Clinical Utility of the Sports Mental Health Assessment Tool in NCAA Collegiate Athletes

OBJECTIVES: This study evaluates the performance of the International Olympic Committee's Sports Mental Health Assessment Tool-1 (SMHAT-1) in a collegiate athlete population. The SMHAT-1 was introduced by the International Olympic Committee in 2021 as a mental health screening tool in elite athletes. Recent studies have shown high false-negative rates in elite athletes but the tool has not been previously evaluated in a population of collegiate athletes. DESIGN: Cohort study. SETTING: National Collegiate Athletic Association (NCAA) collegiate athletic institutions. PARTICIPANTS: 1.631 collegiate athletes (NCAA division 1 and 2). INTERVENTION: Athletes underwent mental health screening including the triage and follow-up Form 2 components of SMHAT-1 during preparticipation evaluation. MAIN OUTCOME MEASURE: Sensitivity and specificity of Athlete Psychological Strain Questionnaire (APSQ) triage for detection of positive Form 2 screening. RESULTS: 9.7% of athletes were positive in the AQSP triage phase, while 41.8% were positive on at least 1 Form 2 instrument. The APSQ had a 19% sensitivity and 97% specificity for follow-up screening. 81% of athletes with a positive follow-up screen were missed during triage. CONCLUSIONS: Sequential screening using SMHAT-1 ASPQ and Form 2 steps results in a high false-negative rate. APSQ showed low sensitivity for positive Form 2 follow-up screening. The false-negative rate of 81% is concerning as a triage step for the detection of mental health concerns in collegiate athletes. We do not recommend the use of SMHAT-1 for mental health screening in collegiate athletes without modification.