Evaluating workforce well-being: an investigation of healthcare professionals' mental health and burnout symptoms at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVE: To explore the prevalence of symptoms of mental health conditions and burnout of healthcare professionals (HCPs) working during the Tokyo 2020 Paralympic Games and the Beijing 2022 Paralympic Winter Games. METHODS: In this cross-sectional, observational study, HCPs working during the Tokyo 2020 and Beijing 2022 Paralympic Games were asked to complete an online, anonymous survey, which included demographic questions and questions regarding mental health symptoms including depression (Patient Health Questionnaire 9-item depression scale) and anxiety (Generalized Anxiety Disorder 7-item scale) as well as burnout (Maslach Burnout Inventory-Human Services Survey: depersonalisation, emotional exhaustion, personal accomplishment). Correlation coefficients (r) were calculated between demographic characteristics and mental health symptoms. RESULTS: In total, 256 HCPs (of 857 HCPs; 30%) completed the surveys. Twelve and eight per cent of HCP scores fell within the moderate to severe depression and moderate to severe anxiety categories, respectively. More than 30% reported moderate to high burnout (depersonalisation: 36%; emotional exhaustion: 36%; personal accomplishment: 58%). In addition, thoughts of self-harm and/or suicidality were reported by some HCPs (8%). Weak correlations were observed between age and depression (r=-0.13, p=0.046), anxiety (r=-0.16, p=0.010) and burnout (emotional exhaustion: r=-0.14, p=0.032; personal accomplishment: r=0.27, p<0.001). CONCLUSION: Although most HCPs reported good mental health, this study suggests that a subset of HCPs experienced symptoms of depression, anxiety, burnout or thoughts of self-harm during the Tokyo 2020 and Beijing 2022 Paralympic Games. While the generalisability of these findings outside of COVID-19 restrictions should be tested, appropriate guidance and mental health support of HCPs leading up to the Paralympic Games should be prioritised.

Leadership experiences of elite football team physicians during the COVID-19 pandemic: a pilot study.

OBJECTIVES: The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic. METHODS: A pilot-study based on a cross-sectional design by means of an electronic survey was conducted. The survey relied on 25 questions divided into distinct sections including among others professional and academic experience, leadership experiences and perspectives. RESULTS: A total of 57 physicians (91% male; mean age: 43 years) gave their electronic informed consent and completed the survey. All participants agreed that the demands of their role had increased during the COVID-19 pandemic. Fifty-two (92%) participants reported that they felt they were expected to take more of a leadership role during the COVID-19 pandemic. Eighteen (35%) reported feeling under pressure to make clinical decisions which were not in keeping with best clinical practice. Additional roles, duties and demands expected of team doctors during the COVID-19 pandemic were subdivided into communication, decision-making, logistical, and public health demands. CONCLUSION: The findings from this pilot study suggest that the way in which team physicians at professional football clubs operate has altered since the onset of the COVID-19 pandemic, with greater demands placed on leadership skills including decision-making, communication and ethical stewardship. This has potential implications for sporting organisations, clinical practice and research.

Help-seeking behaviours related to mental health symptoms in professional football.

OBJECTIVES: The primary objective was to examine the attitudes of professional footballers towards help-seeking behaviours related to mental health symptoms and the impact of a mental health awareness video on these help-seeking behaviours. The secondary objective was to evaluate whether the mental health awareness video was feasible in professional football. METHODS: A quasi-experimental study based on a one-group pretest post-test was conducted using a questionnaire. Attitude, help-seeking behaviours and confidence were measured with validated questionnaires, including the Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF) and General Help-Seeking Questionnaire (GHSQ). RESULTS: Sixty-five professional footballers (63% men; 37% women) were enrolled in the study. The mean ATSPPH-SF score was 18.1 at pretest and 19.4 at post-test (p=0.00). The mean GHSQ score was 47.6 at pretest and 48.9 at post-test (p=0.00). The level of confidence in helping someone experiencing mental health symptoms was 11.1 at pretest and 11.7 at post-test (p=0.00). All participants rated the mental health awareness video as relevant; 88% mentioned that it added value to raise awareness about mental health symptoms and disorders in professional football. Eighty-three per cent rated the design positively, 69% were positive about the duration of the video and 88% of participants reported an increase in their knowledge and understanding of mental health symptoms and disorders in professional football. CONCLUSION: The mental health awareness video led to a better attitude of professional footballers towards mental health. We recommend the mental health awareness video be implemented in professional football to disseminate essential information related to mental health symptoms in professional football.

Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group.

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

Mental health management of elite athletes during COVID-19: a narrative review and recommendations.

Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

Anxiety and Depressive Symptoms During the COVID-19 Emergency Period: A Comparative Cross-Sectional Study in Professional Football.

OBJECTIVE: The primary objective of our study was to establish the prevalence of anxiety and depressive symptoms among professional football (ie, soccer; hereinafter "football") players during the COVID-19 emergency period, drawing comparisons with players assessed before exposure to the COVID-19 emergency period. DESIGN: Observational comparative cross-sectional study by means of electronic questionnaire. SETTING: Professional football. PARTICIPANTS: A total of 468 female (mean age: 22.8 years) and 1134 male (mean age: 26.0 years) players participated. The non-COVID-19 comparison group consisted of 132 female (mean age: 23.1 years) and 175 male (mean age: 24.8 years) professional footballers. INTERVENTION: N/A. MAIN OUTCOME MEASURES: Anxiety symptoms were measured with the validated Generalized Anxiety Disorder 7 and depressive symptoms with the validated Patient Health Questionnaire 9. Both instruments have been widely used in both clinical and research settings among different populations, showing excellent psychometric properties. RESULTS: During the COVID-19 emergency period, the 2-week prevalence of symptoms consistent with a diagnosis of generalized anxiety disorder and depression was 18.2% and 21.6%, respectively, among female professional footballers and 15.5% and 12.9%, respectively, among male players. The 2-week prevalence of anxiety and depressive symptoms among professional footballers was significantly higher during the COVID-19 emergency period than before the global pandemic (P < 0.01). Differences were most pronounced for those worried about the playing future. CONCLUSIONS: The COVID-19 emergency period is associated with increased symptoms of anxiety and depression in professional footballers, especially among those worried about their future as players.