategies remain relatively unknown. This study delves deep into the impact of mindfulness on athletes' impulsive behavior, revealing the mediating roles of self-reflection and coping effectiveness.

Methods

Using a combination of snowball and convenience sampling, a sample of 403 athletes from high-level sports teams in the Central China region participated in a questionnaire survey. The data were analyzed using Amos v.23 software.

Results

The findings indicate a positive correlation between mindfulness and coping effectiveness (standardized coefficient = 0.336, p < 0.001), as well as between self-reflection and coping effectiveness (standardized coefficient = 0.406, p < 0.001). There is a negative correlation between coping effectiveness and impulsive behavior (standardized coefficient = -0.476, p < 0.001). The positive impact of mindfulness on impulsive behavior (standardized coefficient = -0.371, p < 0.01) is mediated by self-reflection and coping effectiveness. The explanatory power of this study is R2 = 0.35.

Discussion

Mindfulness reduces impulsive behavior by enhancing self-reflection capabilities and improving coping effectiveness. Based on these substantive research results, to mitigate impulsive behavior in athletes, it is recommended that the National Sports Administration and coaches actively implement mindfulness training. Additionally, targeted psychological intervention strategies should be developed to enhance athletes' mental health levels and optimize their sports performance.

Coping strategies for handling stress and providing mental health in elite athletes: a systematic review

Background

The combination of stressors unique to the athletic context plus the sensitive developmental phase that elite athletes go through during their peak performance may increase the athletes' vulnerability to mental health decrements. To emphasize the necessity to raise elite athletes' awareness of health risks, it seems to be essential to teach them coping skills to handle stress and to make affected athletes aware of how to recognize, evaluate, and articulate potential risks to their health.

Objective

This systematic review analyzes coping strategies used by elite athletes to deal with stress and the effect of these strategies on mental health to identify gaps that future research could prioritize.

Methods

The current review analyzes studies containing quantitative, qualitative, and mixed data and results, all of them focusing on coping strategies to deal with stress and the effect of coping strategies on elite athletes' mental health. Literature search for this systematic review took place between August and October 2023 and included the use of 3 electronic databases: PubMed, PsychINFO, SPORTdiscus.

Results

There were initially 5,705 hits from 3 electronic databases, hand search and from a complementary search in Google Scholar. After the screening process and quality appraisal 30 studies were included. The analyzed study results point to a broad spectrum of coping categories, elite athletes make use of to deal with stressful situations. The results of this review underpin the necessity that especially young athletes being confronted with a wide range of stressors, need to be taught mental skills to cope with these stressors. In addition, teaching coaches and teammates about social support seemed to decrease elite athletes' stress reactions, such as anxiety or depressive symptoms.

Conclusion

Coping in elite sporting settings is very complex and dynamic. There is evidence of coping being effective to buffer stress, but the interrelationships between stressor, appraisal of the stressor, application of a corresponding coping strategy and its effect especially in terms of mental health outcomes is still unclear because of lacking intervention-based study designs.

Beyond a Game: A Narrative Review of Psychopathic Traits in Sporting Environments

There has been a growing interest around the broader effects of psychopathic traits, particularly in relation to deviant behaviors and the notion of so-called "successful psychopathy". As significant sociocultural touchstones, sporting events are often characterized by competitiveness and a sense of prestige. However, there has been limited attention towards psychopathic traits across recreational, amateur, and elite sports. Accordingly, we conducted a narrative review synthesizing primary observations on this topic, searching keywords in Scopus, APA PsychNet, and PubMed. Twenty-four academic papers were included in our results, which we thematized around demographic groups, namely: athletes and sport-adjacent non-athletes (i.e., coaches and spectators). Based on empirical findings from the reviewed papers, psychopathic traits could have medicolegal and forensic implications in relation to substance use, aggression, and violence. These could intersect with wider issues around doping, cheating, foul play, and have adverse outcomes for fellow participants, team dynamics, and spectators. Interestingly, our review also indicates that psychopathic traits may have correlations with determination and achievement in sport, echoing developing ideas around "successful psychopathy" in other domains. As such, increased awareness from all stakeholders and further multidisciplinary exchanges are vital to better understand the effects of psychopathic traits in sporting frameworks and their wider consequences.

Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance

In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement.In response to a paucity of epidemiological data on athlete mental health, the IOC mental health working group adapted the IOC consensus statement on injury and illness surveillance to improve the capturing of athlete mental health data. In addition to the members of the working group, other experts and athlete representatives joined the project team to address gaps in expertise, and to add stakeholder perspective, respectively. Following an in-person meeting, the authors worked remotely, applying the scientific literature on athlete mental health to the IOC injury and illness surveillance framework. A virtual meeting was held to reach consensus on final recommendations.Practical outcomes based on the analysis of the scientific literature are provided with respect to surveillance design, data collection and storage, data analysis and reporting of athlete mental health data. Mental health-specific report forms for athlete and health professional utilisation are included for both longitudinal and event-specific surveillance.Ultimately, this publication should encourage the standardisation of surveillance methodology for mental health symptoms and disorders among athletes, which will improve consistency in study designs, thus facilitating the pooling of data and comparison across studies. The goal is to encourage systematic surveillance of athlete mental health.

Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer

CONTEXT

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited.

OBJECTIVE

To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care.

DESIGN

Qualitative study.

SETTING

Individual interviews.

PATIENTS OR OTHER PARTICIPANTS

Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed.

DATA COLLECTION AND ANALYSIS

Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes.

RESULTS

CONCLUSIONS

Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

The effect of web-based educational interventions on mental health literacy, stigma and help-seeking intentions/attitudes in young people: systematic review and meta-analysis

OBJECTIVES

This study aims to provide a systematic review and meta-analysis of the literature on The Effect of Web-Based Educational Interventions on Mental Health Literacy, Stigma and Help-seeking intentions/attitudes in young people.

METHODS

Articles in English published between April 1975 and February 2023 were retrieved from seven databases, leading to a total of 2023 articles identified.

RESULTS

20 studies were included after applying exclusion criteria, 10 of which were eligible for meta-analysis. Results showed that web-based educational interventions had a significant positive effect on mental health literacy knowledge (SMD = 0.70, 95% CI = [0.16, 1.25]), but not on stigma (SMD = -0.20, 95% CI = [-0.48, 0.08]) or help-seeking intentions/attitudes (SMD = 0.48, 95% CI = [-0.50, 1.46]).

CONCLUSION

This study reviewed and analyzed the effect of web-based educational interventions on mental health literacy, stigma, and help-seeking intentions/attitudes among young people. The results showed that web-based educational interventions improved mental health literacy knowledge, but not stigma or help-seeking outcomes. The study suggested several recommendations to enhance the effectiveness of web-based educational interventions on stigma and help-seeking outcomes, such as using more rigorous designs and methods, more comprehensive and multifaceted interventions, more tailored and targeted interventions, and more collaborative and participatory approaches. The study concluded that web-based educational interventions may have a greater impact on reducing stigma and promoting help-seeking among young people, which may ultimately lead to better mental health outcomes and well-being for this population.

Associations between dimensions of mental health literacy and adolescent help-seeking intentions

BACKGROUND

The majority of long-term mental health problems begin during adolescence. Low mental health literacy (MHL) may impede help-seeking for these problems. Although MHL is a multidimensional construct and adolescent help-seeking can be through formal and informal means, little is known about how dimensions of MHL influence these help-seeking intentions. This study examines associations between dimensions of MHL and formal and informal help-seeking intentions among adolescents. It also investigates whether informal help-seeking mediates the association between dimensions of MHL and formal help-seeking, and whether these associations are moderated by gender.

METHODS

A cross-sectional survey including measures of MHL, and help-seeking intentions was distributed to participants in 10 schools (12-17 years) across Scotland (n = 734). Data were analysed using Confirmatory Factor Analyses (CFA) and Structural Equation Modelling (SEM).

RESULTS

Confirmatory Factor Analyses identified two distinct dimensions of MHL: ability to identify a mental health problem, and knowledge of treatment efficacy. Only knowledge of treatment efficacy was associated with increased intention to seek formal and informal help. Ability to identify a mental health problem was negatively associated with both forms of help-seeking intentions. Informal help-seeking mediated the association between both forms of MHL and formal help-seeking. Gender did not moderate the associations between MHL and help-seeking.

