Key result
MHRS shows low clinical utility for screening student-athletes due to ~25% specificity.
Why the study?
Mental health screenings are recommended during preparticipation physical examinations and the MHRS is suggested in consensus statements, but evidence on its effectiveness is lacking.
Is the Mental Health-Related Survey (MHRS) a valid screening tool for mental health conditions in collegiate student-athletes?
Cross-Sectional (n=515)
No
Is the Mental Health-Related Survey (MHRS) a valid screening tool for mental health conditions in collegiate student-athletes?
Answers are grounded in this paper and cite their sources.
Despite being recommended in consensus statements, the MHRS has low specificity and overall accuracy, suggesting it has low clinical utility as a mental health screening tool for collegiate student-athletes.
CONTEXT: Mental health screenings are recommended during preparticipation physical examinations. The Mental Health-Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in three consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS. OBJECTIVE: To assess the validity of the MHRS for mental health screening in collegiate student- athletes. DESIGN: Cross-sectional study. SETTING: University athletic program. PATIENTS: 515 NCAA Division II student-athletes (20±1 years old). MAIN OUTCOME MEASURES: Participants completed the MHRS, PHQ-9 for depression, and GAD-7 for anxiety. A stratified sample underwent a neuropsychiatric interview (MINI). Descriptive statistics and Pearson correlations were performed. An area under the curve (AUC) analysis compared the MHRS to the MINI. Validity was determined using sensitivity, specificity, Youden's index, predictive values, and accuracy. RESULTS: 322 student-athletes (62.5%) indicated 'yes' to one or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more 'yes' answers than men (p<0.001). Average scores were 2.21±3.06 on the PHQ-9 and 2.66±3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r=0.713, p<0.001; GAD-7: r=0.745, p<0.001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The AUC score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions. CONCLUSION: Most student-athletes indicated 'yes' to at least one item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.
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Keenan et al. (2025) conducted a cross-sectional in Mental health conditions (n=515). Mental Health-Related Survey (MHRS) vs. Neuropsychiatric interview (MINI) was evaluated on Validity of the MHRS compared to the MINI interview (sensitivity, specificity, accuracy, and AUC) (AUC 0.762). The Mental Health-Related Survey demonstrated high sensitivity but low specificity and an AUC of 0.762, indicating low clinical utility as a screening tool in student-athletes.
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