Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review

Needs and Demands of e-Mental Health Interventions for Elite Athletes: User-Centered Design Approach Based on a Cross-Sectional Study

Introduction: Elite athletes experience sport-specific stressors and are at risk of developing mental health symptoms during and after their careers. E-Mental health interventions may pioneer a new approach to health care, which could help overcome barriers regarding its accessibility for elite athletes. This study aims to examine the needs and demands regarding the design and content of e-mental health interventions for elite athletes. Methods: A cross-sectional study was conducted via a web-based survey with N = 275 elite athletes, of which 167 were female and who participated in a variety of individual and/or team sports. Previous experience using e-mental health interventions was assessed. Needs and demands regarding format, frequency, content, and topics of an e-mental health intervention were analyzed descriptively and were compared between individual and team athletes using ANOVAs. Results: Elite athletes expressed a preference for an individual program via smartphone app (94.2%) with audio/video material (69.1%) and interactive tasks (60.4%). Regarding the frequency of e-mental health intervention, athletes in individual (62.2%) and team sports (60.0%) both preferred weekly intervention with sessions lasting between 20 and 30 min, whereas athletes engaged in both kinds of sports favored an intervention either on a weekly basis (44.7%) or on request (38.3%). The most relevant topics of e-mental health interventions for elite athletes were "Coping with pressure" (92%) and "Self-worth/self-esteem" (90%). Conclusions: The results of this study highlight the potential relevance of a user-centered design approach and could contribute valuable insights into developing e-mental health interventions for elite athletes.

Mental health help-seeking knowledge, attitudes and behaviour among male elite rugby players: the role of masculine health-related values

Objectives

Masculine norms of toughness and self-reliance can discourage help-seeking among elite athletes who are men. Effective ways to leverage masculine norms for help-seeking is a relatively unexplored area in athlete mental health. The study aimed to investigate how masculine health-related values measured by the Intentions Masculine Values Scale (IMVS) affect help-seeking behaviours among male elite rugby players.

Methods

A cross-sectional survey was conducted among 220 Japanese male elite rugby players in the Japan Rugby League One (response rate: 40.6%). Participants completed an online survey assessing help-seeking knowledge, attitudes and behaviours, along with masculine health-related values using the IMVS. Psychological safety within sports settings was evaluated using the Sport Psychological Safety Inventory (SPSI). Multiple regression analyses examined relationships between help-seeking behaviours and IMVS/SPSI.

Results

The Open and Selfless IMVS value was significantly associated with help-seeking knowledge (β=0.059, p=0.009) and attitudes (β=0.064, p=0.006), increasing recognition of the need for help and willingness to seek it. However, no significant association with actual help-seeking behaviour was found (β=-0.006, p=0.774). The Healthy and Autonomous IMVS value was associated with lower help-seeking behaviour (β=0.060, p=0.010), indicating higher autonomy may inhibit seeking professional support. The SPSI was not significantly related to help-seeking measures.

Conclusion

Findings highlight critical gaps between intention and actual help-seeking behaviour among male elite athletes. Further research is needed to explore additional cultural and organisational factors that may better explain help-seeking behaviour and inform effective intervention strategies.

Screening for Anxiety and Depression Symptoms Using Concussion Symptom Scales Among Varsity Athletes

OBJECTIVE

This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology.

DESIGN

Prospective cross-sectional study.

SETTING

York University in Toronto, Canada.

PARTICIPANTS

Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years ( M = 20.01 years, SD = 1.69 years; 52% male).

MAIN OUTCOME MEASURES

The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively.

RESULTS

Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 ( r' s > 0.400; P' s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 ( r' s >0 .400; P' s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 ( P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 ( P' s < 0.05).

CONCLUSIONS

These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.

Mental health help-seeking preferences and behaviour in elite male rugby players

Objectives

Mental health symptoms and mental illnesses are common in elite athletes. There is an urgent need to develop care systems to support the mental health of elite athletes. Understanding elite athletes' preferences in mental health help seeking can help explore strategies to develop such systems. Therefore, this study aims to investigate with whom/where elite athletes feel comfortable discussing mental health concerns and seeking help.