CONCLUSIONS

Care should be taken when providing MHL interventions to ensure that adaptive forms of MHL are promoted. Future research should investigate possible mechanisms by which discrete forms of MHL influence adolescent help-seeking as well as investigating other potential moderators of MHL and help-seeking, such as stigma.

Barriers to and Facilitators of Collegiate Athletes Seeking Mental Health Services

CONTEXT

Approximately 1 in 5 student-athletes experience some type of mental health concern. However, fewer than half of student-athletes who report mental health concerns seek mental health treatment (ie, psychotherapy or medication). Data concerning barriers to student-athletes seeking mental health care are limited but suggest that stigma is the primary reason. Further, whether having shared identities with their sport psychologists (eg, race and gender) encourages student-athletes to seek help has been minimally explored.

OBJECTIVES

To determine the frequency of internal and external barriers to athletes seeking mental health care and examine the importance of athletes and sport psychologists sharing identities as a facilitator of seeking help.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

A total of 266 student-athletes (53.8% women, 42.5% White) from a National Collegiate Athletic Association Division I university.

MAIN OUTCOME MEASURES

Student-athletes responded to 9 binary (yes or no) prompts related to internal barriers (eg, beliefs and attitudes about mental health) and 7 reflecting external barriers (ie, different stakeholders, such as the head coach). Regarding facilitators of mental health help-seeking, student-athletes rated how important it was for them to share each of 10 identities with their sport psychologist from 1 (not at all important) to 5 (extremely important). All identified barriers and facilitators were derived from existing research.

RESULTS

Differences were found in athletes' ratings of internal and external barriers. For example, a belief in one's own reliance and not having enough time were significant barriers, as was their head coach having a negative attitude about the importance of mental health. Female student-athletes rated sharing a gender identity with their sport psychologist as more important than did male student-athletes.

CONCLUSIONS

Despite efforts by the National Collegiate Athletic Association to reduce the stigma surrounding mental health, persisting barriers within collegiate sports may keep athletes from seeking help.

Clinical Commentary: Depression and Anxiety in Adolescent and Young Adult Athletes

Mental health (MH) symptoms and disorders are common in adolescents and young adults, and athletes may be at risk due to sport-specific triggers such as injury or illness as well as stressors related to performance, transition, or retirement from sport. Anxiety and depression are reported frequently in this age group, and early recognition and treatment can improve outcomes. The medical team (eg, athletic trainers or therapists, team physicians) should be familiar with the symptoms of depression and anxiety, recognize "red flags" for these symptoms and disorders, and seek to provide screening assessments and develop MH plans and MH emergency action plans. As a part of their scope of practice, team physicians should have the initial assessment and management of patients with these MH conditions and appreciate the importance of referrals to other MH providers with expertise caring for athletes. Athletic trainers are often the first point of contact for athletes who may be experiencing MH symptoms and therefore play a key role in early recognition and referrals to team physicians for early diagnosis and treatment. Additional resources that provide more in-depth information regarding the treatment and management of anxiety and depression are provided herein.

Mental Health in the Specialized Athlete

PURPOSE OF REVIEW

The aim of this review is to interpret the existing evidence regarding the psychological aspects of sport specialization within the context of a developmental framework.

RECENT FINDINGS

The growing trend toward early sport specialization is associated with increased risk for injury and burnout, both of which have significant implications for mental health. Mental health literacy programs designed to promote awareness, decrease stigma, and encourage help-seeking behaviors can be an effective way to increase resilience and early recognition of those in need. The trend toward early sport specialization is likely motivated in large part by the expectation that it will increase the likelihood of long-term athletic success. However, recent studies suggest that the majority of elite athletes delay specialization at least until mid to late adolescence. It is essential to consider the developmental psychology of children and adolescents and to avoid imposing expectations that are beyond their neurocognitive capabilities. In addition to depression, anxiety, and burnout, young athletes who are pressured to perform to excessively high standards are likely to internalize athletic failures as feelings of shame. This can lead to maladaptive perfectionistic traits and potentially overtraining, clinical eating disorders, or other harmful behaviors that will result in declines in performance, physical health, and overall wellbeing. Further work is needed to better inform sport-specific recommendations regarding sport specialization and to optimize the beneficial effects of sport participation while limiting the risks of harm.

