Article

Mental health screening for athletes: Program development, implementation, and evaluation

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Abstract

The mental health of collegiate student-athletes is a growing concern within university athletics. Student-athletes experience a wide array of mental health concerns (e.g., depression, anxiety); however, due to the stigma of mental health and/or lack of available resources, many student-athletes may not seek support on their own. Thus, we describe the mental health screening process we have developed to educate, assess, and follow-up on collegiate student-athletes’ psychological well-being. Based on our experiences and best practices from the NCAA and NATA, we conclude by offering recommendations for how mental health screening may be conducted at other colleges and universities.

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... While there are promising developments being made in areas of nutrition (Reguant-Closa et al., 2020) and mental health (Tomalski et al., 2019;NCAA, 2020), there is still a need to engage athletes and reduce stigma without unloading extra responsibility onto both staff and athletes (Kroshus, 2016;Sontang-Padilla et al., 2018;Purcell et al., 2019;Baugh et al., 2020). In addition, COVID-19 has further limited the opportunities for schools to hire more staff or obtain greater resources (DePietro, 2020;Moody, 2020). ...
... Although no comprehensive framework exists for supporting and responding to student-athlete mental health (Purcell et al., 2019), there have been published protocols that are meeting student-athlete needs (Tomalski et al., 2019;NCAA, 2020). An efficient mental health screening protocol for one university included administering a 5-min mental health survey after a 45-min mental literacy talk or activity session given by a sport psychology staff member (Tomalski et al., 2019). ...
... Although no comprehensive framework exists for supporting and responding to student-athlete mental health (Purcell et al., 2019), there have been published protocols that are meeting student-athlete needs (Tomalski et al., 2019;NCAA, 2020). An efficient mental health screening protocol for one university included administering a 5-min mental health survey after a 45-min mental literacy talk or activity session given by a sport psychology staff member (Tomalski et al., 2019). After surveying the athletes, follow-up meetings were conducted with any student-athletes who were flagged for potentially life-threatening situations (Tomalski et al., 2019). ...
Article
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Research has shown a strong relationship between nutrition and mental health. Packed schedules and little rest time may make student-athletes more susceptible to mental health issues than the general population, but few athletes are fully aware of the effects that nutrition can have on their mental health. While collegiate athletic programs are beginning to recognize the individual contributions of nutrition and mental health to performance and are hiring sport dietitians and psychologists for their athletes, it is unclear whether these topics are ever discussed within the same context. The goal of this study was to understand the perspectives of different athletic personnel on the relationship between nutrition and mental health. 17 athletic personnel (11 Female, 6 Male) from 6 NCAA Division I universities were recruited for a 30–45-min semi-structured WebEx interview. Participants included athletic trainers, coaches, dietitians, sport psychologists, strength and conditioning coaches, and sports medicine physicians. Participants were asked questions about their educational backgrounds, resources, and perspectives on the integration of nutrition and mental health in their programs. Transcribed responses were sorted into four themes: (1) Resources, (2) Education, (3) Department Integration or Collaboration, and (4) Student and Coach Engagement. All participants reported a need for greater monetary resources and staffing. Around 59% of the participants felt they had little more than general or personal interest-level knowledge on topics pertaining to nutrition or mental health, with the exception of sports dietitians or psychologists. Each school varied in the degree to which their athletic staff regularly communicated about their work and athlete health statuses. Athletes were reportedly more or less likely to utilize the resources provided depending on coach attitudes toward nutrition or mental health. Regardless of size, reputation and annual spending, each university was reported to be in the early stages of integrating nutrition and mental health programs into their existing athletic departments. Implications of this work may be to help schools plan for ways to reallocate funding for nutrition or mental health programming.
... Emerging from the study are themes indicative of retirement from collegiate athletics as an eventuality, with both physical and emotionally salient temporal dimensions that forever altered participants' sense of identity, and were heavily impacted by significant others in unforeseen ways. These findings and themes amplify recent concerns for the mental health and well-being of contemporary 71 Downloaded by Tiara A Cash on Wed Jun 23 2021 at 16:29:49 PM MST collegiate student-athletes Kerr, DeFreese, and Marshall 2014;Born 2017;Henriksen et al. 2020;Tomalski et al. 2019;Gouttebarge et al. 2019;Ryan, Gayles, and Bell 2018). ...
