A systematic review investigating the characteristics and effectiveness of multi-level mental health interventions in sport

Consensus has begun to emerge around the potential effectiveness of multi-level, mental health interventions within sport. The aim of this review was to evaluate the effectiveness of existing multi-level interventions aimed at enhancing mental health and wellbeing and/or reducing mental ill-health (depression, anxiety, eating disorders, gambling and alcohol use) within sport and identify key characteristics of effective multi-level interventions. The protocol was pre-registered with PROSPERO (CRD42023385320). We systematically searched PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed up to August 2025. This search yielded 19 studies evaluating 12 different multi-level interventions. We examined methodological quality through the Mixed Methods Appraisal Tool and used a narrative synthesis. We provide evidence for the effectiveness of multi-level interventions in enhancing individuals’ mental health and/or reducing mental ill-health within amateur and collegiate level sport. Key characteristics of effective multi-level interventions included: engagement with key stakeholders and/or significant others, involvement of multiple sessions/points of contact and inclusion of multiple, targeted components. Methodological quality across the studies was mixed with evaluations lacking long term follow-up data and process evaluations and a paucity of interventions targeting the elite sport context, female participants, and/or gambling outcomes. This review was funded by the Economic Social Research Council.