Engaging Older Adolescent Boys Into School-Based Mental Health Workshops: Testing Theory-Based Facilitators and Barriers in Focus Groups

Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.

Prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of German first and lower leagues

BACKGROUND

While several studies on mental health of elite athletes were published in recent years, few compared the prevalence with the general population and none included field hockey players.

AIMS

To analyze the prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of different skill levels and to compare it to the general population.

METHODS

Male and female hockey players from different leagues were asked to answer questions on player characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7).

RESULTS

One hundred and eighty-seven players (incl. 54 first and 28 second league players) participated in the study (response rate 97.4%). More than a third (n = 64; 35.0%) reported to be affected by an injury/health complaint, but 157 (86.3%) were able to train and play without limitations. The CES-D score indicated depression symptoms in more female (n = 15; 18.3%) than male (n = 5; 4.8%) players (χ2=8.8; p < 0.01). No male and one female player had symptoms of generalized anxiety disorder. Players who played 60 or more matches in the previous 12 months had on average significantly higher depression (t = 2.3; p < 0.05) and generalized anxiety scores (t = 4.2; p < 0.001) than players who played fewer matches. The prevalence of depression and of generalized anxiety symptoms was similar to or lower than in the general population. Although 20 (10.7%) players had depression symptoms, only 4 (2.2%) received psychological counseling or psychotherapy.

CONCLUSION

It is recommended to provide routine screening of mental health problems and low-threshold access to adequate treatment for elite athletes.

Initial examination of the mental health disorders: screening instrument for athletes

Introduction

There is a need to psychometrically develop assessment instruments capable of screening mental health disorders in athlete populations. The current study was conducted to determine reliability, validity and clinical utility of the Mental Health Disorders Screening Instrument for Athletes (MHDSIA).

Methods and results

259 collegiate athletes completed the MHDSIA. Factor analysis determined a single factor with good internal consistency, and this factor was positively correlated with an established measure of psychiatric symptomology (Symptom Checklist 90-R), demonstrating its concurrent validity. An optimum clinical cutoff score (i.e., 32) was determined using Receiver Operating Characteristic (ROC) analyses to assist appropriate mental health referrals.

Discussion

Results suggest the MHSIA is a reliable, valid, and relatively quick and easy to interpret screen for the broad spectrum of mental health disorders in collegiate athletes. As expected, NCAA athletes reported lower MHDSIA scores than club and intramural athletes, while males reported similar severity scores as females.

Understanding the role of coaches in supporting the mental health of elite athletes

OBJECTIVES

Elite sport coaches often rely on their discretion when assisting athletes struggling with mental health, with clear guidelines yet to be broadly adopted. This study aimed to explore how coaches perceive their role in athlete mental health and their role clarity.

DESIGN

This study employed a descriptive qualitative approach with semi-structured interviews.

METHODS

17 Australian elite level swimming coaches were interviewed, focusing on their perceived experiences with athlete mental health and any discrepancies between what their role is currently and what they perceive it should be. Thematic analysis was used to analyse results.

RESULTS

Analysis revealed that coaches perceive their role to include open communication, actively observing their athletes' mood, and acknowledging their potential mental health knowledge deficits. They also indicated a lack of clarity for when to refer an athlete on to a medical professional. Athletes were perceived as responsible for maintaining self-awareness and help-seeking, whilst the organisational role included providing education and funding. Barriers for supporting athlete mental health included a lack of resources and poor mental health literacy. Coaches suggested a variety of recommendations to ameliorate these barriers including education and redesigning systems of support.

CONCLUSIONS

Australian swimming coaches would greatly benefit from formal guidelines on how to identify, manage, and support athlete mental health. These guidelines should be established with input from coaches and key staff, in addition to clinical professionals and utilising evidence-based measures, including consideration of boundaries around coaches as non-mental health professionals.

