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

Research output: Contribution to journalArticle

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Abstract

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.
LanguageEnglish
Pages1-15
JournalSystematic Reviews
Volume6
Issue number177
Early online date31 Aug 2017
DOIs
Publication statusE-pub ahead of print - 31 Aug 2017

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Athletes
Mental Health
Sports
Referral and Consultation
Databases
Psychological Theory
Program Evaluation
Mentoring
Administrative Personnel
Mental Disorders
Research Design
Research Personnel
Outcome Assessment (Health Care)

Keywords

  • mental health literacy
  • sport
  • resilience
  • athletes
  • interventions
  • health pro

Cite this

@article{71628e24487347a4b00713f698d89a83,
title = "A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials",
abstract = "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.",
keywords = "mental health literacy, sport, resilience, athletes, interventions, health pro",
author = "Gavin Breslin and Stephen Shannon and Tandy Haughey and Paul Donnolly and Gerard Leavey",
note = "Reference text: 1 World Health Organization. Mental health: a state of well-being 2014. 2 Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet 2013;382:1575-86. 3 World Health Organization. http://www. who. int/mediacentre/factsheets/fs340/en. url> http://www.who.int/mediacentre/factsheets/fs241/en/</url 2014. 4 Abuse S. Mental Health Services Administration (2012) Results from the 2011 National survey on drug use and health: summary of national findings, NSDUH series H-44, HHS publication no.(SMA) 12-4713. Substance Abuse and Mental Health Services Administration, Rockville, MD 2012. 5 Rice SM, Purcell R, De Silva S, et al. The mental health of elite athletes: a narrative systematic review. Sports Medicine 2016;46:1333-53. 6 B{\"a}r K, Markser VZ. Sport specificity of mental disorders: the issue of sport psychiatry. Eur Arch Psychiatry Clin Neurosci 2013;263:205-10. 7 Elbe A, Jensen SN. Commentary: comparison of athletes' proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in psychology 2016;7. 8 Nixdorf I, Frank R, Beckmann J. Comparison of athletes’ proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in psychology 2016;7. 9 Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 2012;12:1. 10 Hammond T, Gialloreto C, Kubas H, et al. The prevalence of failure-based depression among elite athletes. Clin J Sport Med 2013;23:273-7 doi:10.1097/JSM.0b013e318287b870 [doi]. 11 Biddle S, Gorely T, Mutrie N. Psychology of physical activity: determinants, well-being and interventions. Milton Park, Abingdon, Oxon; New York, NY: Routledge 2015. 12 Bauman NJ. The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport?. Br J Sports Med 2016;50:135-6 doi:10.1136/bjsports-2015-095570 [doi]. 13 Donohue B, Miller A, Crammer L, et al. A standardized method of assessing sport specific problems in the relationships of athletes with their coaches, teammates, family, and peers. J Sport Behav 2007;30:375. 14 Evans M, Weinberg R, Jackson A. Psychological factors related to drug use in college athletes. The Sport Psychologist 1992;6:24-41. 15 Masland RP. The adolescent: Athletics and development. Journal of Adolescent Health Care 1983;3:237-40. 16 Wiese‐Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high‐intensity athletes: a consensus statement. Scand J Med Sci Sports 2010;20:103-11. 17 King KA, Dowdall MP, Wagner DI. Coaches’ attitudes and involvement in alcohol prevention among high school athletes. J Community Health 2010;35:68-75. 18 Trojian T. Depression is under-recognised in the sport setting: time for primary care sports medicine to be proactive and screen widely for depression symptoms. Br J Sports Med 2016;50:137-9 doi:10.1136/bjsports-2015-095582 [doi]. 19 Fletcher D, Scott M. Psychological stress in sports coaches: A review of concepts, research, and practice. J Sports Sci 2010;28:127-37. 20 Thelwell RC, Weston NJ, Greenlees IA, et al. A qualitative exploration of psychological-skills use in coaches. The sport psychologist 2008;22:38-53. 