... Such programs could holistically nurture athletes' identities while forestalling foreclosure and preparing them for the ultimate transition-healthy retirement from competitive sport. Indeed, proactive programs, as articulated by Kidd et al. (2018), that are controlled outside of the athletic department and dedicated to improving psychological well-being, nurturing positive help-seeking knowledge, attitudes and behaviors, and reducing stigma have begun to appear in the literature (Kim et al. 2020;Bu et al. 2020;Tomalski et al. 2019;Kroshus 2016;. Early assessments indicate that while these programs show promise for easing the transition into retirement for student-athletes, they represent additional expenditures and resources from the very colleges and universities who have already profited from the retiring athletes' efforts. ...
Article
At the height of research on concussions and trauma, this study aims to explore other avenues of student-athlete health by taking a narrative perspective pre- and post-play to question one’s individual sense of wellbeing. Using phenomenological investigation and an exploratory approach, this study delves deeper into the transition of student-athletes into retirement by creating a “life world” narrative. Findings from “Retirement Sucks: Translating the Division 1 Student-Athlete Experience of Retirement” were used to conduct one-on-one interviews with eight participants (three current, five retired). An open-coding method and qualitative phenomenological analysis revealed five themes that collectively explore the phenomena of transition into retirement: 1) retirement as an event; 2) time as a factor; 3) athletic identity; 4) “others” playing a role; and 5) cognitive appraisals. While these findings provide new insights, further research is needed to determine common connections between transition experiences and to identify tools and intersectional skills to help student-athletes prepare for and cope with post-play life across their entire lifespan after retirement.
... (3) disordered eating or relative energy deficiency in sport (RED-S); (4) pre or early season screening for mental health symptoms or disorders; (5) mental health emergencies and serious injuries [2,5,[44][45][46][47]. Each of these issues requires a proactive attempt to collaborate and coordinate with key members of a team's medical and coaching staff and possibly family members. ...
... For disordered eating or RED-S, care must be coordinated with the athletic trainer, the primary care sports medicine physician, psychotherapist, and sports dietician [5]. For pre/early season screening for distress, anxiety, depression, poor sleep, disordered eating and alcohol and other substance misuse coordination must occur between those that are administering the screen (usually the athletic trainer or primary care sports medicine physician) with those who are doing the triage for screen positives (usually the team physician) with those conducting an in-depth assessment and treatment as required (usually a licensed mental health clinician) [46]. Finally, for mental health or physical health emergencies coordination must occur with the athlete's coach, administrator, family member(s), trainer/team physician; and other mental health providers [47]. ...
Article
Primary objective: In this review, we detail the issues and disorders athletes present with, guidelines for making diagnostic formulations and treatment goals, and strategies for delivering integrated treatment attuned to the athlete and their team and/or sport. In addition, we highlight special issues associated with athletes and their families. Reasoning: Athletes experience comparable or higher prevalence rates to the general population of depression and anxiety symptoms and disorders. The mental and physical demands placed on athletes are unique and may increase their susceptibility to certain mental health problems. The current literature regarding integrative interventions in athletes is sparse and largely anecdotal. We provide a summary of the scientific evidence from a literature review conducted by the IOC Consensus Committee on Mental Health in Elite Athletes, reviews and expert clinical strategies recommended by the authors of four books on sports psychiatry written since 2012, and our own review of the literature related to psychotherapy with elite and non-elite- athletes. Main outcomes and results: At the moment there are no randomized controlled trials assessing the use of psychotherapy or medication for mental illness in athletes to guide treatment. Controlled studies examining psychological interventions in collegiate athletes have demonstrated improvements in mental health symptomology. Although these studies were limited to collegiate athletes they assist in providing a foundation for elite athletes as well. For the assessment and management of the mental health needs of athletes' to be on a par with their physical needs, more high-quality scientific epidemiological and treatment intervention studies are needed. Conclusions: Development of specific models of psychiatric intervention for athletes with significant psychopathology and impairment appears to be warranted. These interventions should include individual, family/marital, and group psychotherapy with or without medication using evidence-based treatments.
... Several factors may contribute to these rates, including injury, over-training, involuntary career termination, and performance expectations [12]. Moreover, many student athletes do not seek mental health support due to stigma or a lack of mental health resources [14]. In addition to these concerns, existing literature points to an increase in negative emotions during the pandemic among both college students [15] and athletes in general [16]. ...