Considerations for Developing a Mental Health Emergency Action Plan for High School Football Programs and Athletic Departments

High school students in the United States are being educated during an unprecedented time of social unrest, public health concerns, and gun violence. High school student athletes can be further challenged by sports-related stressors that may lead to anxiety, burnout, depression, disordered eating, sleep difficulty, performance-based identity concerns, and substance use. High school football players, in particular, are at higher risk of concussion, musculoskeletal injury, and may feel excess pressure to compete from coaches, parents, and peers. One way to address these stressors among high school student athletes is to increase athletic department staff members' awareness of the symptoms of mental health disorders. Increased awareness helps staff members recognize when an athlete is in crisis, as well as respond with an established mental health emergency action plan as needed. In this review article, the authors provide a blueprint by which high school personnel can more readily identify and respond to mental health emergencies among student athletes.

Supporting The Mental Health Of Elite-Level Coaches Through Early Intervention

Current evidence indicates that elite-level coaches encounter a range of performance, organizational, and personal stressors that may influence or compromise mental health. With exposure to these stressors, supports need to be established to protect and preserve the mental health of elite-level coaches. Given the paucity of evidence available, this article proposes a number of considerations that should be taken into account when developing a mental health and rehabilitation framework for high-performance coaches. We argue that early intervention should be positioned at the core of this framework, to address the onset of symptoms prior to the emergence of a mental disorder or mental health crisis. Mental health screening and monitoring of coaches, the psychological safety of high-performance environments, the mental health literacy of coaches, and the tailored pathways to support are discussed. Beyond these strategies, it is proposed that rehabilitation and reintegration should be addressed to assist coaches who are currently experiencing mental ill health or have left their role due to mental health reasons. Although further research is needed to implement evidence-based strategies, it is recommended that a future mental health framework should incorporate the perspectives of coaches to ensure it is consistent with their needs and experiences.

"Knowing the Noise That Surrounds the Athlete": A Qualitative Study Exploring the Health-Seeking Behaviors of Athletes With Limb Deficiency Drawing on the Experiences and Perceptions of the Medical Staff and Athletes

OBJECTIVE

The aim of the study is to explore the health-seeking behaviors of athletes with limb deficiency, drawing on the experiences and perception of the sports medicine team and athletes.

DESIGN

The study used an interpretive hermeneutic phenomenological methodology with a subtle realist paradigmatic view to investigate commonality in unique experiences within reality. Data collection was completed with two focus groups in December 2019 and March 2020. Thirteen participants took part including athletes and sports medicine team members (physiotherapists, doctors, and strength and conditioning coaches) working in parasports. Focus group manuscripts were transcribed verbatim from audio recordings. An inductive, iterative process was used to identify themes and subthemes, with processes in place to establish rigor.

RESULTS

Two themes and five subthemes emerged in relation to the "internalization and adjustment to social identity" and "the importance and impact of factors, which impact the athlete social identity."

CONCLUSIONS

Health-seeking behaviors of athletes with limb deficiency were influenced by a unique blend of personal and environmental factors that contribute toward social identity. The sports medicine team require specific awareness of factors that may diminish health-seeking behaviors to deliver a personalized approach and negate consequences.

Theory of Planned Behavior and Active Duty Air Force Members' Mental Health Help-Seeking

INTRODUCTION

Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members.

MATERIALS AND METHODS

The 2017 Air Force Community Feedback Tool was used for this study. This confidential survey was completed by a large sample of the military population (N = 10,705). The survey was used to examine relationships between the TPB-related variables and respondents with mood problems identifying a need for professional counseling, seeking MH services, and reporting that the services met their needs. Multiple linear and binary logistic regression models were utilized to analyze findings from this sample.

RESULTS

This study highlights how attitudes, subjective norms, and perceived behavioral control impact help-seeking behavior for these individuals. Findings include the MH providers' good reputations, wait times for services, ease of access to care, and negative experiences with supervisor permission, all of which showed a statistically significant impact on help-seeking behavior. Dependent variables included "I need professional counseling," "I contacted a MH care provider in the past year to try to meet this need," and "How much the MH care provider helped you meet your needs." Each of these variables had statistically significant relationships with the connecting variables of the TPB.

CONCLUSIONS

Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.

