Analysis of the Sport Mental Health Assessment Tool 1 (SMHAT-1) in Team USA athletes

Abstract

Objective: The Sport Mental Health Assessment Tool 1 (SMHAT-1) was introduced as a critical component to the athlete health evaluation. However, the effectiveness of the initial triage step questionnaire (Athlete Psychological Strain Questionnaire (APSQ)) has yet to be analysed within a National Olympic and Paralympic Committee delegation. This study evaluated the ability of the APSQ to identify athletes at risk for mental health concerns.

Methods: Athletes completed the APSQ and all subsequent screening questionnaires of the SMHAT-1 as part of their Tokyo and Beijing Olympic and Paralympic Games health history screening. Each questionnaire was scored according to published guidelines, and the false-negative rate (FNR) for the APSQ identifying athletes that were positively screened on the subsequent questionnaires was computed.

Results: 1066 athletes from 51 different Olympic and Paralympic and Summer and Winter sports completed the SMHAT-1. The FNRs for all athletes who were positively screened on a subsequent questionnaire with an APSQ score of <17 ranged from 4.8% to 66.7%. The global FNR for being positively screened on any questionnaire was 67.5%. Female, Paralympic and Winter athletes scored higher on one or more questionnaires compared with male, Olympic and Summer athletes, respectively (p<0.05).

Conclusion: Due to the high FNR of the APSQ detecting a potential mental health concern, we recommend athletes complete the APSQ and all subsequent questionnaires of the SMHAT-1 rather than using only the APSQ as an initial screening test.

Keywords: Psychology, Sports.

Figure 1

Proportion of athletes with positive screen on APSQ and all subsequent questionnaires. APSQ, Athlete Psychological Strain Questionnaire; ASSQ, Athlete Sleep Screening Questionnaire; AUDIT-C, Alcohol Use Disorders Identification Test Consumption; BEDA-Q, Brief Eating Disorders in Athletes Questionnaire; CAGE-AID, Cutting Down, Annoyance by Criticism, Guilty Feeling and Eye Openings Adapted to Include Drugs; GAD-7, General Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9.

Figure 2

Questionnaire responses by sex, games, and season. APSQ, Athlete Psychological Strain Questionnaire; ASSQ, Athlete Sleep Screening Questionnaire; AUDIT-C, Alcohol Use Disorders Identification Test Consumption; BEDA-Q, Brief Eating Disorders in Athletes Questionnaire; CAGE-AID, Cutting Down, Annoyance by Criticism, Guilty Feeling, and Eye-openings Adapted to Include Drugs; GAD-7, General Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9.