Malte Christian Claussen’s research while affiliated with University of Zurich and other places

Purpose The purpose was to evaluate the individual and combined use of the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) to detect clinical indicators associated with Relative Energy Deficiency in Sport (REDs). Methods In this cross-sectional study, 50 female endurance athletes training ≥4x/week completed the LEAF-Q and BEDA-Q and were assessed for presence of selected REDs indicators. Athletes meeting the criteria for mild or more severe REDs severity/risk according to the International Olympic Committee REDs Clinical Assessment Tool Version 2 (IOC REDs CAT2) were classified as REDs cases. Diagnostic properties of the German versions of the LEAF-Q and BEDA-Q were assessed at different cut-offs using receiver operating characteristics calculations. Results Fourteen (28%) athletes were classified as REDs cases. The LEAF-Q had a sensitivity of 79% and a specificity of 50%, with a positive predictive value (PPV) of 38% and negative predictive value (NPV) of 86%. For detection of disordered eating behaviour/eating disorder (DE/ED), the BEDA-Q showed a sensitivity and specificity of 71% and 76%, respectively, with a PPV of 68% and NPV of 79%. Out of 14 REDs cases, nine (64%) scored positive in the LEAF-Q and BEDA-Q. Two athletes (14%) scored positive only in the LEAF-Q and one athlete scored positive only in the BEDA-Q. Two REDs cases remained undetected by both questionnaires. Conclusions Among German female endurance athletes, the LEAF-Q and BEDA-Q are good screening tools to detect REDs cases with mild or more severe severity/risk as classified according to the IOC REDs CAT2. Further clinical assessments should be initiated when athletes score positive in at least one of the questionnaires.

Introduction: Sports psychiatry is an emerging medical and psychiatric discipline that has experienced significant development in recent years. This growth has been accompanied by an increase in scientific outputs from sports psychiatrists and other academics that address the three fields of activity of sports psychiatry: namely, mental health and disorders in competitive and elite sports, mental health and sport-specific mental disorders in recreational sports, and the use of sport, exercise and physical activity in the prevention and treatment of mental disorders. Conceptual publications have discussed the scope of sports psychiatry and education and training. However, some topics receive more attention than others, with evidence gaps in other key areas of sports psychiatry. Advancing the field towards evidence-based practice requires an assessment of the current state of the literature and the development of a strategic research agenda. Methods: Following the Working Group on Research Gaps, Priorities and Agenda at the Summit on Sports Psychiatry arranged by the International Society for Sports Psychiatry (ISSP), the ISSP Scientific Committee conducted a narrative review of the sports psychiatry literature to benchmark the current academic state of the discipline and further developed the research agenda to provide a strategic framework for future research directions. Results: We discuss a research agenda according to five key areas: sports psychiatry as a discipline, education and training in sports psychiatry, and the three clinical fields of activity of sports psychiatry. Conclusion: This sports psychiatry research agenda provides a framework to guide the strategic development of the scientific literature in the field.

Objective This cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee consensus statement on Relative Energy Deficiency in Sport (REDs) identified depression as both an outcome of LEA and a secondary risk factor for REDs. However, the direct link between LEA and depression has yet to be fully established. Methods We assessed 57 female athletes participating in weight-sensitive sports at different levels of competition training at least four times a week. Assessment was conducted using laboratory analyses, clinical interviews and the Patient Health Questionnaire-9 questionnaire. Participants were recruited through various channels, including German sports clubs, Olympic training centres, social media platforms and the distribution of flyers at competitions. Indicators of LEA were defined if at least two of the following three physiological indicators were present: menstrual disturbances, suppressed resting metabolic rate and suppressed thyroid hormones. Logistic and linear regression analysis were used to examine the relationship between LEA, depression and DE/ED. Results The lifetime prevalence of depressive disorders was 29.6%. 19% of the participants were diagnosed with an ED, and an additional 22.6% exhibited DE.LEA was not significantly associated with either lifetime prevalence of depressive disorders or current depressive symptoms. However, a significant association was found between depression and DE/ED in terms of both lifetime prevalence and current depressive symptoms. DE/ED increased the probability of lifetime prevalence of depressive disorders by 34% (19%–49%) compared with normal eating behaviour. Conclusion We found no evidence that LEA is an independent factor for depression in female athletes. Its association with LEA and REDs appears to occur primarily in the presence of DE/ED.