Methods

We analyse data from 219 Japanese male rugby players out of 612 players (565 Japanese, 47 foreigners) aged 18 and over who belong to the Japan Rugby Players Association using a cross-sectional design and an anonymous, web-based, self-administered questionnaire. In the questionnaire, the players are asked to rate on a 5-point Likert scale how comfortable they feel talking about their mental health concerns with affiliation/team staff, family/relatives, friends, mental health professionals, rugby-related seniors and teammates. Analysis of variance and Dunnett's test are performed to detect differences in their preferences for sources of help.

Results

Dunnett's test shows that the mean scores for preferring to consult affiliation/team staff are significantly lower than for all the other groups (p<0.001), indicating that players are reluctant to seek help for mental health concerns from affiliation/team staff. Fewer players sought help from affiliation/team staff or mental health professionals than from other groups.

Conclusion

Regarding mental health concerns, for elite male rugby players as elite athletes, it can be difficult to ask for help or talk to team staff.

Integrated Analgesic Care in the Current Human Monkeypox Outbreak: Perspectives on an Integrated and Holistic Approach Combining Old Allies with Innovative Technologies

Monkeypox (MPX) is a zoonotic infection caused by an orthopoxvirus that is endemic to Central and Western Africa. The MPX virus is a part of the same family of viruses as the variola virus, which causes smallpox. Since May 2022, there has been a global increase in the incidence of MPX infections in multiple countries where the illness is not usually prevalent. A growing number of publications have emphasized on the need for increased awareness among all health professionals for the rapid recognition and diagnosis of this disease and for proper public health measures. However, atypical presentations and occurrence of uncommon symptoms receive less than the desired attention. More specifically, MPX infection related nociceptive symptoms are currently underexposed. Nevertheless, reports from the current outbreak have revealed that (severe) pain is one of the major causes for distress and even hospitalization in these patients. As for all serious pain conditions, an integrated, multidisciplinary, and holistic approach is indicated. This approach should be multimodal and include non-pharmacological therapies alongside pharmacological approaches. Health care professionals should be aware of available alternatives when first choice analgesic therapies fail. Protocols for identification of pain type and prolonged monitoring of clinical status should be implemented to improve patient well-being during acute infection, but also prevent chronic nociceptive syndromes.

System Construction of Athlete Health Information Protection Based on Machine Learning Algorithm

The exercise volume and exercise level can be quantitatively assessed by measuring and collecting athletes’ health and exercise data. The protection of athletes’ health information has lately become an important research topic due to a rise in sports activities. However, due to the nature of the data and the limits of protection models, protecting athlete health data is a complex undertaking. Machine learning and blockchain have caused worldwide technological innovation, and it is bound to bring deep modifications to the sports industry. The main purpose of blockchain is security, decentralization, traceability, and credibility of the athlete’s health data protection and gathering system. To progress and increase the sports industry and methodically assess the physical fitness of sportspersons’ health information, this study concentrates on the Machine Learning and Blockchain-based Athlete Health Information Protection System (MLB-AHIPS) proposed in the sports industry. The ML technique is utilized to clean and handle the information to comprehend the recognition and secure managing of the sportsperson’s fitness information. The system uses attribute-based access control, which permits dynamic and fine-grained access to athlete health data, and then stores the health data in the blockchain, which can be secured and tamper-proof by expressing the respective smart contracts. The simulation outcomes illustrate that the suggested MLB-AHIPS attains a high accuracy ratio of 97.8%, security ratio of 98.3%, an efficiency ratio of 97.1%, scalability ratio of 98.9%, and data access rate of 97.2% compared to other existing approach.

Physical Activity Levels and Psychological Well-Being during COVID-19 Lockdown among University Students and Employees

During the lockdown for the coronavirus disease 2019 (COVID-19), entire populations were instructed to live in home confinement. We investigated the effects of the COVID-19 lockdown on the physical activity (PA) and mental health of students and employees in a Colombian University. A cross-sectional study was conducted through an online survey during the first isolation. A total of 431 respondents (192 males) aged 18-60 years old (28.1 ± 11.1 years) participated. The international Physical Activity Questionnaire (IPAQ) and the short version of the Psychological General Well-Being Index (PGWBI-S) were used. The lockdown had a negative effect on PA levels, with students exhibiting the greatest decrease (~34%; p ˂ 0.001) compared to employees (~24%; p ˂ 0.01). The analysis showed a greater change in PA behavior before and during the lockdown in highly active student participants (5750 vs. 5141 MET min/week; p < 0.05). Additionally, the psychological assessment revealed a lower score in students compared to employees in the male (70.1 vs. 82.6) and female groups (60.2 vs. 79.6). Moreover, the results revealed an influence of sex, with only the female students exhibiting a state of distress. Self-reported PA and psychological well-being were compromised during the COVID-19 lockdown in the academic community, with students and females being more affected.

