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Impairments in motor automaticity cause patients with Parkinson's disease to rely on attentional resources during gait, resulting in greater motor variability and a higher risk of falls. Although dopaminergic circuitry is known to play an important role in motor automaticity, little evidence exists on the neural mechanisms underlying the breakdown of locomotor automaticity in Parkinson's disease. This impedes clinical management and is in great part due to mobility restrictions that accompany the neuroimaging of gait. This study therefore utilized a virtual reality gait paradigm in conjunction with functional MRI to investigate the role of dopaminergic medication on lower limb motor automaticity in 23 patients with Parkinson's disease that were measured both on and off dopaminergic medication. Participants either operated foot pedals to navigate a corridor (‘walk’ condition) or watched the screen while a researcher operated the paradigm from outside the scanner (‘watch’ condition), a setting that controlled for the non-motor aspects of the task. Step time variability during walk was used as a surrogate measure for motor automaticity (where higher variability equates to reduced automaticity), and patients demonstrated a predicted increase in step time variability during the dopaminergic “off” state. During the “off” state, subjects showed an increased blood oxygen level-dependent response in the bilateral orbitofrontal cortices (walk>watch). To estimate step time variability, a parametric modulator was designed that allowed for the examination of brain regions associated with periods of decreased automaticity. This analysis showed that patients on dopaminergic medication recruited the cerebellum during periods of increasing variability, whereas patients off medication instead relied upon cortical regions implicated in cognitive control. Finally, a task-based functional connectivity analysis was conducted to examine the manner in which dopamine modulates large-scale network interactions during gait. A main effect of medication was found for functional connectivity within an attentional motor network and a significant condition by medication interaction for functional connectivity was found within the striatum. Furthermore, functional connectivity within the striatum correlated strongly with increasing step time variability during walk in the off state (r=0.616, p=0.002), but not in the on state (r=−0.233, p=0.284). Post-hoc analyses revealed that functional connectivity in the dopamine depleted state within an orbitofrontal-striatal limbic circuit was correlated with worse step time variability (r=0.653, p<0.001). Overall, this study demonstrates that dopamine ameliorates gait automaticity in Parkinson's disease by altering striatal, limbic and cerebellar processing, thereby informing future therapeutic avenues for gait and falls prevention. •Parkinson's disease patients performed a virtual reality gait task during fMRI.•The role of dopamine on gait automaticity impairments was investigated.•Limbic interference and poor striatal and cerebellar processing impair automaticity.•Dopamine ameliorates gait automaticity impairments in Parkinson's disease.

ObjectivesTo examine gender differences in the reporting of, and contributors to, mental health symptoms.MethodsThis was a cross-sectional observational study of adult athletes within a national elite sporting system (n=523; women=292;56%), who completed a battery of assessments including measures of mental health and adverse life events. Group differences across a range of scores were examined, followed by gender-stratified bootstrapped linear regression and meta-regression on measures where gender differences were observed.ResultsWomen athletes reported higher rates of mental health symptoms, and lower rates of mental well-being, although there were no differences in general psychological distress or life satisfaction. Women reported experiencing several adverse life events at higher rates than men; particularly interpersonal conflict, financial hardship and discrimination. Low self-esteem was consistently associated with poorer mental health outcomes for all athletes. While a range of factors were associated with poor mental health in men or women athletes, meta-regression suggested that experiencing financial difficulty and social media abuse were more uniquely associated with mental health symptoms in men.ConclusionGender differences in mental health in elite athletes are apparent. Approaches to increasing well-being are required in elite sport.

There are reports of poor working conditions for early and mid-career academics (EMCAs) in universities, however, empirical data using validated tools are scarce. We conducted an online, cross-sectional survey using validated tools to assess workplace satisfaction, exposure to workplace abuse, and mental health. Participants included employees of medical and health faculties of two of the largest Australian universities, surveyed between October 2020 and January 2021. Overall, 284 participants responded. Many reported job insecurity: half (50.7%) working on contracts with less than one remaining year. Workloads were considerable, with 89.5% of participants working overtime and 54.8% reporting burnout. Workplace abuse in the forms of bullying (46.6%), sexual harassment (25.3%), sexism (49.8%) and racism (22.5%) were commonly reported. Clinically significant symptoms of depression (28.0%), anxiety (21.7%) and suicidal ideation or self-harm (13.6%) were reported; with a higher prevalence among those working more overtime, and those exposed to workplace abuse. Priorities include providing a stable and safe workplace, increasing accountability and transparency in addressing workplace abuse, and supporting professional development. In summary, EMCAs in our study were commonly exposed to precarious employment conditions and workplace abuse. Our findings provide empirical evidence on where universities and funding bodies should direct resources and change organisational risk factors, to improve workplace culture.