21 Anshel MH, Weinberg RS. Sources of acute stress in American and Australian basketball referees. Journal of Applied Sport Psychology 1995;7:11-22. 22 Anshel MH, Kang M, Jubenville C. Sources of acute sport stress scale for sports officials: Rasch calibration. Psychol Sport Exerc 2013;14:362-70. 23 Rainey DW. Stress, burnout, and intention to terminate among umpires. J Sport Behav 1995;18:312. 24 Al-Haliq M, Altahayneh ZL. Levels of burnout among sports referees in Jordan. Journal of Physical Education and Sport 2014;14:47. 25 Jorm AF, Korten AE, Jacomb PA, et al. {"}Mental health literacy{"}: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997;166:182-6. 26 Jorm A. Mental health literacy: Public knowledge and beliefs about. British Journal of Psychiatry 2000;177:396-401. 27 Miller WR, Zweben J, Johnson WR. Evidence-based treatment: why, what, where, when, and how?. J Subst Abuse Treat 2005;29:267-76. 28 Fox A. Fear of failure in the context of competitive sport. International Journal of Sports Science & Coaching 2008;3:173-7. 29 Sebbens J, Hassm{\'e}n P, Crisp D, et al. Mental health in sport (MHS): improving the early intervention knowledge and confidence of elite sport staff. Frontiers in psychology 2016;7. 30 Goodheart CD. Psychology practice: design for tomorrow. Am Psychol 2011;66:339. 31 Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med 2016;50:145-8 doi:10.1136/bjsports-2015-095586 [doi]. 32 Cooper P, Stringer W, Howes J, et al. The State of Mind Boot Room: Reducing social isolation and promoting mental fitness. British Journal of Mental Health Nursing 2015;4:136-9. 33 Wolanin A, Hong E, Marks D, et al. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med 2016;50:167-71 doi:10.1136/bjsports-2015-095756 [doi]. 34 Brown GT, Hainline B, Kroshus E, et al. Mind, body and sport: understanding and supporting student-athlete mental wellness 2014. 35 Breslin G, Shannon S, Haughey T, et al. A Review of Mental Health and Wellbeing Awareness Programmes in Sport 2016. 36 Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015;4:1. 37 Rejeski WJ, Brawley LR. Defining the Boundaries of Sport Psychology. Sport Psychologist 1988;2. 38 Egger M, Juni P, Bartlett C, et al. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews?: Empirical study 2003. 39 Goodger K, Gorely T, Lavallee D, et al. Burnout in sport: A systematic review. The sport psychologist 2007;21:127-51. 40 Coalter F. Sport for development: What game are we playing?: Routledge 2013. 41 Mehta N, Clement S, Marcus E, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 2015;207:377-84 doi:10.1192/bjp.bp.114.151944 [doi]. 42 World Health Organization. World health report 2001: mental health 2001. 43 Watson JC. Student-athletes and counseling: Factors influencing the decision to seek counseling services. College Student Journal 2006;40:35. 44 Reese LMS, Pittsinger R, Yang J. Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science 2012;1:71-9. 45 Field A. Discovering statistics using IBM SPSS statistics: Sage 2013. 46 Cohen J. A power primer. Psychol Bull 1992;112:155. 47 Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Wiley Online Library 2008. 48 Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928 doi:10.1136/bmj.d5928 [doi]. 49 Thomas H. Quality assessment tool for quantitative studies Hamilton. Ontario: Effective Public Health Practice Project 2003. 50 Deeks J, Dinnes J, D'amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess 2003;7:iii,x, 1-173. 51 Schumacker RE, Lomax RG. A beginner's guide to structural equation modeling: Psychology Press 2004. 52 Donohue B, Pitts M, Gavrilova Y, et al. A culturally sensitive approach to treating substance abuse in athletes using evidence-supported methods. Journal of Clinical Sport Psychology 2013;7:98-119. 53 Yang J, Schaefer JT, Zhang N, et al. Social support from the athletic trainer and symptoms of depression and anxiety at return to play. J Athl Train 2014;49:773-9 doi:10.4085/1062-6050-49.3.65 [doi]. 54 Piacentini MF, Meeusen R. An online training-monitoring system to prevent nonfunctional overreaching. International journal of sports physiology and performance 2015;10:524-7. 