Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model.

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than 'wear a mask', different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

Positive youth development as a guiding framework in sport research: Is it time to plan for a transition?

Positive youth development is a popular guiding framework for studying the psychosocial development of youth. In sport research, for more than two decades, this framework has enhanced our understanding of the mechanisms involved in successful shifts from youth to adulthood. Nonetheless, scholars have recently taken a more critical stance on the positive youth development framework by elucidating some of its shortcomings. To help determine whether it may be warranted to plan for a transition from the positive youth development framework in sport research, a critical commentary is offered. The purpose of this commentary lies in situating three ontologically distinct arguments that depict the shortcomings of the positive youth development framework, namely the operationalization argument, the social justice argument, and the posthumanist argument. This paper is offered as an open invitation to instigate dialogue on what may come next for youth development in sport research and whether planning for a transition is warranted.

Process evaluations of health-promotion interventions in sports settings: a systematic review.

Sports settings have been identified as an ideal place to conduct complex multi-level health-promotion interventions, with the potential to engage a broad audience. Whilst the benefits of delivering health-promotion interventions in sports settings are well documented, such interventions' real-world implementation and success must be better understood. Process evaluations can be conducted to provide information related to an intervention's fidelity, replication, scaling, adoption, and the underlying mechanisms driving outcomes. This systematic review summarizes how process evaluations of health-promotion interventions are conducted in sports settings and highlight facilitators and barriers to health-promotion intervention delivery using narrative synthesis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, searches included original peer-reviewed articles from inception-January 2023. We searched eight electronic databases: Academic Search Complete; MEDLINE, PsycARTICLES; PsycINFO; SPORTSDiscus with Full Text; MEDLINE; SCOPUS; Pub Med, and Pro Quest Central. Thirty-two studies were included. Findings suggest that most process evaluations of health-promotion interventions have acknowledged the inherent complexity of sports settings, and investigated factors that explain their intervention's success (e.g. trust building, engagement). However, poor use of process evaluation frameworks or guidelines resulted in wide variations of how process evaluations are conducted and reported, which made findings difficult to integrate and standardize with consistency. Accordingly, this review provides a guide on how future process evaluations can be conducted to improve health-promotion interventions' transparency, replicability and reliability in real-world settings.

Optimising the effects of physical activity on mental health and wellbeing: A joint consensus statement from Sports Medicine Australia and the Australian Psychological Society.

OBJECTIVES: This consensus statement from Sports Medicine Australia and the Australian Psychological Society aims to provide guidance to practitioners on the ways that physical activity can be promoted to maximise benefits to mental health. METHODS: Following the Clinical Consensus Statement protocol, an expert group comprised of eight members with expertise in physical activity and mental health articulated recommendations regarding five physical activity contextual factors: type, physical environment, delivery, domain, and social environment. RESULTS: To optimise the mental health benefits of physical activity, we recommend: i) activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type (type); ii) facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals' basic needs for autonomy, competence and social connection (delivery); iii) participation in physical activity with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone (social environment); iv) where possible and appropriate, some physical activity should be undertaken outside in pleasant natural environments (physical environment); and, v) at least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one personally chooses to undertake (domain). CONCLUSIONS: The type, domain, physical and social environment of physical activity, as well as the way in which it is delivered, will determine mental health outcomes. Practitioners can use these recommendations to optimise the effects of physical activity on mental health.

The (over)use of SMART goals for physical activity promotion: A narrative review and critique.

The SMART acronym (e.g., Specific, Measurable, Achievable, Realistic, Timebound) is a highly prominent strategy for setting physical activity goals. While it is intuitive, and its practical value has been recognised, the scientific underpinnings of the SMART acronym are less clear. Therefore, we aimed to narratively review and critically examine the scientific underpinnings of the SMART acronym and its application in physical activity promotion. Specifically, our review suggests that the SMART acronym: is not based on scientific theory; is not consistent with empirical evidence; does not consider what type of goal is set; is not applied consistently; is lacking detailed guidance; has redundancy in its criteria; is not being used as originally intended; and has a risk of potentially harmful effects. These issues are likely leading to sub-optimal outcomes, confusion, and inconsistency. Recommendations are provided to guide the field towards better practice and, ultimately, more effective goal setting interventions to help individuals become physically active.

Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis.

It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.

Developing and evaluating a peer-based mental health literacy intervention with adolescent athletes.

