Internet-based interventions to
promote mental health help-seeking in elite athletes: an exploratory randomized
controlled trial.
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.
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.
https://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.
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?
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
Jeffrey Driban
Reviewed by:
Stephen Thomas
Stephen Thomas
Related
Article of Interest:
Article of Interest:
Gulliver 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