A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials

Background: To conduct a systematic review determining the effect of sport-specific mental health awareness programs to improve mental health knowledge and help-seeking among sports coaches, athletes and officials. To review study quality and report on the validity of measures that were used to determine the effectiveness of programs. Methods: Sport-specific mental health awareness programs adopting an experimental or quasi-experimental design were included for synthesis. Six electronic databases were searched: Psychinfo, Medline (OVID interface), Scopus, Cochrane, Cinahl and Sport Discus. Each database was searched from its year of inception to October 2016. Risk of bias was assessed using the Cochrane and QATSQ tools. Results Ten studies were included from the 1216 studies retrieved: four comprising coaches or service providers, one with officials, four with athletes, and one involved a combination of coaches and athletes. A range of outcomes were used to assess indices of mental health awareness and well-being. Mental health referral-efficacy was improved in six studies, while three reported an increase in knowledge about mental health disorders. However, seven studies did not report effect sizes for their outcomes, limiting clinically meaningful interpretations. Furthermore, there was substantial heterogeneity and limited validity in the outcome measures of mental health knowledge and referral efficacy. Seven studies demonstrated a high risk of bias. Conclusions: Further well-designed controlled intervention studies are required. Researchers, practitioners and policy makers should adhere to available methodological guidance and apply psychological theory of behaviour change when developing and evaluating complex interventions.