Article
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(1) Background: The COVID-19 pandemic has created challenges for college athletes as they return to sport and campus life. Emerging literature highlights some of these challenges, but no studies have used a primarily qualitative approach to assess the impact of the pandemic on college athletes. The purpose of this study was to better understand factors affecting college athletes’ return to sport and campus life amidst the COVID-19 pandemic. (2) Methods: Semi-structured interviews were conducted with varsity athletes who participated in the 2020–2021 season at a single university. Qualitative analysis was performed using the Strauss and Corbin method to derive codes, categories, and themes. Additionally, Athletic Coping Skills Inventory-28 (ACSI-28) scores were recorded and analyzed using descriptive statistics. (3) Results: A total of 20 student athletes were interviewed, revealing that confidence and motivation, increased stress and anxiety, and adaptive coping strategies were common themes affecting their experiences returning to sport and campus life. Results from the ACSI-28 showed an average score of 49.5 and a range of 24–66. (4) Conclusions: Semi-structured interviews revealed factors impacting return to sport and student life. These findings can help inform how to better support college athletes throughout the remainder of the current pandemic and moving forward.
... In practice, mental health screens are rarely systematically implemented within organisations. However, Tomalski et al. (2019) describe a model screening programme within the context of an athletic department within the United States. Workshops are implemented with all athletes in the system during their health evaluations to reduce stigma associated with mental health and increase athletes' comfort with help seeking. ...
... The current research identified athletes' feelings of loneliness from the lack of social interaction with their athletic peers and the negative impact this had on their wellbeing. Tomalski et al. (2019) similarly identified student-athletes as a unique population at a heightened risk for the development of mental health problems, coupled with a decreased willingness to seek help. It has been reported that periods of reduced physical activity compound feelings of isolation from teammates, distance athletes from the athletic community, allow less interaction with coaches and this lack of social support can cause emotional and psychological distress (Reardon et al., 2019). ...
Article
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Countries all over the globe have implemented mandatory social distancing measures in an attempt to suppress and control the spread of the Coronavirus disease (COVID-19). This enforced period of isolation, disruption to normal training routines and competition cancellation, could be having an adverse effect on the mental health and wellbeing of athletes. This study sought to explore the perceived impact of the COVID-19 social distancing measures on athlete wellbeing. Fourteen elite athletes who were unable to train or compete due to government imposed lockdown measures were recruited to participate in this qualitative study. Utilising the photo elicitation method, participants were asked to take a series of photographs that represented their experiences as athletes living in lockdown. These photographs were used to guide discussions in follow up unstructured interviews. Reflexive inductive thematic analysis identified three main themes that captured athletes’ experience of social distancing measures and the implications for their wellbeing: (1) threats to wellbeing; (2) adapting routines and maintaining motivation; and (3) reflecting on participation in competitive elite sport. The initial sudden loss of sport in the athlete’s lives posed a threat to their wellbeing, but over the duration of the lockdown period the athletes developed numerous strategies to protect their wellbeing. Furthermore, their time away from sport encouraged them to reflect on their athletic identity and to make life changes that would protect their wellbeing during the rest of the lockdown period and when they returned to sport. A number of immediate practical recommendations are offered for athlete support personnel working with athletes during the crisis, these include developing self-care strategies and social networks, adapting routines, setting new goals and encouraging the pursuit of dual-careers. Future research is encouraged to investigate how practitioners can deliver effective psychological support through tele-consulting, and to consider whether their support is best focused on therapeutic counselling or mental skills training during the pandemic.
... We believe the implementation of costeffective mental health awareness programs that incorporate the internet (Gulliver et al., 2012a;van Raalte et al., 2015) and video-based technologies (Kern et al., 2017) may be especially promising in this regard. Consistent with these efforts, formalized procedures have been disseminated to assist implementation of mental health screening procedures in NCAA athletes (Tomalski et al., 2019) and sport specific screens have been validated to accurately identify and predict appropriate mental healthcare referrals in collegiate Hussey et al., 2019) and professional athletes (Donohue et al., 2018b;Rice et al., 2019). This is important because the results suggest collegiate athletes who evidence relatively high mental health symptom severity may be particularly motivated to pursue psychological assessment; a finding that is consistent with previous studies involving collegiate students from the general population (American College Health Association, 2009;Blanco et al., 2008;Eisenberg et al., 2011). ...
Article
The current study addresses the need to empirically develop effective mental health interventions for youth from ethnic/racial minority and low-income neighborhoods. Using Stage Model evaluation methods supported by the National Institutes of Health in the US to address underutilization of mental healthcare among racial/ethnic minority youth, this feasibility study demonstrates empirical adaptation of an innovative sport-specific psychological intervention for use in youth from ethnic/racial minority and low-income neighborhoods. An international group of professionals familiar with sport performance and mental health intervention serving the target population experientially examined the adapted intervention protocols in workshops and provided feedback. Survey results indicated the professionals found the intervention components were easy to administer and likely to be safe, enjoyable, engaging and efficacious for youth mental health and sport performance. The protocols were revised based on feedback from these professionals and the intervention was examined in a case trial involving an Asian American youth who evidenced Social Anxiety Disorder. Case study results indicated the intervention could be implemented with integrity, and severity of psychiatric symptoms and factors interfering with sport performance decreased after intervention implementation. The participant’s relationships with family, coaches and teammates were also improved.