Potential and Pitfalls of Mobile Mental Health Apps in Traditional Treatment: An Umbrella Review

While the rapid growth of mobile mental health applications has offered an avenue of support unbridled by physical distance, time, and cost, the digitalization of traditional interventions has also triggered doubts surrounding their effectiveness and safety. Given the need for a more comprehensive and up-to-date understanding of mobile mental health apps in traditional treatment, this umbrella review provides a holistic summary of their key potential and pitfalls. A total of 36 reviews published between 2014 and 2022—including systematic reviews, meta-analyses, scoping reviews, and literature reviews—were identified from the Cochrane library, Medline (via PubMed Central), and Scopus databases. The majority of results supported the key potential of apps in helping to (1) provide timely support, (2) ease the costs of mental healthcare, (3) combat stigma in help-seeking, and (4) enhance therapeutic outcomes. Our results also identified common themes of apps’ pitfalls (i.e., challenges faced by app users), including (1) user engagement issues, (2) safety issues in emergencies, (3) privacy and confidentiality breaches, and (4) the utilization of non-evidence-based approaches. We synthesize the potential and pitfalls of mental health apps provided by the reviews and outline critical avenues for future research.

A meta-review of psychological resilience during COVID-19

Psychological resilience has emerged as a key factor in mental health during the global COVID-19 pandemic. However, no work to date has synthesised findings across review work or assessed the reliability of findings based on review work quality, so as to inform public health policy. We thus conducted a meta-review on all types of review work from the start of the pandemic (January 2020) until the last search date (June 2021). Of an initial 281 papers, 30 were included for review characteristic reporting and 15 were of sufficient review quality for further inclusion in strategy analyses. High-level strategies were identified at the individual, community, organisational, and governmental levels. Several specific training and/or intervention programmes were also identified. However, the quality of findings was insufficient for drawing conclusions. A major gap between measuring the psychological resilience of populations and evaluating the effectiveness of strategies for those populations was revealed. More empirical work, especially randomised controlled trials with diverse populations and rigorous analyses, is strongly recommended for future research.

Human-Computer Interaction in Digital Mental Health

Human-computer interaction (HCI) has contributed to the design and development of some efficient, user-friendly, cost-effective, and adaptable digital mental health solutions. But HCI has not been well-combined into technological developments resulting in quality and safety concerns. Digital platforms and artificial intelligence (AI) have a good potential to improve prediction, identification, coordination, and treatment by mental health care and suicide prevention services. AI is driving web-based and smartphone apps; mostly it is used for self-help and guided cognitive behavioral therapy (CBT) for anxiety and depression. Interactive AI may help real-time screening and treatment in outdated, strained or lacking mental healthcare systems. The barriers for using AI in mental healthcare include accessibility, efficacy, reliability, usability, safety, security, ethics, suitable education and training, and socio-cultural adaptability. Apps, real-time machine learning algorithms, immersive technologies, and digital phenotyping are notable prospects. Generally, there is a need for faster and better human factors in combination with machine interaction and automation, higher levels of effectiveness evaluation and the application of blended, hybrid or stepped care in an adjunct approach. HCI modeling may assist in the design and development of usable applications, and to effectively recognize, acknowledge, and address the inequities of mental health care and suicide prevention and assist in the digital therapeutic alliance.

Anxiety and Depressive Symptoms in the New Life With COVID-19: A Comparative Cross-Sectional Study in Japan Rugby Top League Players

Objectives: The primary objective is to compare the prevalence of mental health problems, including psychological distress, anxiety and depressive symptoms in Japan Rugby Top League players in the new life with COVID-19 with those evaluated before COVID-19.