Freezing of gait (FOG) is a disabling motor symptom experienced by a large proportion of patients with Parkinson’s disease (PD). While it is known that FOG contributes to lower health-related quality of life (HRQoL), previous studies have not accounted for other important factors when measuring the specific impact of this symptom. The aim of this study was to examine FOG and HRQoL while controlling for other factors that are known to impact patient well-being, including cognition, motor severity, sleep disturbance and mood. Two hundred and three patients with idiopathic PD (86 with FOG) were included in the study. All patients were between Hoehn and Yahr stages I–III. A forced entry multiple regression model evaluating the relative contribution of all symptoms was conducted, controlling for time since diagnosis and current dopaminergic treatment. Entering all significantly correlated variables into the regression model accounted for the majority of variance exploring HRQoL. Self-reported sleep–wake disturbances, depressive and anxious symptoms and FOG were individually significant predictors. FOG accounted for the highest amount of unique variance. While sleep–wake disturbance and mood have a significant negative impact on HRQoL in PD, the emergence of FOG represents the most substantial predictor among patients in the earlier clinical stages of disease. This finding presumably reflects the disabling loss of independence and fear of injury associated with FOG and underlines the importance of efforts to reduce this common symptom.

Background Elite-level coaches are exposed to multiple performance, organisational and personal stressors which may contribute to reduced mental health and wellbeing. This systematic scoping review examined the current body of evidence to explore what is known about the mental health of elite-level coaches (i.e. wellbeing and mental ill-health), the risk and protective factors that influence coach mental health, and the relationship between mental health and coaching effectiveness. Methods The review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken and updated in September 2022 using six electronic databases. Results 12,376 studies were identified and screened, with 42 studies satisfying the inclusion criteria. Despite the paucity of high-quality research, findings indicated that 40% of the included studies examined themes connected to wellbeing, with 76% assessing the nature or prevalence of mental ill-health in elite-level coaches. Among studies exploring mental ill-health, coach burnout was the primary focus, while scant research examined symptoms associated with clinical disorders (e.g. anxiety and depression). Overall, psychological outcomes for elite-level coaches were shaped by risk and protective factors operating at the individual, interpersonal, organisational and societal level. Preliminary evidence was also found to suggest that poor mental health may contribute to reduced coaching effectiveness. It is proposed that coaching effectiveness could therefore be employed as a ‘hook’ to engage elite-level coaches in greater consideration of their mental health needs. Conclusion Alongside the development of methodologically robust research, there is a need to examine dynamic individual (e.g. psychological skills), interpersonal (e.g. strong social supports) and organisational (e.g. workload) factors that aim to preserve the mental health and optimise the efficacy of elite-level coaches. Key Points At present, there is lack of high-quality research investigating the mental health of elite-level coaches. Limited research has also focused on understanding the nature and prevalence of mental disorders in elite-level coaches, with greater attention directed towards themes associated with wellbeing and burnout. Current evidence indicates that a variety of risk and protective factors operating at the individual, interpersonal, organisational and societal level may influence the mental health of elite-level coaches. Further research is required to determine which factors contribute most significantly towards mental health outcomes. Despite the paucity of research, preliminary evidence indicates that mental health may impact coaching effectiveness, including both a coach’s own and team/athlete’s functioning. Robust research is needed to examine this relationship in greater depth, to assess whether coaching effectiveness could be employed as a ‘hook’ to engage elite-level coaches in greater consideration of their mental health needs.

Effectively supporting the mental health of elite athletes and coaches requires validated tools that assess not only individual-level factors but organisational-level influences. The aim of this study was to develop a bespoke scale assessing perceived psychological safety within high-performance environments. 337 elite athletes ( =24.12 years) and 238 elite-level coaches and high-performance support staff (HPSS; M=41.9 years) identified via the Australian Institute of Sport provided data across a range of mental health and well-being domains. Exploratory factor analysis (EFA; n=169 athletes) with parallel analysis identified the Sport Psychological Safety Inventory (SPSI) factor structure. Confirmatory factor analysis (CFA) validated the identified structure in separate validation subsamples of athletes (n=168) and coaches/HPSS (n=238). EFA identified the 11-item, 3-factor SPSI. Factors assessed domains of the Mentally Healthy Environment, Mental Health Literacy and Low Self-Stigma. All scale items loaded strongly on their specific domain. CFA model fit indices validated scale structure for athletes and coaches/HPSS. Internal consistency and convergent and divergent validity were evident. Logistic regression indicated that incrementally higher Mentally Healthy Environment scores reduced the likelihood of athletes scoring in the 'moderate' range of general and athlete-specific distress, with a stronger endorsement of the Low Self-Stigma subscale reducing the likelihood of being identified for athlete-specific distress. Psychometric properties of the SPSI support scale utility among athletes and coaches/HPSS in elite sports settings, though further psychometric efforts are needed. This brief measure may support benchmarking efforts across elite sporting contexts to improve mental health culture and broader well-being among athletes and coaches/HPSS.