... According to previous research, this group could be at risk for suffering from psychological problems. Considering that, adolescent athletes are a population with a low tendency for help-seeking behaviors (Tomalski et al., 2019), present results emphasize the need to pay attention to young athletes' mental health to prevent potential psychosocial problems. ...
Article
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During the 2020, the pandemic caused by the massive spread of the SARS-CoV-2 coronavirus (COVID-19) resulted in a global crisis. In Spain, the COVID-19 pandemic caused a lockdown for almost 100 days and forced the sudden stop of sport practices and competitions. This interruption had a negative impact on high-level athletes' mental health. However, its impact on young athletes, who are intrinsically developing a high-demanding dual career, remains unclear. Therefore, this study aimed at (1) describing and characterizing the general impact that COVID-19 lockdown had on Spanish young athletes' life-spheres and mental health, and (2) identifying different profiles of athletes regarding life-conditions and sport-related variables. A sample of 544 young athletes (M = 15.9; SD = 1.51) participated in this study. Measures included life-conditions and sport-related information along with the Holistic Monitoring Questionnaire (HMQ) and the General Health Questionnaire (GHQ-12). After the screening and description of the data, profiles were defined using a two-level cluster analysis using HMQ and GHQ-12 subscales. We explored differences in demographic and sports information between profiles using MANOVA and subsequent ANOVA. Results suggest a general negative impact of COVID-19 on young athletes' life-spheres and mental health, but with three different clusters regarding the degree of such impact. Cluster 1 grouped the 54.78% of the sample and exhibited a low negative impact of COVID-19 lockdown on life-spheres and few mental health issues. Cluster 2 grouped a 29.96% of the participants who reported a medium negative impact on life-spheres and moderate mental health issues. Cluster 3 represented 15.26% of the sample including participants who showed a high negative impact of the COVID-19 lockdown with high mental health issues. The paradigmatic participant in this third group would be a female student-athlete from a medium or low socioeconomic status with high academic demands and poor or inexistent training conditions during lockdown. Current findings emphasize the need to pay attention to young athletes' mental health and suggest possible influencing contextual variables. We suggest some applied recommendations aimed at helping clubs and sports institutions to mitigate the negative effects of such difficult circumstances on athletes' mental health.
... We believe the implementation of costeffective mental health awareness programs that incorporate the internet (Gulliver et al., 2012a;van Raalte et al., 2015) and video-based technologies (Kern et al., 2017) may be especially promising in this regard. Consistent with these efforts, formalized procedures have been disseminated to assist implementation of mental health screening procedures in NCAA athletes (Tomalski et al., 2019) and sport specific screens have been validated to accurately identify and predict appropriate mental healthcare referrals in collegiate Hussey et al., 2019) and professional athletes (Donohue et al., 2018b;Rice et al., 2019). This is important because the results suggest collegiate athletes who evidence relatively high mental health symptom severity may be particularly motivated to pursue psychological assessment; a finding that is consistent with previous studies involving collegiate students from the general population (American College Health Association, 2009;Blanco et al., 2008;Eisenberg et al., 2011). ...
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Although collegiate athletes underutilize mental health programming , investigators have rarely examined factors that may influence their participation in such programs. The current study examined how structured interviews and demographic factors influence collegiate athletes to use psychological programming. Two-hundred and eighty-nine collegiate athletes were referred to the study. They were screened for mental health and randomly assigned to one of two semi-structured interviews based on experimental phase. Participants in Phase I received standard engagement (SE; N = 35) or SE + discussion of mental health (DMH; N = 44). Phase II participants received SE + DMH (N = 82) or SE + DMH + discussion of personal ambitions (DPA; N = 66). Phase III participants received SE + DMH + discussion about their culture of choice (DCC; N = 25) or SE + DMH + discussion of sport culture (DSC; N = 37). After receiving the respective interview participants were offered psychological assessment and intervention. χ 2 analyses revealed class standing, mental health symptom severity, referral type, and type of engagement interview influenced program commitment/utilization. Logistic regression analyses indicated SE + DMH + DPA and SE + DMH + DSC uniquely improved assessment attendance Psychol Schs. 2020;1-17. wileyonlinelibrary.com/journal/pits
... Within college settings, intercollegiate student-athletes are a unique population. Student-athletes already experience heightened risk of certain mental health problems alongside decreased willingness to seek help [12]. Student-athletes also have a lot to "lose" in relation to how canceled competitive seasons threaten their athletic careers, and distancing measures may reduce access to teammates who are a key source of social connectedness and support [13,14]. ...