Methods: An observational comparative web-based cross-sectional study was employed for Japan Rugby Top League players. We compared the data from 220 Japanese and 7 foreign players during the new life with COVID-19 with the data from before COVID-19, which was obtained from 233 Japanese and 18 foreign players. We measured anxiety and depression symptoms with the validated Kessler-6, which has been widely used in clinical and research settings among different populations. To investigate the distribution of K6 score and whether there are discrete clusters or not, we conducted the two-step cluster analysis.

Results: In the new life with COVID-19, 15.0% of players reported mild symptoms, which was significantly lower than the 32.3% of players before COVID-19. The prevalence of moderate and severe symptoms was 6.7 and 3.5%, respectively, in the group during the new life with the COVID-19, and 4.8 and 5.2% in the pre-COVID-19 group, with no significant difference. A two-step cluster analysis supported the existence of these two qualitatively different clusters in both groups.

Conclusions: With the spread of new lifestyles related to COVID-19, some rugby players may have improved mental health status due to changes in their daily living environment. Such environmental adjustments alone may not have been sufficient to change the mental health status of others. Rugby players or their teams may require mental health professionals and systems that ensure rest, adjust the environment, and sustainably provide more professional care.

Posttraumatic Stress Disorder in Elite Athletes

ABSTRACT

Posttraumatic stress disorder (PTSD), which may develop following exposure to severe trauma, can occur in all people at any age. PTSD affects approximately 10 million Americans, with an incidence of approximately 3.5% diagnosed every year. Elite athletes are not immune to posttraumatic stress. While difficult to precisely quantify, an estimated 1 in 8 elite athletes suffers from PTSD. Because of its complex presentation, PTSD can be challenging to diagnose and effectively treat in athletes. Several barriers unique to elite athletes exist which may inadvertently delay or prevent access to the appropriate clinical experts. Several best practice models for mental health screening in elite athletes have been developed in the past decade. Treatment of PTSD in the athlete population is similar to trauma-informed treatment in the general population, but should involve the athlete's multidisciplinary team of clinical experts to account for unique demands and preferences in the context of sport.

Learning Agility of Learning & Development Professionals in the Life-Sciences Field during the Pandemic: An Empirical Study (Preprint)

Background

The COVID-19 pandemic has impacted the life sciences field worldwide. Life sciences organizations (eg, pharmaceutical and med-tech companies) faced a rapidly increasing need for vital medical products, patient support, and vaccine development. Learning and development (L&D) departments play a crucial role in life sciences organizations as they apply learning initiatives to organizational strategy within a constantly evolving sector. During the COVID-19 pandemic, the work of L&D professionals in life sciences organizations changed profoundly during the abrupt shift to remote work, since learning and training normally occur in a face-to-face environment. Given the complex and dynamic situation of the pandemic, both individuals and organizations needed to learn quickly and apply what they learned to solve new, unprecedented problems. This situation presents an opportunity to study how characteristics of learning agility were evidenced by life sciences organizations and individual employees in the remote working mode.

Objective

In collaboration with Life Sciences Trainers & Educators Networks (LTEN), this study investigated the responses and learning agility of L&D professionals and their organizational leadership within the life sciences sector to the work changes due to the pandemic. The study answered the following questions: (1) How did L&D professionals in the life sciences sector respond to the changes in their work environment during the COVID-19 pandemic? (2) How did L&D professionals in the life sciences sector demonstrate learning agility during remote working?

Methods

We adopted a mixed methods approach that included a semistructured interview and a survey. Participants who were life sciences or health care L&D practitioners and in relevant positions were recruited via email through the LTEN and its partner pharmaceutical, biotech, or medical devices organizations. Interviews with 12 L&D professionals were conducted between June and August 2020 through phone or online conferencing, covering 22 open-ended questions to stimulate ideas that could be explored further in the survey. The semistructured interview questions were grounded in theory on learning agility. In total, 4 themes were developed from the interviews, which formed the basis for developing the survey items. The subsequent survey regarding 4 specific themes was conducted from August to October 2020 using Qualtrics. Both interview and survey data were analyzed based on a learning agility framework.

Results

Findings revealed generally positive organizational and individual responses toward the changes brought about by the pandemic. Results also indicated that a disruptive crisis, such as the shift from working in the office to working from home (WFH), required professionals’ learning agility to both self-initiate their own learning and to support the learning agility of others in the organization.