55 Goldberg L, Elliot DL, MacKinnon DP, et al. Drug testing athletes to prevent substance abuse: background and pilot study results of the SATURN (Student Athlete Testing Using Random Notification) study. Journal of Adolescent Health 2003;32:16-25. 56 Hashim HA, Hanafi Ahmad Yusof H. The effects of progressive muscle relaxation and autogenic relaxation on young soccer players' mood states. Asian J Sports Med 2011;2:99-105. 57 Tranaeus U, Johnson U, Engstr{\"o}m B, et al. A psychological injury prevention group intervention in Swedish floorball. Knee surgery, sports traumatology, arthroscopy 2015;23:3414-20. 58 Elliot DL, Goldberg L, Moe EL, et al. Preventing substance use and disordered eating: initial outcomes of the ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) program. Arch Pediatr Adolesc Med 2004;158:1043-9. 59 Elliot DL, Moe EL, Goldberg L, et al. Definition and outcome of a curriculum to prevent disordered eating and body‐shaping drug use. J Sch Health 2006;76:67-73. 60 Elliot DL, Goldberg L, Moe EL, et al. Long-term Outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) Program for Female High School Athletes. J Alcohol Drug Educ 2008;52:73-92. 61 Bapat S, Jorm A, Lawrence K. Evaluation of a mental health literacy training program for junior sporting clubs. Australasian Psychiatry 2009;17:475-9. 62 Breslin, G., Haughey, T., Donnelly, P., Kearney, C., & Prentice, G. (In Press). Promoting Mental Health Awareness in Sport Clubs. Journal of Public Mental Health. 63 Donohue B, Chow GM, Pitts M, et al. Piloting A Family-Supported Approach to Concurrently Optimize Mental Health and Sport Performance in Athletes. Clinical Case Studies 2015;14:159-77. 64 Gulliver A, Griffiths KM, Christensen H, et al. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. Journal of medical Internet research 2012;14:e69. 65 Longshore K, Sachs M. Mindfulness training for coaches: A mixed-method exploratory study. Journal of Clinical Sport Psychology 2015;9:116-37. 66 Pierce D, Liaw S, Dobell J, et al. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International journal of mental health systems 2010;4:10. 67 Slack L, Butt J, Maynard I, et al. Understanding mental toughness in elite football officiating: perceptions of English Premier League referees. Sport and exercise psychology review 2014;10:4-24. 68 Tester GJ, Watkins GG, Rouse I. The Sports Challenge international programme for identified 'at risk' children and adolescents: a Singapore study. Asia Pac J Public Health 1999;11:34-8. 69 Van Raalte JL, Cornelius AE, Andrews S, et al. Mental health referral for student-athletes: Web-based education and training. Journal of Clinical Sport Psychology 2015;9:197-212. 70 Hagger MS, Chatzisarantis NL. Assumptions in research in sport and exercise psychology. Psychol Sport Exerc 2009;10:511-9. 71 Cotterill S, Weston N, Breslin G. Sport and exercise psychology: practitioner case studies: John Wiley & Sons 2016. 72 Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655 doi:10.1136/bmj.a1655 [doi]. 73 Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68. 74 Ajzen I. Theory of planned behavior. Handb Theor Soc Psychol Vol One 2011;1:438. 75 Maiman LA, Becker MH. The health belief model: Origins and correlates in psychological theory. Health Education & Behavior 1974;2:336-53. 76 Michie S, Ashford S, Sniehotta FF, et al. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 2011;26:1479-98. 77 Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men's help-seeking for depression: a systematic review. Clinical psychology review, 49, 106-118. 78 Cavanagh, A., Wilson, C. J., Kavanagh, D. J., & Caputi, P. (2017). Differences in the expression of symptoms in men versus women with depression: a systematic review and meta-analysis. Harvard review of psychiatry, 25(1), 29-38. 79 Elite Athlete Brief Counselling Support Program. Accessed from: https://www.ausport.gov.au/ais/performance_support/psychology/elite_athlete_brief_counseling_support_program (04.07.17). 80 Adams, R. J., Smart, P. and Huff, A. S. (2016), Shades of Grey: Guidelines for Working with the Grey Literature in Systematic Reviews for Management and Organizational Studies. International Journal of Management Reviews. doi:10.1111/ijmr.12102. 81 Biddle, S. J., & Asare, M. (2011). Physical activity and mental health in children and adolescents: a review of reviews. British journal of sports medicine, bjsports90185.",