Sleep Profiles in Eating Disorders: A Scientometric Study on 50 Years of Clinical Research

Sleep and diet are essential for maintaining physical and mental health. These two factors are closely intertwined and affect each other in both timing and quality. Eating disorders, including anorexia nervosa and bulimia nervosa, are often accompanied by different sleep problems. In modern society, an increasing number of studies are being conducted on the relationship between eating disorders and sleep. To gain a more comprehensive understanding of this field and highlight influential papers as well as the main research domains in this area, a scientometric approach was used to review 727 publications from 1971 to 2023. All documents were retrieved from Scopus through the following string "TITLE-ABS (("sleep" OR "insomnia") AND ("anorexia nervosa" OR "bulimia nervosa" OR "binge eating" OR "eating disorder*") AND NOT "obes*") AND (LIMIT-TO (LANGUAGE, "English"))". A document co-citation analysis was applied to map the relationship between relevant articles and their cited references as well as the gaps in the literature. Nine publications on sleep and eating disorders were frequently cited, with an article by Vetrugno and colleagues on nocturnal eating being the most impactful in the network. The results also indicated a total of seven major thematic research clusters. The qualitative inspection of clusters strongly highlights the reciprocal influence of disordered eating and sleeping patterns. Researchers have modelled this reciprocal influence by taking into account the role played by pharmacological (e.g., zolpidem, topiramate), hormonal (e.g., ghrelin), and psychological (e.g., anxiety, depression) factors, pharmacological triggers, and treatments for eating disorders and sleep problems. The use of scientometric perspectives provides valuable insights into the field related to sleep and eating disorders, which can guide future research directions and foster a more comprehensive understanding of this important area.

The relationship between depression, healthy lifestyle behaviors and internet addiction: a cross-sectional study of the athlete university students in Turkey

Introduction

Mental health research exists for university students in the areas of prevalence and association of depression, internet addiction and healthy lifestyle behaviors. However, the studies examining prevalence rates and these relationships in athlete university students are needed. This study aimed to evaluate the relationship between depression, healthy lifestyle behaviors and internet addiction among athlete university students in Turkey.

Methods

A cross-sectional design was conducted, measuring depression using the Center for Epidemiologic Studies Depression Scale, healthy lifestyle behaviors (HPLP-II), and internet addiction (YIAT-SF). Predictive factors associated with depressive symptoms were estimated using binary logistic regression.

Results

Of the 501 participants, 61.3% were male, with a mean age of 21.45 years (SD: 3.19). Student-athletes were at risk of depressive symptoms (76.4%), internet addiction (34.4%) and had moderate healthy lifestyle behaviors (130.41 ± 22.93). No significant differences were found for age, smoking, time spent on social network, number of sports days, number of social networks use for depressive symptoms (p > 0.05), however significant differences were found for depressive symptoms by sex and living with family status (p < 0.05). Pathological internet addiction (OR: 12.74, 95% CI: 2.91-55.77) and low spiritual growth (OR: 0.854, 95% CI: 0.79-0.92) were found to be predictors of depressive symptoms within the athlete university students (p < 0.001).

Conclusion

The athlete university students are at increased risk for depressive symptoms and internet addiction and decreased healthy lifestyle behaviors. It is essential to establish programs to improve the mental health of students in universities and to strengthen the psychological counseling services offered to students. These findings can assist universities in establishing effective measures to improve mental health outcomes.

Mental health help-seeking preferences and behaviour in elite male rugby players

Objectives

Mental health symptoms and mental illnesses are common in elite athletes. There is an urgent need to develop care systems to support the mental health of elite athletes. Understanding elite athletes' preferences in mental health help seeking can help explore strategies to develop such systems. Therefore, this study aims to investigate with whom/where elite athletes feel comfortable discussing mental health concerns and seeking help.

Methods

We analyse data from 219 Japanese male rugby players out of 612 players (565 Japanese, 47 foreigners) aged 18 and over who belong to the Japan Rugby Players Association using a cross-sectional design and an anonymous, web-based, self-administered questionnaire. In the questionnaire, the players are asked to rate on a 5-point Likert scale how comfortable they feel talking about their mental health concerns with affiliation/team staff, family/relatives, friends, mental health professionals, rugby-related seniors and teammates. Analysis of variance and Dunnett's test are performed to detect differences in their preferences for sources of help.

