Mental health and workplace experiences in elite sport: The HOWRU? study

The #HowRU? research project is a cross-sectional cohort study assessing the mental health (MH) status and experiences of harassment and abuse of the multi-disciplinary athlete health care professional staff working in elite sport.

Methodology

An online survey captured the following information:

• Sociodemographic data
• PHQ-9: 2-week history of depression symptoms
• GAD-7: 2-week history of anxiety symptoms
• International Olympic Committee (IOC) Mental Health Symptom List: 12-month history of common mental health symptoms in sport
• The need for and use of support for mental health problems
• 12-month history of experiences of harassment and abuse in sport: Psychological, Physical, Sexual, and Instrumental via a modified Violence Towards Athletes Questionnaire

The research team consisted of Dr. Margo Mountjoy (Clinical Professor McMaster-sports medicine), Dr. Astrid Junge (University of Hamburg-clinical psychology), Professor Sylvie Parent (Laval University-sport science), and Professor Rosie Purcell (University of Melbourne – sport psychology), and Joanna Fear (WRC class of 2027 and Olympian).

The recruitment team consisted of 22 professionals (17 women, 9 men) from 19 countries representing the following professions: sports medicine, orthopaedics, sport psychiatry, sport psychology, sport science, sport physiotherapy, sports dietitian, sport chiropractor, and sport massage.

Results

1541 responses were collected from 103 countries representing all athlete health care disciplines currently treating elite level athletes. The prevalence of at least moderate depression symptoms (PHQ-9) was 11.9%, and of at least moderate generalised anxiety disorder symptoms (GAD-7) was 10.4%. Over a quarter of the participants (27.3%) reported more than five MH symptoms and 19.7% sought help for their MH problems in the last 12 months. A third of the men and 56.8% of the women participants had wanted or needed support from a physician, psychologist, or psychotherapist for MH problems, including 6.7% (men) and 19.0% (women) who wanted or needed it currently. MH problems need for, and use of therapeutical support were more frequent in women than in men, and in younger than older participants.

Psychological violence was the most commonly reported type of IV (44.0%) in the last 12 months, followed by instrumental (26.1%), sexual (10.4%), and physical violence (1.4%). Coaches and non-medical entourage members were the most frequent perpetrators. Younger age independently predicted psychological, instrumental, and sexual violence, and female gender independently predicted psychological and sexual violence. Experiences of psychological, instrumental, or sexual violence was each associated with higher depression, anxiety, and overall MH symptom scores (all p<0.001), as well as greater need for and use of psychological support.

Study Impact

1. Mental health of the athlete health care providers:

• Health care providers working with elite athletes require access to mental health support that is knowledgeable of the sport environment and culture.
• Barriers to seeking help for personal or mental health issues should be identified, along with stressors in the elite sport setting, to help prevent mental health symptoms in elite athlete health care professionals and ensure access to care for those requiring assistance.
• Interventions specifically addressing the sport environment and mental health needs of women and younger health care professionals in elite sport are needed.

2. Experiences of harassment and abuse of athlete health care providers:

This study:

• provides the first global evidence on the prevalence, characteristics, and mental health impact of interpersonal violence among athlete health care professionals, establishing a foundation for future research in this understudied population.
• supports the inclusion of health care professionals in safe sport policies and safeguarding initiatives, recognising them as an integral part of the athlete entourage who also require protection from interpersonal violence.
• highlights the need for workplace prevention and reporting strategies, particularly those addressing psychological violence and providing targeted support for younger professionals and females, who appear to be at greater risk.
• suggests that protecting health care professionals may also improve athlete safety and quality of care, as interpersonal violence can undermine clinical autonomy and influence medical decision-making.

The studies are currently in publication.

Thank you to the Department of Family Medicine for their support in developing the graphics for recruitment.

Project Leads: Margo Mountjoy, Astrid Junge, Sylvie Parent, Rosie Purcell, Joanna Fear
Contact: Margo Mountjoy (mountjm@mcmaster.ca)