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N1 - Reference text: 1 World Health Organization. Mental health: a state of well-being 2014. 2 Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet 2013;382:1575-86. 3 World Health Organization. http://www. who. int/mediacentre/factsheets/fs340/en. url> http://www.who.int/mediacentre/factsheets/fs241/en/</url 2014. 4 Abuse S. Mental Health Services Administration (2012) Results from the 2011 National survey on drug use and health: summary of national findings, NSDUH series H-44, HHS publication no.(SMA) 12-4713. Substance Abuse and Mental Health Services Administration, Rockville, MD 2012. 5 Rice SM, Purcell R, De Silva S, et al. The mental health of elite athletes: a narrative systematic review. Sports Medicine 2016;46:1333-53. 6 Bär K, Markser VZ. Sport specificity of mental disorders: the issue of sport psychiatry. Eur Arch Psychiatry Clin Neurosci 2013;263:205-10. 7 Elbe A, Jensen SN. Commentary: comparison of athletes' proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in psychology 2016;7. 8 Nixdorf I, Frank R, Beckmann J. Comparison of athletes’ proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in psychology 2016;7. 9 Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 2012;12:1. 10 Hammond T, Gialloreto C, Kubas H, et al. The prevalence of failure-based depression among elite athletes. Clin J Sport Med 2013;23:273-7 doi:10.1097/JSM.0b013e318287b870 [doi]. 11 Biddle S, Gorely T, Mutrie N. Psychology of physical activity: determinants, well-being and interventions. Milton Park, Abingdon, Oxon; New York, NY: Routledge 2015. 12 Bauman NJ. The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport?. Br J Sports Med 2016;50:135-6 doi:10.1136/bjsports-2015-095570 [doi]. 13 Donohue B, Miller A, Crammer L, et al. A standardized method of assessing sport specific problems in the relationships of athletes with their coaches, teammates, family, and peers. J Sport Behav 2007;30:375. 14 Evans M, Weinberg R, Jackson A. Psychological factors related to drug use in college athletes. The Sport Psychologist 1992;6:24-41. 15 Masland RP. The adolescent: Athletics and development. Journal of Adolescent Health Care 1983;3:237-40. 16 Wiese‐Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high‐intensity athletes: a consensus statement. Scand J Med Sci Sports 2010;20:103-11. 17 King KA, Dowdall MP, Wagner DI. Coaches’ attitudes and involvement in alcohol prevention among high school athletes. J Community Health 2010;35:68-75. 18 Trojian T. Depression is under-recognised in the sport setting: time for primary care sports medicine to be proactive and screen widely for depression symptoms. Br J Sports Med 2016;50:137-9 doi:10.1136/bjsports-2015-095582 [doi]. 19 Fletcher D, Scott M. Psychological stress in sports coaches: A review of concepts, research, and practice. J Sports Sci 2010;28:127-37. 20 Thelwell RC, Weston NJ, Greenlees IA, et al. A qualitative exploration of psychological-skills use in coaches. The sport psychologist 2008;22:38-53. 21 Anshel MH, Weinberg RS. Sources of acute stress in American and Australian basketball referees. Journal of Applied Sport Psychology 1995;7:11-22. 22 Anshel MH, Kang M, Jubenville C. Sources of acute sport stress scale for sports officials: Rasch calibration. Psychol Sport Exerc 2013;14:362-70. 23 Rainey DW. Stress, burnout, and intention to terminate among umpires. J Sport Behav 1995;18:312. 24 Al-Haliq M, Altahayneh ZL. Levels of burnout among sports referees in Jordan. Journal of Physical Education and Sport 2014;14:47. 25 Jorm AF, Korten AE, Jacomb PA, et al. "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997;166:182-6. 26 Jorm A. Mental health literacy: Public knowledge and beliefs about. British Journal of Psychiatry 2000;177:396-401. 