Widespread adolescent involvement in organized sport means that sport contexts are well-suited to 'actively' integrate prevention programs that may promote population-level change. This mixed methods study aimed to evaluate the feasibility and acceptability of a peer-based mental health literacy intervention. The intervention (i.e., Team Talk) was presented to eleven adolescent sport teams in the United States, with a total of 174 participants. Athlete participants completed surveys immediately before and after the intervention-including measures of workshop acceptability, social identity, and help-seeking behaviors. Semi-structured interviews were also conducted with a subset of five athletes, nine parents, and two coaches. With respect to recruitment as an indicator of feasibility, club-level adoption of the intervention was low, with difficulty recruiting clubs for intervention delivery. This signals that feasibility of the intervention-as it is currently designed and implemented by the research team-is low when considering similar competitive adolescent sport clubs and delivered as team-level workshops. Meanwhile, participants reported high acceptability of the intervention, and acceptability levels across participants was predicted by contextual factors related to implementation such as session duration. Regarding limited efficacy testing with measures completed before and after the intervention session: (a) social identity scores increased following the intervention, and (b) significant differences were not identified regarding efficacy to recognize symptoms of mental disorders. Athlete, coach, and parent interview responses also described potential adaptations to mental health programs. This research demonstrates the potential utility of peer-based mental health literacy interventions, while also revealing that further implementation research is necessary to adapt mental health literacy interventions to suit diverse adolescent sport contexts.

A Systems Theory of Mental Health in Recreational Sport.

The focus on mental health outcomes in sport, including the ways in which mental health can be protected and promoted, has become a major international priority for all sports, including the recreational sports system. The aim of this paper is to outline a systems theory of mental health care and promotion that is specific to needs of the recreational sport system so that context-specific, effective policies, interventions, and models of care can be articulated and tested. Based on general systems theory, we offer a preliminary theory and accompanying postulates that outline the general principles that explain mental health in recreational sports. Namely: one of the purposes of the recreational sport system is to protect and promote the mental health of all involved; the recreational sport system is comprised of components (individuals, groups, organisations, communities, society); the role and function of those components vary by context; the purpose of the system is achieved through coordinated and reciprocal relationships between its components; and, the system should be regulated from within to ensure that mental health is protected and promoted. We have also outlined the ways in which the subcomponents of the system interact, their potential influence on mental health in recreational sports, and the ways in which they may be regulated. This information provides a theoretical foundation upon which research, programming, and policy can be based to protect and promote the mental health of all involved in recreational sports.

Protocol for national mental health guidelines for community sport in Australia.

Organised sports are the most common settings for sports participation. Despite a range of documented benefits from participation, these positive outcomes are not always guaranteed. Emotional distress from pressure and injuries can mean some participants experience negative outcomes. To ensure organised sports are well equipped to promote the mental health of their members, evidence-based guidelines for them are required. Using a Community-Based Participatory Research framework, mental health guidelines for community sport will be developed. In Phase One, community sport stakeholders will participate in focus groups. The aim is to understand their preferences of the content, purpose and scope of the guidelines. In Phase Two, an e-Delphi study will be conducted with experts in mental health and sport in Australia to gather recommendations on the purpose and scope of the guidelines. In Phase Three, a national consensus meeting with an Expert Guideline Development Committee will be held to draft the guidelines. In Phase Four, follow-up focus groups will be held with community sport stakeholders to understand the usability and acceptability of the draft guidelines. In Phase Five, a second e-Delphi study will be conducted to provide feedback on the revised guidelines after community stakeholder review. In Phase Six, implementation case studies will assess the implementation of the guidelines in community sport clubs. These mental health guidelines will answer an urgent call for action by experts. The guidelines will be based on sector needs and preferences, be acceptable and useable, and be able to be implemented by community sport clubs globally by 2025.

Is prosocial behaviour a missing link between green space quality and child health-related outcomes?

BACKGROUND: This study aimed to investigate prosocial behaviour-those behaviours that benefit others or enhance relationships with others-as a mediator of the associations between green space quality and child health-related outcomes (physical activity, mental health, and health-related quality of life (HRQOL)). METHODS: This study involved data from 4983 children with 10-year follow-up (2004-2014) retrieved from the Longitudinal Study of Australian Children. Green space quality (the exposure), prosocial behaviour (the candidate mediator), and child health-related outcomes were assessed biennially based on caregiver reports. Causal mediation analysis was used, with four mediation models developed for each outcome. RESULTS: Mediation by prosocial behaviour appeared in the late childhood mediation model with higher mediation proportions reported compared to models of earlier and middle childhood. Prosocial behaviour had moderate mediation consistency for the association between green space quality and physical activity enjoyment, but no mediation was evident for other physical activity variables. Prosocial behaviour had low mediation consistency for child mental health (internalising and externalising subscales). Similarly, low mediation consistency of prosocial behaviour was also evident for all HRQOL variables, such as physical, emotional, social, school functioning, psychosocial health, and total quality of life (QOL). CONCLUSION: Prosocial behaviour partially mediated the association between green space quality and child health-related outcomes (physical activity enjoyment, mental health, and HRQOL). Improving the quality of neighbourhood green space that supports the development of prosocial behaviour may result in better child health-related outcomes. Other physical activity variables might not specifically relate to social interactions, and therefore, no mediation by prosocial behaviour was apparent.