In competitive and elite sports, mental health and athletic performance cannot be considered separately. Mental disorders in sports are bidirectionally associated with reduced athletic performance. A decline in performance, both within and outside of sport, can be a sign of mental disorder. Additionally, poor athletic performance is a potential risk factor for mental disorders in athletes. The central role sports psychiatrists play in the mental health of athletes is well‐established. However, their role in athletic performance is less well‐described and more controversial, perhaps due to a perception that performance is purely a secondary outcome of good mental health. This paper discusses the role that sports psychiatrists can play in athletic performance within competitive and elite sports. Performance can be distinguished into three key focus areas for sports psychiatrists: (i) performance restoration, (ii) performance maintenance, and (iii) performance enhancement. These should be considered throughout the continuum of mental health care, from prevention, treatment, to ongoing care for mental disorders. When reduced performance is due to a mental disorder, psychiatric treatment should purposefully aim to restore functioning and performance as part of management. Maintenance of performance is, similarly, an important element of the prevention, psychiatric treatment, and ongoing care of mental disorders. Holistic sports psychiatrists may also choose to aim for athletic performance enhancement beyond the context of mental health symptoms and disorders, to help athletes flourish and achieve their goals.

Sports psychiatry is a young field of medicine and psychiatry that focuses on mental health among athletes, and sports and exercise within psychiatry and mental disorders. However, the development of sports psychiatry and its fields of activity vary from region to region and are not uniform yet. Sports psychiatry and the role of sports psychiatrists have also already been discussed in the field of sports and exercise medicine, and within medical teams in competitive and elite sports. A uniform definition on sports psychiatry, its fields of activity, sports psychiatrist, and the essential knowledge, skills, and abilities (plus attitudes, eKSA+A) of the sports psychiatrist were developed as part of an International Society for Sports Psychiatry (ISSP) Summit, as well as First International Consensus Statement on Sports Psychiatry. Three fields of activity can be distinguished within sports psychiatry: (i) mental health and disorders in competitive and elite sports, (ii) sports and exercise in prevention of and treatment for mental disorders, and (iii) mental health and sport‐specific mental disorders in recreational sports. Each of these fields have its own eKSA+A. The definitions on sports psychiatry and sports psychiatrists, as well as the framework of eKSA+A in the different fields of activity of sports psychiatrists will help to unify and standardize the future development of sports psychiatry, establish a standard of service within sports psychiatry and together with the neighboring disciplines, and should be included into current, and future sports psychiatry education and training.

Introduction: Physical activity (PA) shows beneficial effects for various mental illnesses, but exercise-prescription has not yet become routine practice in psychiatry. Therefore, this survey addresses attitudes and barriers towards exercise-prescription in health professionals. Methods: We conducted an anonymous online-survey among health professionals on the importance of PA in prevention and treatment of mental illness and perceived barriers as part of a larger survey on sports psychiatry. The survey was promoted by societies for sports psychiatry. Results: N = 310 health professionals from Switzerland (86.5%) and other countries responded to the online survey. Sixty percent were physicians (51.1% psychiatrists). Most respondents strongly agreed that PA plays an important role in prevention and treatment of mental (80.2%, 69.8%) and physical (84.5%, 72.0%) illness. Forty-six percent use PA in prevention and 59.4% in treatment of mental illness with lower proportions for physical illness (39.5%, 36.2%). Most mentioned barriers to the use of PA were “insufficient possibilities” in psychiatric institutions (34.8%) and “no reimbursement” (41.9%) in private practice. Participants working in private practice rated barriers in practice significantly higher than those from other workplaces. “No motivation” was found to be the most common barrier for patients (56.5%). PA was used most often for depression (39.5%) followed by substance use disorders (32.1%) and anxiety disorders (30.9%). Conclusions: Health professionals in Switzerland and some extent other European countries show a positive attitude towards the use of PA in mental illness. Current barriers, especially reimbursement in private practice should be addressed to improve prescription-rates of PA.

Symposium 5: Mental health and substance use in Swiss elite para-athelets