27 Miller WR, Zweben J, Johnson WR. Evidence-based treatment: why, what, where, when, and how?. J Subst Abuse Treat 2005;29:267-76. 28 Fox A. Fear of failure in the context of competitive sport. International Journal of Sports Science & Coaching 2008;3:173-7. 29 Sebbens J, Hassmén P, Crisp D, et al. Mental health in sport (MHS): improving the early intervention knowledge and confidence of elite sport staff. Frontiers in psychology 2016;7. 30 Goodheart CD. Psychology practice: design for tomorrow. Am Psychol 2011;66:339. 31 Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med 2016;50:145-8 doi:10.1136/bjsports-2015-095586 [doi]. 32 Cooper P, Stringer W, Howes J, et al. The State of Mind Boot Room: Reducing social isolation and promoting mental fitness. British Journal of Mental Health Nursing 2015;4:136-9. 33 Wolanin A, Hong E, Marks D, et al. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med 2016;50:167-71 doi:10.1136/bjsports-2015-095756 [doi]. 34 Brown GT, Hainline B, Kroshus E, et al. Mind, body and sport: understanding and supporting student-athlete mental wellness 2014. 35 Breslin G, Shannon S, Haughey T, et al. A Review of Mental Health and Wellbeing Awareness Programmes in Sport 2016. 36 Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015;4:1. 37 Rejeski WJ, Brawley LR. Defining the Boundaries of Sport Psychology. Sport Psychologist 1988;2. 38 Egger M, Juni P, Bartlett C, et al. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews?: Empirical study 2003. 39 Goodger K, Gorely T, Lavallee D, et al. Burnout in sport: A systematic review. The sport psychologist 2007;21:127-51. 40 Coalter F. Sport for development: What game are we playing?: Routledge 2013. 41 Mehta N, Clement S, Marcus E, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 2015;207:377-84 doi:10.1192/bjp.bp.114.151944 [doi]. 42 World Health Organization. World health report 2001: mental health 2001. 43 Watson JC. Student-athletes and counseling: Factors influencing the decision to seek counseling services. College Student Journal 2006;40:35. 44 Reese LMS, Pittsinger R, Yang J. Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science 2012;1:71-9. 45 Field A. Discovering statistics using IBM SPSS statistics: Sage 2013. 46 Cohen J. A power primer. Psychol Bull 1992;112:155. 47 Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Wiley Online Library 2008. 48 Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928 doi:10.1136/bmj.d5928 [doi]. 49 Thomas H. Quality assessment tool for quantitative studies Hamilton. Ontario: Effective Public Health Practice Project 2003. 50 Deeks J, Dinnes J, D'amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess 2003;7:iii,x, 1-173. 51 Schumacker RE, Lomax RG. A beginner's guide to structural equation modeling: Psychology Press 2004. 52 Donohue B, Pitts M, Gavrilova Y, et al. A culturally sensitive approach to treating substance abuse in athletes using evidence-supported methods. Journal of Clinical Sport Psychology 2013;7:98-119. 53 Yang J, Schaefer JT, Zhang N, et al. Social support from the athletic trainer and symptoms of depression and anxiety at return to play. J Athl Train 2014;49:773-9 doi:10.4085/1062-6050-49.3.65 [doi]. 54 Piacentini MF, Meeusen R. An online training-monitoring system to prevent nonfunctional overreaching. International journal of sports physiology and performance 2015;10:524-7. 55 Goldberg L, Elliot DL, MacKinnon DP, et al. Drug testing athletes to prevent substance abuse: background and pilot study results of the SATURN (Student Athlete Testing Using Random Notification) study. Journal of Adolescent Health 2003;32:16-25. 56 Hashim HA, Hanafi Ahmad Yusof H. The effects of progressive muscle relaxation and autogenic relaxation on young soccer players' mood states. Asian J Sports Med 2011;2:99-105. 57 Tranaeus U, Johnson U, Engström B, et al. A psychological injury prevention group intervention in Swedish floorball. Knee surgery, sports traumatology, arthroscopy 2015;23:3414-20. 58 Elliot DL, Goldberg L, Moe EL, et al. Preventing substance use and disordered eating: initial outcomes of the ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) program. Arch Pediatr Adolesc Med 2004;158:1043-9. 