Effects of online continuum and categorical belief manipulations on schizophrenia stigma, help-seeking, and help-provision.

Most research investigating the effect of continuum beliefs on stigma has used weak manipulations which may contribute to mixed findings within the experimental literature. There is also a lack of research into how continuum belief manipulations may impact help-seeking and help-provision. This study used an online manipulation of continuum and categorical beliefs about schizophrenia to examine the subsequent impacts on stigma, help-seeking, and help-provision. A total of 271 participants were randomised into either a continuum, categorical, or control condition. Participants received an informational video, a magazine article, and research highlights relevant to their condition. Prosocial support behaviour was assessed through a novel volunteering measure. The magnitude of change between pre-intervention and post-intervention measures of continuum and categorical beliefs was large. Continuum presentations reduced prognostic pessimism and negative stereotyping. Meanwhile, categorical presentations increased prognostic pessimism. Participants across conditions showed increased help-providing intentions after removing the highest scores to avoid ceiling effects. Fear and blame also decreased significantly across all conditions. There was no difference between conditions on our novel volunteer help-provision measure. Our findings have implications for anti-stigma programs and may help inform the design of future continuum belief manipulations.

Multiple effects health economic evaluation of the Ahead of The Game Study for mental health promotion in sporting club communities.

BACKGROUND: This study evaluates the Ahead Of The Game (AOTG) mental health promotion strategy for adolescent males relative to usual practice in team based sporting club community settings, allowing for joint incremental effects across 13 dimensions and 5 domains alongside intervention implementation costs. METHODS: Analysis is undertaken between matched communities with difference in differences analysis of joint multiple pre-post effect changes alongside implementation costs employing radar plots in cost-disutility space. A robust bootstrapping method allowed including all observed change in effect data from 343 AOTG and 273 control arm participants across 13 effect dimensions. RESULTS: Triangulation across joint evidence shows mean incremental effects favoured AOTG in all dimensions (10/13 significantly at 5% level) and in simple aggregation to each of five pre-specified 5 domains (each significant at < 1% level) and global measures (significant at 0.001% level), while mean AOTG implementation costs were conservatively estimated as $37.47 per participant. CONCLUSION: The AOTG strategy was found to represent an effective mental health promotion strategy across all domains and globally with associated significant potential for downstream health system cost savings to offset against modest implementation costs. Evaluation methods extend conventional cost-effectiveness analysis to enable robust joint presentation and triangulation under uncertainty of multiple effect dimensions alongside costs. TRIAL REGISTRATION: ANZCTR, ACTRN12617000709347 . Registered 17th May 2017.

Profiles of mental health help seeking among Australian adolescent males.

INTRODUCTION: Adolescent males are at increased risk of mental illness and are reluctant to engage in treatment. This study aims to identify subgroups of help-seeking intentions among a sample of Australian male adolescents. METHODS: A sample of 1038 male adolescent sport participants in Australia (age M = 14.69 years, SD = 1.35) reported help-seeking intentions from ten sources and from 'no one'. Latent profile analysis was conducted based on these 11 items. Identified profiles were then compared across mental health measures. RESULTS: Four latent profiles were identified: Low general help-seekers (10.5%), Moderate general help-seekers (46.8%), High general help-seekers (25.5%), High family and friends help-seekers (17.2%). Low, Moderate, and High general help-seekers had uniformly low, moderate, and high intentions to seek help from all sources, respectively. High family and friends help-seekers reported high endorsement of intentions to seek help from intimate partners, friends, parents, and other relatives, but low intentions for other sources. Low general help-seekers had lower intentions to seek help from parents compared to all other profiles. They also had significantly lower perceived family support and higher psychological distress. CONCLUSIONS: Low general help-seekers were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Their distinct profile offers potential to identify this high-risk group through the use of ratings on the parent help-seeking intentions item. Further research should investigate the predictive utility of this item on help-seeking and mental health, and should consider the influence of masculinity and previous experiences of help-seeking.

Extraversion development in childhood, adolescence and adulthood: Testing the role of sport participation in three nationally-representative samples.

