Explore the vast range of titles available.

ObjectivesTo develop an assessment and recognition tool to identify elite athletes at risk for mental health symptoms and disorders.MethodsWe conducted narrative and systematic reviews about mental health symptoms and disorders in active and former elite athletes. The views of active and former elite athletes (N=360) on mental health symptoms in elite sports were retrieved through an electronic questionnaire. Our group identified the objective(s), target group(s) and approach of the mental health tools. For the assessment tool, we undertook a modified Delphi consensus process and used existing validated screening instruments. Both tools were compiled during two 2-day meeting. We also explored the appropriateness and preliminary reliability and validity of the assessment tool.Sport Mental Health Assessment Tool 1 and Sport Mental Health Recognition Tool 1The International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) was developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes (defined as professional, Olympic, Paralympic or collegiate level; aged 16 years and older) potentially at risk for or already experiencing mental health symptoms and disorders. The SMHAT-1 consists of: (i) triage with an athlete-specific screening tool, (ii) six subsequent disorder-specific screening tools and (iii) a clinical assessment (and related management) by a sports medicine physician or licensed/registered mental health professional (eg, psychiatrist and psychologist). The International Olympic Committee Sport Mental Health Recognition Tool 1 (SMHRT-1) was developed for athletes and their entourage (eg, friends, fellow athletes, family and coaches).ConclusionThe SMHAT-1 and SMHRT-1 enable that mental health symptoms and disorders in elite athletes are recognised earlier than they otherwise would. These tools should facilitate the timely referral of those athletes in need for appropriate support and treatment.

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

ObjectivesThe primary objective was to examine the attitudes of professional footballers towards help-seeking behaviours related to mental health symptoms and the impact of a mental health awareness video on these help-seeking behaviours. The secondary objective was to evaluate whether the mental health awareness video was feasible in professional football.MethodsA quasi-experimental study based on a one-group pretest post-test was conducted using a questionnaire. Attitude, help-seeking behaviours and confidence were measured with validated questionnaires, including the Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF) and General Help-Seeking Questionnaire (GHSQ).ResultsSixty-five professional footballers (63% men; 37% women) were enrolled in the study. The mean ATSPPH-SF score was 18.1 at pretest and 19.4 at post-test (p=0.00). The mean GHSQ score was 47.6 at pretest and 48.9 at post-test (p=0.00). The level of confidence in helping someone experiencing mental health symptoms was 11.1 at pretest and 11.7 at post-test (p=0.00). All participants rated the mental health awareness video as relevant; 88% mentioned that it added value to raise awareness about mental health symptoms and disorders in professional football. Eighty-three per cent rated the design positively, 69% were positive about the duration of the video and 88% of participants reported an increase in their knowledge and understanding of mental health symptoms and disorders in professional football.ConclusionThe mental health awareness video led to a better attitude of professional footballers towards mental health. We recommend the mental health awareness video be implemented in professional football to disseminate essential information related to mental health symptoms in professional football.

There is strong and consistent evidence that eating disorders are prevalent in sport and especially in weight sensitive sports such as endurance, weight category and aesthetic sports as well as jumping events. These illnesses are not only common but lead to significant physical and psychological morbidity and impaired performances.Sports organizations, and by extension the professionals whose job it is to help and support athletes, have important roles in dealing with these conditions. Preventative practices can be adopted if there is an understanding of how the sports environment contributes to the development of eating disorders. Some disorders can be difficult to detect especially in a sports environment and simple screening instruments are available. Athletes may also need help to access appropriate treatment whilst they are recovering.In many sports prevention, screening and support programs have been developed for a variety of medical conditions or sportsrelated injuries. Similar programs should be developed for eating disorders.

This concise and practical handbook covers the breadth of psychiatric conditions with which sportspeople may present.

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.

Studies are limited by the influence of stigma related to mental health symptoms and disorders both in and out of sporting contexts, which likely impact athletes’ responses and do not take account of additional barriers to reporting, specifically cultural barriers including sex, religion, race and socioeconomic factors. A validated tool developed by the IOC (Sport Mental Health Assessment Tool 1) is an important advance, providing comprehensive screening and identification of ‘next steps’ such as when to seek further assessment and clinical support.4 It is recommended that mental health screening is conducted as systematically as other health checks, and further work is needed to ensure that screening tools remain valid when used in different languages and cultures as well as in different sporting contexts such as individual or team sports and at developmental and elite levels. Competing interests MP wishes to declare the following: consulting fees from Major League Soccer (USA); participation on advisory board as senior advisor, NFL (USA), Head, Neck and Spine Committee; participation on advisory board as committee member, US Soccer Medical Advisory Committee; participation on advisory board as committee member, USOPC Mental Health Task Force.