59 Elliot DL, Moe EL, Goldberg L, et al. Definition and outcome of a curriculum to prevent disordered eating and body‐shaping drug use. J Sch Health 2006;76:67-73. 60 Elliot DL, Goldberg L, Moe EL, et al. Long-term Outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) Program for Female High School Athletes. J Alcohol Drug Educ 2008;52:73-92. 61 Bapat S, Jorm A, Lawrence K. Evaluation of a mental health literacy training program for junior sporting clubs. Australasian Psychiatry 2009;17:475-9. 62 Breslin, G., Haughey, T., Donnelly, P., Kearney, C., & Prentice, G. (In Press). Promoting Mental Health Awareness in Sport Clubs. Journal of Public Mental Health. 63 Donohue B, Chow GM, Pitts M, et al. Piloting A Family-Supported Approach to Concurrently Optimize Mental Health and Sport Performance in Athletes. Clinical Case Studies 2015;14:159-77. 64 Gulliver A, Griffiths KM, Christensen H, et al. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. Journal of medical Internet research 2012;14:e69. 65 Longshore K, Sachs M. Mindfulness training for coaches: A mixed-method exploratory study. Journal of Clinical Sport Psychology 2015;9:116-37. 66 Pierce D, Liaw S, Dobell J, et al. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International journal of mental health systems 2010;4:10. 67 Slack L, Butt J, Maynard I, et al. Understanding mental toughness in elite football officiating: perceptions of English Premier League referees. Sport and exercise psychology review 2014;10:4-24. 68 Tester GJ, Watkins GG, Rouse I. The Sports Challenge international programme for identified 'at risk' children and adolescents: a Singapore study. Asia Pac J Public Health 1999;11:34-8. 69 Van Raalte JL, Cornelius AE, Andrews S, et al. Mental health referral for student-athletes: Web-based education and training. Journal of Clinical Sport Psychology 2015;9:197-212. 70 Hagger MS, Chatzisarantis NL. Assumptions in research in sport and exercise psychology. Psychol Sport Exerc 2009;10:511-9. 71 Cotterill S, Weston N, Breslin G. Sport and exercise psychology: practitioner case studies: John Wiley & Sons 2016. 72 Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655 doi:10.1136/bmj.a1655 [doi]. 73 Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68. 74 Ajzen I. Theory of planned behavior. Handb Theor Soc Psychol Vol One 2011;1:438. 75 Maiman LA, Becker MH. The health belief model: Origins and correlates in psychological theory. Health Education & Behavior 1974;2:336-53. 76 Michie S, Ashford S, Sniehotta FF, et al. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 2011;26:1479-98. 77 Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016). The role of masculinity in men's help-seeking for depression: a systematic review. Clinical psychology review, 49, 106-118. 78 Cavanagh, A., Wilson, C. J., Kavanagh, D. J., & Caputi, P. (2017). Differences in the expression of symptoms in men versus women with depression: a systematic review and meta-analysis. Harvard review of psychiatry, 25(1), 29-38. 79 Elite Athlete Brief Counselling Support Program. Accessed from: https://www.ausport.gov.au/ais/performance_support/psychology/elite_athlete_brief_counseling_support_program (04.07.17). 80 Adams, R. J., Smart, P. and Huff, A. S. (2016), Shades of Grey: Guidelines for Working with the Grey Literature in Systematic Reviews for Management and Organizational Studies. International Journal of Management Reviews. doi:10.1111/ijmr.12102. 81 Biddle, S. J., & Asare, M. (2011). Physical activity and mental health in children and adolescents: a review of reviews. British journal of sports medicine, bjsports90185.

PY - 2017/8/31

Y1 - 2017/8/31

N2 - 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.

AB - 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.

KW - mental health literacy

KW - sport

KW - resilience

KW - athletes

KW - interventions

KW - health pro

U2 - 10.1186/s13643-017-0568-6

DO - 10.1186/s13643-017-0568-6

M3 - Article

VL - 6

SP - 1

EP - 15

JO - Systematic Reviews

T2 - Systematic Reviews

JF - Systematic Reviews

SN - 2046-4053

IS - 177

ER -