Article
Full-text available
Purpose: Physical distancing measures to combat the spread of the novel coronavirus have presented challenges for the mental health and well-being of college students. As campus activities ceased, student-athletes abruptly became isolated from teammates and were no longer able to participate in sport activities that are often central to their identity as an athlete. However, student-athletes who have supportive social connections with teammates during this pandemic may maintain their athletic identity to a greater extent and report better mental health. The present study examined how student-athletes' mental health was associated with teammate social support, connectedness, and changes to athletic identity from before to during COVID-19. Method: A sample of 234 student-athletes completed surveys before COVID-19 physical distancing (February 2020), with 135 (63% female) participating in a follow-up in the month following school closures (April 2020). Path models estimated the effects of teammate social support and connectedness (during COVID-19), as well as changes in athletic identity on indices of mental health. Results: Considering all path models tested, student-athletes who received more social support and reported more connectedness with teammates reported less dissolution of their athletic identity and-in most models-reported better mental health and well-being. Indirect effects indicated that student-athletes' change in athletic identity mediated the effects of teammate social support on psychological well-being and depression symptoms. Conclusions: In addition to advancing theory on how small groups relate to mental health, these findings demonstrate the value in remaining socially connected with peers and maintaining role identities during the COVID-19 pandemic.
... It has been suggested that assessment of psychiatric symptoms among athletes can be conducted during pre-season physicals (Neal et al., 2013), and often this is done in conjunction with concussion baseline testing. While some have advocated for a specific mental health screening process (e.g., Tomalski et al., 2019), others have suggested that analysis of symptom reporting in the context of baseline concussion testing may be done in the absence of a supplemental depression assessment. For example, Riegler et al. (2019) established cutoffs for ImPACT's PCSS affective symptom cluster, which correlated highly with the Beck Depression Inventory-Short Form (BDI-SF); however, just over 2% of individuals in this study were incorrectly classified by ImPACT's affective symptom cluster as potentially having depression when the BDI-SF was not suggestive of depression (i.e., false positives). ...
Article
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Accurate identification of athletes in need of mental health services is essential. The clinical utility of the Patient Health Questionnaire- 9 (PHQ-9), a stand-alone measure of depression, was explored among Division II college athletes (n = 1,209) completing pre-participation concussion baseline assessments (mean age = 19.28), which also included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). ImPACT's symptom inventory can be divided into four clusters: affective, cognitive, physical/somatic, and sleep. Most athletes (81.9%) did not endorse any items on the affective symptom cluster; however, 90 athletes (7.4%) fell above the cutoff of 5 for depression on the PHQ-9, and approximately half of all athletes endorsed one or more PHQ-9 items. Simple linear regressions revealed ImPACT's sleep symptom cluster as the best predictor of PHQ-9 total score; however, affective, cognitive, and physical symptom clusters significantly predicted PHQ-9 total score as well. Due to relative under-endorsement of items on ImPACT's affective symptom cluster compared to the PHQ-9, the clinical utility of incorporating a stand-alone measure of depression such as the PHQ-9 during baseline testing is supported.
Article
Participants completed surveys assessing demographics, wellness, life satisfaction, and perceived stress. Results revealed higher stress levels among faculty and staff compared to students and higher stress scores among female students compared to males. Overall, stress levels for all participants were far above the norm, while wellness and life satisfaction scores were neither high nor low. Taken together students, faculty, and staff from this university were somewhat physically active, stressed, and not satisfied or unsatisfied with their lives, thus demonstrating potential to increase stress and wellness values for students, faculty, and staff.
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Mental health screening of athletes is of increasing concern to key stakeholders (e.g., sport administrators, psychologists, performance consultants, and coaches) at many institutions and governing bodies in the United States. Recently, Tomalski et al. (2019) described the implementation of a comprehensive collegiate student-athlete mental health screening program, including recommendations for professionals interested in replicating this program at other institutions. This excellent program involves resources and staffing that many institutions may not have. The current paper describes a variety of recommended adaptations of this comprehensive program and additional considerations to help professionals who have fewer resources or less institutional support to implement key aspects of student-athlete mental health screening. Specifically, recommendations for how to address staffing and time limitations, identify mental health providers, select screening questionnaires that maximize classification accuracy, and encourage accurate student-athlete reporting of mental health concerns are provided. Moreover, we emphasize the importance and utility of supporting mental health literacy of coaching staff as a cornerstone to effective mental health screening and intervention with collegiate student-athletes.
