Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial.
Gulliver A, Griffiths KM, Christensen H, Mackinnon A, Calear AL, Parsons A, Bennett K, Batterham PJ, Stanimirovic R. J Med Internet Res. 2012 Jun 29;14(3):e69.
http://www.ncbi.nlm.nih.gov/pubmed/22743352 (Full-length text available for free)
Young athletes have a similar prevalence of depression compared to the general population but have less positive attitudes towards seeking help than nonathletes. Unfortunately, there are very few studies that have examined how to improve attitudes towards seeking help among athletes. To address this void, Gulliver et al. conducted an exploratory randomized-controlled trial to evaluate the effectiveness of three brief fully-automated internet-based interventions intended to increase mental health help-seeking attitudes among elite-level athletes in Australia (18 to 48 years of age). The interventions were: 1) mental health literacy with destigmatization (content focused on education and decreasing stigma), 2) feedback condition (provided athletes with their levels of depression and anxiety as well as content regarding the athlete’s responsibilities and choices, advice, strategies for change, etc), and 3) minimal content condition (provided a list of help-seeking resources), and 4) control condition (no intervention, only received emails to the surveys). The online content was spaced out evenly over 2 weeks. Each week the athletes receiving the first two conditions (mental health literacy and feedback) were also given minimal content (a list of help-seeking resources).The athletes completed two online surveys before the intervention, 2 weekly surveys during the intervention period, 1 immediate post-intervention survey, and finally, 2 and 5 months after completing the intervention the athletes completes follow-up surveys. All of the surveys included the Attitudes toward Seeking Professional Psychological Help-Short Form and General Help-Seeking Questionnaire (GHSQ) with adaptive questioning for the help-seeking behavior items. Adaptive questioning is an increasingly popular method used in surveys in which some questions only appear if certain answers are provided on key questions. 48 out of the 59 (81%) athletes visited the intervention website both weeks to review the assigned material. Furthermore, 34 (58%) athletes reported a prior experience with counseling. The mental health literacy/destigmatization intervention had greater increase in anxiety and depression literacy (knowledge) as well as better reductions in depression and anxiety stigma than the control group (suggesting that the learning objectives for this group were met). These improvements were not found with the other two intervention groups. Unfortunately, none of the interventions improved help-seeking attitudes, intentions, or behaviors compared to the control group. There was some subtle evidence that athletes completing the mental health literacy/destigmatization intervention had greater increases immediately after the intervention in help-seeking behavior from formal sources (e.g., doctors, mental health professional) compared to the athletes in the control condition. As the authors note, these results should be approached with caution since they were unable to recruit their goal of 500 participants.
While the small sample size limits this study, I believe it highlights the need for more mental-health research in sports medicine and demonstrates that internet-based interventions may have a role in addressing mental health issues among athletes. As the authors note “internet-based interventions are available 24 hours a day, 7 days a week, can be accessed anonymously, are cost effective, and can be widely distributed.” Our athletes are not just facing anxiety and depression (which were addressed in this study) but also other concerns like eating disorder behaviors. Internet-based mental health programs might not be the be-all and end-all tool we need but it could provide us another resource that some athletes might feel more comfortable approaching first. Do you feel athletes are hesitant to report depression or anxiety? Do you think internet-based mental health programs could help some of our athletes?
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas
Related Article of Interest:
Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletesGulliver A, Griffiths KM, Christensen H, Mackinnon A, Calear AL, Parsons A, Bennett K, Batterham PJ, & Stanimirovic R (2012). Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. Journal of Medical Internet Research, 14 (3) PMID: 22743352