Background Although there are many benefits associated with working in academia, this career path often involves structural and organisational stressors that can be detrimental to wellbeing and increase susceptibility to psychological distress and mental ill health. This exploratory study examines experiences of work-related psychosocial stressors, psychological distress, and mental health diagnoses among mental health researchers. Methods This international cross-sectional study involved 207 mental health researchers who were post-graduate students or employed in research institutes or university settings. Work-related psychosocial stressors were measured by the Copenhagen Psychosocial Questionnaire III (COPSOQ III). Psychological distress was assessed using the Depression-Anxiety-Stress Scale-21 (DASS-21). Thoughts of suicide was assessed using an adaptation of the Patient Health Questionnaire-9 (PHQ-9). History of mental health diagnoses was assessed through a custom questionnaire. Pearson’s chi-square test of independence was used to compare mental health diagnoses and suicidal ideation across career stages. The association between work-related psychosocial stressors and psychological distress was conducted using multivariate linear regression controlling for key demographic, employment-related and mental health factors. Results Differences in ‘demands at work’ and the ‘work-life balance’ domain were lowest among support staff ( p  = 0.01). Overall, 13.4% of respondents met the threshold for severe psychological distress, which was significantly higher in students compared to participants from other career stages ( p  = 0.01). Among the subgroup of participants who responded to the question on mental health diagnoses and suicidal ideation ( n  = 152), 54% reported a life-time mental health diagnosis and 23.7% reported suicidal ideation since their academic career commencement. After controlling for key covariates, the association between the ‘interpersonal relations and leadership’ domain and psychological distress was attenuated by the mental health covariates included in model 3 ( β  = −0.23, p  = 0.07). The association between the remaining work-related psychosocial stressors and psychological distress remained significant. Conclusions Despite working in the same environment, research support staff report experiencing significantly less psychosocial stressors compared to postgraduate students, early-middle career researchers and senior researchers. Future research that targets key modifiable stressors associated with psychological distress including work organization and job content, and work-life balance could improve the overall mental health and wellbeing of mental health researchers.

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.

ObjectivesTo investigate challenges associated with mental health help-seeking among Olympic and Paralympic coaches. The study also sought to identify which challenges were most important and feasible to address.MethodsThe study employed a mixed-methods group concept mapping methodology. Participants brainstormed, sorted (into groups) and rated (for importance and feasibility) statements on 5-point Likert scales in response to the prompt, ‘What makes it challenging for an Olympic or Paralympic coach to seek help for their mental health?’. Nineteen Olympic coaches, Paralympic coaches and mental health professionals participated.ResultsParticipants brainstormed 68 unique statements. Ranked by importance, 10 core clusters of challenges were identified: (1) pressures and instability within high-performance sports environments, (2) stigma associated with mental health help-seeking, (3) lack of prioritisation for own mental health care, (4) lack of environmental safety to seek mental health support, (5) lack of adequate mental health literacy, (6) time constraints, (7) expectations to manage role-related pressures, (8) misconceptions about mental resilience, (9) lack of access to mental health support, and (10) hesitance to engage with mental health practitioners. A ‘lack of adequate mental health literacy’ and ‘pressures and instability within high-performance sports environments’ were rated the most and least feasible challenges to address, respectively.ConclusionWhile dynamic individual factors with high feasibility may offer short-term solutions (eg, mental health literacy), sports organisations should prioritise eliminating culturally embedded barriers deterring coaches from seeking help. Considering their unique insights, coaches and mental health professionals should play an active role in developing psychological supports for coaches.

The focus of such interventions is to improve functioning of particular cognitive skills such as memory, working memory, attention, and executive functions, as decline in these or other cognitive domains may lead to functional impairment in day-to-day activities as well as contribute to reduced quality of life and disability (Salthouse, 2004). In this way, it would appear that we are moving further from discovering what is most effective by diluting the literature with often incomparable studies. [...]we are blocking our progression toward consistently solid evidence for CT efficacy and uncovering what is hoped are tangible and very real benefits for the ageing population. Factors including cognitive reserve and ability (e.g., education, IQ, employment), relevant personality traits (e.g., locus of control, self-efficacy), pre-training cognitive performance, diet, smoking and alcohol intake, or sub-threshold depressive and anxious symptoms are likely to play an important role in how different participants respond to training. Early exploration of this area appears to support the notion that such factors should be included as possible mediating variables, as they may impact on individual levels of training efficacy. [...]recent work has suggested that such individual differences may be helpful in predicting which patients may benefit most from CT, thus enabling a more targeted approach (Jaeggi et al., 2013; Rebok et al., 2013; Willis and Caskie, 2013).