BackgroundDespite the known mental health benefits of exercise the prevalence of mental health symptoms and disorders in high performance athletes appears to be slightly higher than in the general population and athletes with disabilities may be especially at risk. However data is scarce and valid comparisons are difficult.ObjectiveTo gauge the prevalence of psychological distress and the level of wellbeing amongst UK Olympic and Paralympic programme athletes.DesignCross-sectional questionnaire cohort study.SettingUK Olympic and Paralympic, summer and winter sport athletes.Patients (or Participants)394 athletes from 29 sports.Interventions (or assessment of risk factors)Between October 2018 and June 2019, participants completed the Kessler Psychological Distress Scale (K10) and the World Health Organisation-Five Well-Being Index (WHO5) questionnaires that indicate levels of psychological distress and subjective wellbeing respectively.Main outcome measurementsPercentage of athletes reporting low, moderate, high and very high psychological distress. Percentage of athletes reporting high and low wellbeing.Results24% of athletes reported high or very high psychological distress. More Paralympic that Olympic athletes reported high/very high distress (27% vs 22%). The mean distress score was comparable to age matched population samples. 19% of athletes reported low psychological wellbeing and this was more common in Paralympic athletes than Olympic athletes (23% vs 17%). The mean wellbeing score was comparable to age matched population samples.ConclusionsUK Olympic and Paralympic athletes report psychological distress and wellbeing levels similar to aged matched populations. Paralympic athletes have slightly higher levels of distress and lower wellbeing than Olympic athletes and this may relate to disability specific stressors. Sport programmes should have robust mental health support plans that includes regular athlete screening and commensurate support services with additional specific support for athletes with disabilities.

Correspondence to Dr Margot Putukian, Major League Soccer, Princeton, New Jersey, USA; mputukian@gmail.com #RealityCheck Global social media use rates have nearly tripled1 with 95% of 13–27-year-olds using YouTube and other platforms such as TikTok (67%), Instagram (62%) and Snapchat (59%) and 35% of users doing so ‘almost constantly’.2 95% of teens have access to a smartphone, and 97% use the internet daily.2 The US Surgeon General3 and the American Psychological Association4 have voiced considerable concern about the potential negative impact of social media on youth and adolescent mental health, calling it ‘an urgent public health issue’.3 Although the literature on mental health and social media use has increased, minimal research exists on young and/or elite athletes, leaving many important questions unanswered. Social media creates a space to make connections worldwide and opportunities to learn and gain support, companionship, emotional connection2 5 6 and healthy socialisation.2 4 6 7 This is particularly relevant when individuals are isolated or stressed, especially for LGBTQIA+ adolescents or those experiencing mental health symptoms.3 4 For athletes, it is also an opportunity to promote their ‘brand’, to market themselves, receive financial support, provide endorsements and advocate for social causes.5 7 For fans, social media provides opportunities for increased access and engagement with their sport heroes.5 7 These potential positive experiences using social media are dependent on what individuals are exposed to, their vulnerabilities, strengths, environment and supports.3 #SocialMediaHazards Negative effects of social media are related to both the duration of use and the experience (eg, likes, responses and exposure to cyber abuse/cyberbullying). In a study of German athletes aged 12–19 from a variety of sports, longer daily social media use was associated with an increased negative affect/mood, dysfunctional eating patterns and more mental health symptoms.6 Two studies by World Athletics reported a significant number of abusive posts on social media platforms, with 60% of abuse targeting female athletes and 20% being racially motivated.8 Sexualised and sexist abuse comprised over 40% of all posts, with the majority directed towards females.8 Effects of social media on elite athlete mental health are potentially heightened due to athlete notoriety and the pressures they face, including performance pressures.9–11 There are also demands for athletes to be active on social media (eg, sponsor requirement and event marketing)4 7 and additional risks and scrutiny of athletes that promote political or religious views that may contravene sponsorship or stakeholder expectations. #MentalWellnessResource Despite potential harms from social media use, social media platforms also serve as common sources of health information, including as resources for mental health.2–5 A study of licensed mental health professionals as ‘influencers’ (those with >1 00 000 followers) found their TikTok and Instagram accounts had disclaimers (36%) and crisis support information (55%) present.12 However, only 23.6% (TikTok) and 7.3% (Instagram) of posts addressed elements of mental health literacy and recognition of mental health difficulties.12 Concerns about the information presented on social media platforms include accuracy, credibility, ethics and confirming licensure. Encourage sport governing bodies, athletes, athlete entourage and support staff to follow international best practice guidelines on social media use.7 13 Develop strategies to detect and respond to cyber abuse/cyberbullying.7 13 The authors would like to thank the International Olympic Committee for their prioritisation and support of athlete mental health and specifically Fiona Trabelsi, Kirsty Burrows, Claudia Reardon and Brian Hainline for their support of the IOC Mental Health Working Group.