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Background Adolescence and young adulthood carry risk for suicidal thoughts and behaviours (STB). An increasing subpopulation of young people consists of college students. STB prevalence estimates among college students vary widely, precluding a validated point of reference. In addition, little is known on predictors for between-study heterogeneity in STB prevalence. Methods A systematic literature search identified 36 college student samples that were assessed for STB outcomes, representing a total of 634 662 students [median sample size = 2082 (IQR 353–5200); median response rate = 74% (IQR 37–89%)]. We used random-effects meta-analyses to obtain pooled STB prevalence estimates, and multivariate meta-regression models to identify predictors of between-study heterogeneity. Results Pooled prevalence estimates of lifetime suicidal ideation, plans, and attempts were 22.3% [95% confidence interval (CI) 19.5–25.3%], 6.1% (95% CI 4.8–7.7%), and 3.2% (95% CI 2.2–4.5%), respectively. For 12-month prevalence, this was 10.6% (95% CI 9.1–12.3%), 3.0% (95% CI 2.1–4.0%), and 1.2% (95% CI 0.8–1.6%), respectively. Measures of heterogeneity were high for all outcomes ( I² = 93.2–99.9%), indicating substantial between-study heterogeneity not due to sampling error. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.12–1.67). Higher STB estimates were also found in samples with lower response rates, when using broad definitions of suicidality, and in samples from Asia. Conclusions Based on the currently available evidence, STB seem to be common among college students. Future studies should: (1) incorporate refusal conversion strategies to obtain adequate response rates, and (2) use more fine-grained measures to assess suicidal ideation.
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Background: While mental health among collegiate athletes is receiving increased attention, research on factors surrounding collegiate athletes' decision to seek mental health services is limited. The goal of the present review was to analyze and synthesize the current literature concerning collegiate athletes' utilization of mental health services, including the facilitators of and barriers to use of these services. Methods: The analysis was guided and organized using a socio-ecological framework, which considered the unique context in which collegiate athletes study and perform. A total of 21 articles, published between 2005 and 2016, which concern U.S. collegiate athletes' mental health services utilization (MHSU) were selected and included for the final analysis. Conceptualizations and operationalizations of MHSU were compared and contrasted. Facilitators of and barriers to athletes MHSU were examined and summarized while appropriately considering the proximity of each factor (facilitator or barrier) to the athletes. Results: Results showed variations in conceptualizations and operationalizations of MHSU in the articles analyzed, which made interpretation and cross comparison difficult. Collegiate athletes are willing to utilize mental health services, but gender, perceived stigma, peer norms—for athletes and coaches—plus service availability impact their MHSU. Conclusion: Key stakeholders, administrators, and public health officials should partner to eliminate MHSU barriers, support facilitators, and generally empower collegiate athletes to actively manage their mental health.
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Mental health is a major resource for athletes in relation to their performance and development. Concurrently, athletes experience additional mental health risk factors compared to non-athletic population, such as high training loads, tough competitions, and a stressful lifestyle. Contemporary statistics demonstrate a substantial growth in athletes’ mental health-related problems, such as concussion, overtraining, and identity crisis. Therefore, the International Society of Sport Psychology through this Position Stand provides support to sport psychology researchers, practitioners, sport participants and stakeholders in understanding: (a) mental health phenomenon based on continuum-type models outlining mental illness (prevalence vs. absence) and mental health in association with peak performance, (b) major findings of research dealing with athletes’ performance, career and personal (e.g., identity) development in relation to mental health issues, and (c) interventions aimed at monitoring and maintaining athletes’ mental health as well as preventing various forms of mental ill-being. Five major sections reflect the logic outlined above (i.e., from definitions and theories to research and practice), complemented by ten postulates summarizing the ISSP message intended to spur further discussions on how to make athletes healthier and, thus, more resourceful for (and through) sport. Keywords: mental health; elite athletes; career stressors; holistic development
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Context: Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. Objective: To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening for mental health concerns, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. Design: Cross-sectional study. Setting: College sports medicine departments. Patients or other participants: Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). Main outcome measure(s): Electronic survey of departmental mental health screening activities. Results: A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. Conclusions: The substantial between-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.
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During the 2012–2013 academic year, 7.7 million secondary school students took part in organized interscholastic sports, compared with just 4 million participants during the 1971–1972 year.1 Many student-athletes define themselves by their identities as athletes.2 Threats to that identity may come in the form of struggling performance; a chronic, career-ending, or time-loss injury; conflicts with coaches and teammates; or simply losing the passion for playing their sport.3–5 These challenges and associated factors may put the student-athlete in a position to experience a psychological concern or to exacerbate an existing mental health concern.2
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PURPOSE: The full range of mental health concerns found in the general student population can also be seen in student-athletes attending a university or college. The National Athletic Trainers' Association formed a work group for the purpose of establishing recommendations on developing a plan for the recognition and referral of collegiate student-athletes with psychological concerns.
