Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health
Kroshus E. J Athl Train. 2016;51(5): ahead of print
Take Home Message: Only 39% of respondents indicated that they had a written mental health screening plan. There is a wide variability between mental health screening practices among NCAA institutions.
An athlete’s psychological response to injury or performance pressure may precipitate or exacerbate mental health vulnerabilities. The preparticipation examination (PPE) is an important opportunity to recognize health conditions, such as mental heath concerns, prior to the sport season. Unfortunately, we have no information about whether collegiate institutions are engaging in mental health screening or how they vary between institutions. Therefore, the author distributed a survey to 1076 NCAA supervising sport medicine clinicians to assess whether NCAA sports medicine departments have policies to identify student-athletes with mental health concerns and how these were instituted. A total of 365 clinicians (307 head athletic trainers, 54 physicians, 4 did not report credentials) completed a survey with 4 parts: sports medicine department policy, preparticipation screening, screening initiatives, and institutional characteristics. Only 39% of institutions had a written plan for identifying student-athletes with mental health concerns. Almost one-third of respondents (32%) failed to screen for any of the 6 mental health concerns (eating disorder, depression, anxiety, alcohol abuse, prescription drug abuse, illegal drug abuse). Only 20% of the respondents screened for all 6 mental heath concerns. Many of the respondents indicated that the PPE screened for history of diagnosis for eating disorders (85%), depression (79%), and anxiety (76%). However, less reported using specific screening instruments for symptoms of eating disorders (45%), depression (32%), anxiety (31%), alcohol abuse (57%), prescription drug abuse (52%), and illegal drug abuse (47%). A higher proportion of Division I institutions screened for eating disorders, depression, anxiety, and illegal drug abuse compared to Divisions II and III institutions.
Screening athletes for mental health issues could help limit their health burden, and negative effects on athletic performance. It was alarming to note that 32% of respondents failed to assess any of the 6 primary mental health concerns. The NATA PPE position statement contains 8 questions that broadly assess psychosocial functioning; however, the reliability and validity of these questions for screening for mental health concerns needs to be evaluated. Only 39% of the sports medicine professional respondents noted that they have a written plan for identifying student-athletes with mental health concerns. Division I institutions were more than twice as likely to have a policy than other institutions. This study is important since it highlights the need for more mental health screens among collegiate institutions, which could help improve health outcomes, understand athletes coping strategies, and enable referral of athletes for appropriate care. Screening for mental health vulnerabilities during the PPE seems like a viable opportunity to screen athletes for mental health concerns. Future research needs to be established in validating a screening instrument for use during the PPE, or we need to consult more frequently with medical professionals who are skilled and trained to use currently established mental screening tools (e.g., sport psychologist).
Questions for Discussion: Do you screen for mental health? Do you think screening for mental health problems could improve health outcomes or coping strategies for patients later?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes
Inter-Association Recommendations for Developing a Plan to Recognize and Refer Student-Athletes with Psychological Concerns at the Collegiate Level: An Executive Summary of a Consensus Statement.