Results

Dunnett's test shows that the mean scores for preferring to consult affiliation/team staff are significantly lower than for all the other groups (p<0.001), indicating that players are reluctant to seek help for mental health concerns from affiliation/team staff. Fewer players sought help from affiliation/team staff or mental health professionals than from other groups.

Conclusion

Regarding mental health concerns, for elite male rugby players as elite athletes, it can be difficult to ask for help or talk to team staff.

The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study

BACKGROUND

Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person.

OBJECTIVE

This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking.

METHODS

This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey.

RESULTS

The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user's parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being.

CONCLUSIONS

The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68.

Ecological Factors of Telemental Healthcare Utilization Among Adolescents with Increased Substance Use During the COVID-19 Pandemic: The Moderating Effect of Gender

Background

Adolescent substance use is often associated with concurrent mental health problems (e.g., depression, suicide attempts, parental emotional and physical abuse, not feeling close to people at school, and lower virtual connectedness) at multiple ecological levels.

Objective

This study examined whether such risk factors among adolescents were associated with the use of telemental healthcare (TMHC) and whether gender moderated these associations.

Methods

Data were drawn from the Adolescent Behaviors and Experiences Survey, collected by the U.S. Centers for Disease Control and Prevention from January to June 2021. A hierarchical multiple logistic regression analysis was conducted using a national sample of 1,460 students in Grades 9-12 in the United States who reported having used more alcohol and/or drugs during the pandemic than before it started.

Results

The results showed that only 15.3% of students sought TMHC. Students reporting increased substance use during the pandemic were more likely to use TMHC if they experienced more severe mental health problems (e.g., suicide attempts) compared to other ecological factors, such as issues with their family, school, or community. Analysis of the moderating effect showed that the closer male students felt to people at school, the more likely they were to seek TMHC, whereas the opposite was true for female students.

Conclusions

The findings highlighted that feeling close to people at school is an important aspect of understanding the help-seeking behavior of female and male adolescent substance users.

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

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

Go, go …. You'll be happier. Psychological variables among cyclists during COVID-19 lockdowns

COVID-19 lockdowns involved radical changes in the habits and lifestyles of many. Notably, athletes saw their training routines altered. The relationship between lockdown effects and psychological variables was analysed using a sample comprising 1032 cyclists (average age: 42.97 years, s.d. = 8.94), taking part in the first cycling competition after lockdown. The target variables included psychological variables such as frustration tolerance, subjective vitality, autonomy self-determination, and affective status, as well as sociodemographic and training habits-related variables. The results showed that the constructs under analysis are related. Pre- and post-competition psychological variables were measured, and no significant differences were detected, except concerning subjective vitality. A regression analysis model was designed to analyse the impact of frustration tolerance, autonomy self-determination, and affective status on subjective vitality. The results reveal a lineal relationship (F = 71.789, p < .001) between subjective vitality and a set of independent variables: positive affects; health status; km of training per year; and frustration tolerance, which explain 46.7% of variance. Finally, since the variable that measures subjective vitality was shown to be significant, mediation analyses were undertaken to answer our hypothesis, following the results of the exploratory analysis. The results suggest that frustration tolerance has a direct effect on subjective vitality, and that this relationship is mediated by positive affects, health status, and km of training per year. It is concluded that exercising increases subjective vitality, which is affected by frustration tolerance, positive affects, health status and km of training per year. In addition, it can be argued that these three variables mediate the relationship between frustration tolerance and subjective vitality. Finally, it is worth stressing that, given the positive effects of exercise not only in physical health but also in psychological, social and personal wellbeing, self-determined attitudes in training should be encouraged, as this promotes self-efficacy and self-satisfaction, in both training and competition settings.

Mental Health Awareness and Counseling Practice of Jamaican Clergy: An Exploratory Study

Clergy play a vital role in mental health care in Jamaica but little is known about their mental health awareness and practices. Thirty five Anglican and Baptist clergy were compared to 24 helping professionals and 67 community members using purposive sampling. Clergy's awareness exists with spiritualized beliefs about the etiology of mental illness as well as with effective and unethical counseling practices. Findings indicate the need for more training in mental health sensitization and practice.