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Male athletes have been hypothesized to be at increased risk for disordered eating attitudes and behaviors due to unique pressures in the sport environment. In this study, 203 male collegiate athletes from three universities completed the Questionnaire for Eating Disorder Diagnosis (QEDD; Mintz, O'Halloran, Mulholland, & Schneider, 1997) as well as provided information on binge eating and pathogenic weight control behaviors. None were classified with a clinical eating disorder, though almost 20% reported a sufficient number and level of symptoms to be considered symptomatic. Just over 80% had no significant eating disorder concerns and were classified as asymptomatic. Neither year in school, race/ethnicity, sport type, nor age were related to whether or not the athletes were symptomatic or asymptomatic. In terms of the athletes' body mass, fewer than 2% were underweight and 66% were classified as overweight or obese according to CDC guidelines; over 60% were satisfied with their current body weight. Although the frequency of pathogenic behaviors was low, exercise (37%) and fasting/dieting (14.2%) were the primary and secondary means for controlling weight; fewer than 10% used vomiting, laxatives, or diuretics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Contemporary views regarding masculinity have focused on the ways in which socialized masculine ideologies influence, particularly negatively, the physical and psychological lives of men. Although sport has been conceptualized as an environment in which hypermasculine ideologies (e.g., emphasis on competition and indifference to physical pain) are learned and reinforced, few studies have quantitatively explored how, or if, masculine norms and gender roles differ between athletes and nonathletes and may be related to psychological distress and help-seeking. Male collegiate athletes (n = 220) and nonathletes (n = 203) completed a series of questionnaires to assess their level of conformity to masculine norms and gender role conflicts, depression, substance use, self-stigma, and attitudes and intentions to seek help. Through a series of multivariate and mediational analyses, we found that (a) athletes reported significantly higher levels of masculine norms (e.g., heterosexual self-presentation) and role conflicts than nonathletes; (b) gender role conflicts, such as between work and family, significantly predicted depressive symptomatology, whereas masculine norms, such as risk-taking, were related to greater alcohol use; and (c) across both groups of men, self-stigma partially mediated the relationship of conformity to masculine norms to negative attitudes about, and intentions to seek, psychological help. Although athletes more strongly identified with certain masculine norms, in both groups of men, overall conformity to masculine norms, but not gender role conflict, predicted more negative attitudes about seeking help, both directly and through increases in self-stigma.
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Mental health disorders (MHD) in elite athletes is a topic that has received increased attention in recent years. The overall aim of this position statement is to enhance awareness of this important topic and to critically discuss optimal service provision for athletes who suffer from MHD. In the first part of the paper a short overview of the research on MHD in elite athletes is provided. Elite athletes seem to have comparable prevalence rates for the most common MHD when compared to non-athletic peers, but there are still many disorders that have not been investigated in athletes. Sport specific situations such as injuries, periods of overtraining and career termination may put athletes at an increased risk of developing MHD. In the second part of the paper, models of service provision for elite athletes suffering from MHD from six European countries are presented, focusing on 1) professional service providers, 2) support systems, 3) diagnostic assessment, 4) clinical treatment, 5) performance during treatment, 6) screening, and 7) education systems. It emerges that competencies, certification issues, and professional boundaries of the involved service providers, as well as the structure of the National Health Care systems differ strongly across European countries, which makes defining a golden standard difficult. In the third part of this paper, the authors provide general recommendations for athletes and coaches, clubs, federations, organizations and scholars that hopefully will inspire stakeholders to optimize their support systems.