This research sought to test whether sport participation relates to the development of trait extraversion across three life phases. Sport participation and extraversion were measured in children aged 10.5 ± 0.5 years (n = 3600), in adolescents aged 14.5 ± 0.5 years (n = 3463), and in adults with a mean age of 49.4 ± 18.0 years (n = 12,280), with corresponding data collected four years earlier. There were small mean-level decreases in extraversion during childhood and adulthood, and a large decrease in extraversion during adolescence. Four-year rank-order stability in extraversion was .58 in childhood, .61 in adolescence and .76 in adulthood. Sport participation was associated with higher extraversion in all three samples. After controlling for sociodemographic factors, children and adolescents who dropped out of sport showed greater decreases in extraversion than those who continued participation in sport. Sport participation was unrelated to mean-level change in extraversion during adulthood. Sport participation was also associated with greater intra-individual stability in extraversion for children, adolescents and adults. There were no significant sex moderation effects for mean-level change or individual-level stability. These findings provide evidence that sport participation might have an important role in trait extraversion stability and change across the lifespan.

Attitudes about mental illness and help seeking among adolescent males.

Adolescent males are at particularly high risk of mental health problems and suicide. However, many in need are left undetected and untreated, and rates of help-seeking are low. To help explain this unmet need, the current study aimed to utilise Exploratory Factor Analysis to validate a measure of help-seeking attitudes using 16 items of the Mental Health Literacy Scale. Convergent validity was assessed through correlations of the factors with other measures capturing aspects of mental health literacy and psychological distress. Male adolescent sport participants (N=361) aged between 12 and 18 years participated in the study. The results revealed a distinct four-factor structure: social distance, stigmatising attitudes, confidence accessing information about mental health, and negative help-seeking attitudes. Each factor had satisfactory levels of internal consistency. The patterns of relationships suggest that the four factors may differentiate between important influencers of mental health help-seeking. The measure is brief and is likely to have high utility in measuring attitudes about mental illness and help-seeking among adolescent males. This may have implications for understanding the processes that could influence or improve help-seeking amongst this vulnerable group.

Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence.

Youth sport offers physical and psychosocial components that may be beneficial for adolescents' mental health, but the prospective directionality between sport participation and mental health has not been clearly established. The current study examined longitudinal associations between sport participation (individual and team sport) and mental health indices (depressive symptoms, anxiety symptoms, emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, and prosocial behavior) across adolescence (ages 12-17) in a nationally representative Australian sample of 3956 participants at T1 (Mage = 12.41 years, SD = 0.49; 49% female), 3537 at T2 (Mage = 14.41 years, SD = 0.49; 49% female), and 3089 at T3 (Mage = 16.46 years, SD = 0.51; 49% female). Using random intercept cross-lagged panel modeling, several significant within-person effects were found. Notably, greater participation in team sport prospectively predicted fewer symptoms of depression and anxiety at subsequent timepoints. This study increases the understanding of how sport participation may relate to mental health among adolescents and provides critical evidence to inform policy.

Cross-Sectional Associations of Application Use and Media Program Viewing with Cognitive and Psychosocial Development in Preschoolers.

Executive functions and psychosocial health during childhood are positively associated with health and developmental outcomes into adulthood. Electronic media use has been reported to adversely affect health and development in children; however, what remains unclear is whether contemporary media behaviors, such as electronic application (app) use, exerts similar effects on health and development. We investigated the associations of electronic media use (program viewing and app use) with cognitive and psychosocial development in preschoolers. Parents of preschool children (n = 247, 4.2 ± 0.6 years) reported the time their child spent using electronic media. Direct assessment of the children's executive functions (working memory, inhibition, and shifting) and educator-reported psychosocial difficulties were also collected. Associations were examined using linear regression adjustments for covariates and preschool clustering. Small, but significant, negative associations were observed for total electronic media use (b = -0.001; 95% CI: -0.003, -0.000; p = 0.026) and program viewing (b = -0.002; 95% CI: -0.003, -0.000; p = 0.033) with children's visual-spatial working memory. However, high-dose app users demonstrated higher phonological working memory scores compared to non-users (MD = 0.31; 95% CI: 0.04, 0.58; p = 0.025). Similarly, compared to non-users, low-dose app users displayed statistically significantly fewer total difficulties (MD = -1.67; 95% CI: -3.31, -0.02; p = 0.047). No associations were evident for high-dose app users and the remaining outcomes. The results may suggest that attempts to reduce program viewing while promoting moderate levels of app use may exert positive influences on children's executive functions and psychosocial development.

An Intervention for Mental Health Literacy and Resilience in Organized Sports.

PURPOSE: In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants. METHODS: The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes' psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mean differences on the primary and secondary outcomes were analyzed using linear mixed models, adjusted for clustering at club level, participant age, and socioeconomic status. RESULTS: Significant positive group-time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group-time interaction for the secondary outcome of well-being. There were no group-time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress. CONCLUSIONS: Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs.

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.