Conclusions

This study was designed to better understand education and training in the life sciences field, particularly during the unique circumstances of the global COVID-19 pandemic. We put forward several directions for future research on the learning agility of L&D professionals in life sciences organizations.

Impact of the COVID-19 Pandemic on Estonian Elite Athletes: Survey on Mental Health Characteristics, Training Conditions, Competition Possibilities, and Perception of Supportiveness

Background: The postponement and cancellation of the competition season due to COVID-19 could cause significant mental health problems for an elite athlete. The aim of this study was to describe the mental health characteristics of Estonian elite athletes, their training conditions, competition possibilities, and the support they received during COVID-19. Methods: Athletes completed self-reported questionnaires (including Emotional State Questionnaire). The authors applied descriptive statistics, t-test, and χ² test for comparison of study groups (p < 0.05). Results: Altogether 102 athletes (♂ = 44) were surveyed. The most disturbing issue for athletes was the closing of training centers (57.8%) and cancellation of competitions (50%); 64.7% of athletes reported a negative response from not being able to visit healthcare specialists. Fortunately, athletes could receive virtual coaching. Two-thirds of the athletes had some indication of distress (♀ > ♂): 25% of males and 39.7% of females had symptoms indicating depression; ♀ = 27.6%, ♂ = 13.6% anxiety; ♀ = 56.9%, ♂ = 31.8% fatigue (p = 0.021); ♀ = 55.1%, ♂ = 27.2% insomnia (p = 0.009); 27.5% thought about ending their career (frequency in high distress group compared with low: p = 0.022); and 2.9% were certain they would stop their training completely. Family members were the biggest emotional supporters; 16.7% did not get support from anyone. Conclusion: The Estonian sport community needs to adapt to life in a pandemic environment and help athletes to maintain training and competition activities and in turn, their mental health.

Digital Mental Health Challenges and the Horizon Ahead for Solutions

The demand outstripping supply of mental health resources during the COVID-19 pandemic presents opportunities for digital technology tools to fill this new gap and, in the process, demonstrate capabilities to increase their effectiveness and efficiency. However, technology-enabled services have faced challenges in being sustainably implemented despite showing promising outcomes in efficacy trials since the early 2000s. The ongoing failure of these implementations has been addressed in reconceptualized models and frameworks, along with various efforts to branch out among disparate developers and clinical researchers to provide them with a key for furthering evaluative research. However, the limitations of traditional research methods in dealing with the complexities of mental health care warrant a diversified approach. The crux of the challenges of digital mental health implementation is the efficacy and evaluation of existing studies. Web-based interventions are increasingly used during the pandemic, allowing for affordable access to psychological therapies. However, a lagging infrastructure and skill base has limited the application of digital solutions in mental health care. Methodologies need to be converged owing to the rapid development of digital technologies that have outpaced the evaluation of rigorous digital mental health interventions and strategies to prevent mental illness. The functions and implications of human-computer interaction require a better understanding to overcome engagement barriers, especially with predictive technologies. Explainable artificial intelligence is being incorporated into digital mental health implementation to obtain positive and responsible outcomes. Investment in digital platforms and associated apps for real-time screening, tracking, and treatment offer the promise of cost-effectiveness in vulnerable populations. Although machine learning has been limited by study conduct and reporting methods, the increasing use of unstructured data has strengthened its potential. Early evidence suggests that the advantages outweigh the disadvantages of incrementing such technology. The limitations of an evidence-based approach require better integration of decision support tools to guide policymakers with digital mental health implementation. There is a complex range of issues with effectiveness, equity, access, and ethics (eg, privacy, confidentiality, fairness, transparency, reproducibility, and accountability), which warrant resolution. Evidence-informed policies, development of eminent digital products and services, and skills to use and maintain these solutions are required. Studies need to focus on developing digital platforms with explainable artificial intelligence-based apps to enhance resilience and guide the treatment decisions of mental health practitioners. Investments in digital mental health should ensure their safety and workability. End users should encourage the use of innovative methods to encourage developers to effectively evaluate their products and services and to render them a worthwhile investment. Technology-enabled services in a hybrid model of care are most likely to be effective (eg, specialists using these services among vulnerable, at-risk populations but not severe cases of mental ill health).