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• It may seem unusual to discuss psychopathology in association with sport and exercise because sport success is related to lower levels of psychopathology (Morgan, 1985) and exercise may be used as therapy for depression and other disorders. Yet, the reality is that athletes and exercisers do experience a wide range of psychopathological conditions (for a review, see Reardon & Factor, 2010), so professionals who work in sport and exercise settings need to have a basic understanding and knowledge of mental health disorders and treatment. Such a recommendation is supported by professional organizations’ certification criteria (e.g., Association for Applied Sport Psychology, n.d.) and recent descriptions of integrated sport psychology training programs (Petrie & Harmison, 2012) and underscored by research showing that performance enhancement interventions are less effective for athletes experiencing psychological difficulties (Wolanin & Schwanhausser, 2010). Thus, the main purposes of this chapter are to highlight areas of psychopathology that are particularly relevant to sport and exercise, to review empirical research on the epidemiology of psychopathology in sport and exercise populations, and to provide recommendations for diagnosis and treatment of psychopathology in the context of sport and exercise. (PsycINFO Database Record (c) 2015 APA, all rights reserved) • It may seem unusual to discuss psychopathology in association with sport and exercise because sport success is related to lower levels of psychopathology (Morgan, 1985) and exercise may be used as therapy for depression and other disorders. Yet, the reality is that athletes and exercisers do experience a wide range of psychopathological conditions (for a review, see Reardon & Factor, 2010), so professionals who work in sport and exercise settings need to have a basic understanding and knowledge of mental health disorders and treatment. Such a recommendation is supported by professional organizations’ certification criteria (e.g., Association for Applied Sport Psychology, n.d.) and recent descriptions of integrated sport psychology training programs (Petrie & Harmison, 2012) and underscored by research showing that performance enhancement interventions are less effective for athletes experiencing psychological difficulties (Wolanin & Schwanhausser, 2010). Thus, the main purposes of this chapter are to highlight areas of psychopathology that are particularly relevant to sport and exercise, to review empirical research on the epidemiology of psychopathology in sport and exercise populations, and to provide recommendations for diagnosis and treatment of psychopathology in the context of sport and exercise. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
Article
The challenges and reforms facing the modern American college having to deal with an increasingly diverse range of students--in terms of age, educational purposes, background and preparation, socioeconomic status, and ethnicity--are discussed. Thirteen chapters by professors in the arts, sciences, and professions discuss implications for their disciplines. In 14 other chapters, academic administrators and student personnel professionals provide a similar discussion for their specialties. Part One, Today's Students and Their Needs, offers a synthesis of basic information about the development and learning of adults, including traditional students aged 18 to 25. Its 14 chapters discuss areas such as intellectual and ego development, and learning problems the adult student faces. Part Two, Implications for Curriculum, develops the implications of research and theory examined in Part One for the curriculum; in particular, for a variety of academic disciplines and professional programs. Part Three, Consequences for Teaching, Student Services, and Administration, applies new knowledge about adults to college and university operations, including governance, instructional methods, and out-of-class activities. The introduction and conclusion serve as the foundation and closure points for theories discussed in the book. Individual authors include, among others: David A. Kolb, Robert J. Havighurst, Rita Preszler Weathersby, William G. Perry, Jr., K. Warner Schaie, Joyce Parr, Larry Friedlander, Paul Ward, Elof Axel Carlson, Dean E. Griffith, Robert J. Menges, Jerry S. Gaff, Louis Benezet, Harold L. Hodgkinson, and Jack Lindquist. (LC)
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Presents responses of Arthur W. Chickering to a series of questions about his publication "Education and Identity." Chickering reflects on his original and current thoughts and feelings about the book and the role of student affairs and higher education in student development. (JAC)
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The purpose of the present study was to explore attitudes about sport psychology consulting of high school and college athletes living in the United States. The Sport Psychology Attitudes–Revised form (SPA-R; Martin, Kellmann, Lavallee, & Page, 2002) was administered to 362 high school and 431 college athletes. A 2 (Gender) × 2 (Age Group: High School and College) × 2 (Type of Sport: Physical Contact and Physical Non-contact) MANCOVA was conducted with past sport psychology consulting experience as a covariate and attitudes about sport psychology as dependent variables. Follow-up univariate and discriminant function analyses were then performed to identify the attitudes that maximized differences related to gender, age group and type of sport. Results revealed that male athletes, younger athletes and athletes who have been socialized in sports that involve physical contact may have a stigma toward seeking sport psychology consulting. Sport psychology consultants must be sensitive to how personal characteristics, experience and attitudes influence help-seeking to improve the services they offer.
Article
The authors assessed the prevalence of pathogenic eating and weight-control behaviors among female college athletes, using a psychometrically valid measure. Participants were 204 college athletes (M age=20.16 years, SD=1.31 years) from 17 sports at 3 universities. On average, they participated in their sport for 10.88 years (SD=16.68 years) and on their college team for 2.10 years (SD=1.03 years). Participants completed a demographic and weight background questionnaire, Questionnaire for Eating Disorder Diagnoses, and the Bulimia Test-Revised. The authors classified participants as eating disordered (n=4, 2.0%), symptomatic (n=52, 25.5%), and asymptomatic (n=148, 72.5%). Few participants engaged in binge eating; most used exercise, as opposed to vomiting, dieting, laxatives, or diuretics, to control their weight. Female athletes suffer from eating disorders, and most experience symptom levels that are subclinical but problematic.
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