Vested in support: Applying vested interest theory to increase support for close others with depression

Guided by vested interest theory, we assessed whether a lack of stake explains the discrepancy between people having positive attitudes toward their loved one's recovery from depression and the provision of support. We further investigated whether increasing the perceived personal consequences of providing support (i.e. stake) increased willingness to provide support. A stake-boosting message had no direct, but significant indirect effects on willingness to provide support when compared to a control and comparison condition. In summary, increasing stake in a loved one's recovery indirectly increases intentions to provide support.

How are young people's mental health related to their sexual health and substance use? A systematic review of UK literature

OBJECTIVES

The transition from childhood to adulthood is complex and presents challenges to young people's mental health. Mental health impacts and is impacted by a range of contextual and personal factors. Adolescence and young adulthood also coincide with increased experimentation with sex, sexuality and substance use. Addressing the mental health, sexual health and substance-use challenges experienced by young people therefore necessitates an understanding of how these elements relate to one another. By collecting and analysing existing literature, this review aims to identify associations between young people's mental health and sexual health, their mental health and substance use and any resulting gaps-in-knowledge.

CONTENT

Seven electronic databases were searched between March and May 2021 and updated in May 2022 with terms collated under the categories of "young people", "mental health", "sexual health" and "substance use". English-language articles, presenting data from the UK & Ireland, on young people aged 16-24 years inclusive were screened and subjected to a selection process in accordance with PRISMA guidelines (preregistered on PROSPERO, ref. number CRD42021245096). The quality of the resulting articles were assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were tabulated through a data extraction process.

SUMMARY

27 articles were included in the review. Various mental health indices such as depression, anxiety, self-harm, psychotic-like experiences, hypomanic symptoms and binge-purge type eating disorders were found to be associated with higher use of substances such as alcohol, cannabis, ecstasy and generalised drug use. Additionally, mental health indices such as depression, anxiety and self-harm were found to be associated with sex before age 16 and/or unprotected sex at age 16, positive Chlamydia infection and higher levels of sexual activity at a younger age. Overall, cross-sectional associations were stronger than the longitudinal associations presented in the articles.

OUTLOOK

This review into the specific relations between young people's mental health, sexual health and substance use has revealed the complex and bi-directional nature of these associations, with some conditions and substances having been more extensively investigated (e.g., alcohol and depression/anxiety) as opposed to the relations between young people's sexual health and mental health which is lacking in the UK and Irish context. The findings can help inform mental health related policies and service provisions targeted at young people in the UK and Ireland. Areas for future work are suggested.

Mental health problems, health risk behaviors, and prevention: A qualitative interview study on perceptions and attitudes among elite male soccer players

Background

The purpose of this study was to investigate the perception of mental health problems and health risk behaviors among Swedish male elite soccer players and their attitudes toward possible prevention strategies.

Method

Twenty elite soccer players, aged 15-30 years, were recruited through purposive sampling and interviewed via a digital video calling platform. A semi-structured interview guide, encompassing questions about mental health problems, health risk behaviors among soccer teams, peer-relations, relations to coaches, and attitudes toward health risk behaviors, along with proposals for effective interventions, was employed. The interviews were transcribed verbatim and analyzed with qualitative content analysis.

Results

The informants reported positive feelings in relation to playing soccer, good health, and few health risk behaviors. Risk factors included a large income, excessive free time, and the need for excitement. Stress and mental health problems were linked to performance pressure, social media, and injuries. Hesitation to talk openly about personal problems due to concerns about negative consequences and the "macho culture" was highlighted as barriers to admit and seek help for personal problems. Some statements indicated openness and the club's efforts to destigmatize personal problems. Positive attitudes toward prevention and suggestions for various measures were prominent.

Conclusion

Future research and implementation of interventions should focus on the prevention of health risk behaviors and alleviation of stress and performance pressure, as well as continue the efforts to destigmatize mental health problems and raise awareness among coaches of the importance of their communication and behavior for players' mental health and performance. This could be achieved by developing strategic and systematic policy work, information, and dialogue among players and coaches, in addition to individual digital or face-to-face support, provided by professionals outside the soccer context.