Analysis of the effectiveness of the Sport Mental Health Assessment Tool 1 (SMHAT-1) among endurance and ultra-endurance runners

The Sport Mental Health Assessment Tool (SMHAT-1) is a screening tool aiming to identify mental health issues in elite athletes. The tool is composed of two steps, starting with a short triage questionnaire (Athlete Psychological Strain Questionnaire (APSQ); step 1), followed by subsequent disorder-specific screening instruments (step 2) only if APSQ yields positive results. SMHAT-1 has been successfully employed in various sports settings; however, no studies assessing this screening tool have been examined in endurance (ER, distance runners 21.1-42.2 km) and ultra-endurance runners (UER; >42.2 km), where the prevalence of mental health issues is high. We examined the coherence of the SMHAT-1 overall assessment and the validity of the APSQ screening tool in ER/UER. This is a cross-sectional study, in which 601 ER and UER completed the SMHAT-1 (triage tool APSQ, and all subsequent disorder-specific screening questionnaires) via an online survey. APSQ and screening outcomes were dichotomized using established cut-offs. APSQ performance as a triage tool was evaluated by comparison with disorder-specific screening outcomes. Agreement was assessed using confusion matrices, classifying cases into true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN). We sampled 601 runners (37% female), with a mean age of 42.8 ± 10.1 years. The proportion of FP was 20.14%, and the proportion of FN was 37.43%. Overall, the coherence between APSQ triage and the aggregated screening outcome was 66.89%. A higher concentration of alcohol use, sleep disturbances, eating disorders, and drug use symptoms was observed among FN cases. The APSQ is not suitable to identify ER/UER with a higher risk of mental health symptoms, especially for disorders related to alcohol use, sleep disturbances, eating disorders, and drug use symptoms. The use of the SMHAT-1 screening component (step 2) is more appropriate, although it does not assess for other specific conditions prevalent in this group of athletes.