Insights from the Romanian version of the International Olympic Committee Sport Mental Health Assessment Tool 1 (IOC SMHAT-1) in elite athletes

To explore the extent to which Sport Mental Health Assessment Tool-1 (SMHAT-1) screening tool accounts for potential mental health outcomes we deployed the Romanian version of SMHAT-1 on a sample of 368 active elite Romanian athletes (ages 15–38, M = 20.47, SD = 5.34) registered within the Romanian Olympic and Sports Committee (COSR). Factorial validity was estimated with a confirmatory factorial analysis. Sensitivity and specificity were estimated via Receiver Operating Characteristics (ROC) analysis. Results showed strong predictive accuracy for General Anxiety Disorder-7 (AUC = .854, sensitivity = .771, specificity = .822) and depression assessed with Patient Health Questionnaire-9 (AUC = .868, sensitivity = .853, specificity = .782). Moderate accuracies in distinguishing between participants falling above or below the recommended thresholds were observed for Athlete Sleep Screening Questionnaire (AUC = .767), Alcohol Use Disorder Identification Test Consumption (AUC = .768); and Brief Eating Disorder in Athletes Questionnaire (AUC = .743). Finally, the accuracy in accounting for the outcomes predicted by the Cutting Down, Annoyance by Criticism, Guilty Feelings, and Eye Openings Adapted to Include Drugs for substance misuse was weaker (AUC = .609). Findings suggest that current screening cut-off values may overlook significant cases of sleep disturbance, disordered eating, and alcohol misuse. Future research should refine cut-off values to improve the detection of these mental health issues.