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

Clin J Sport Med. 2026 Jan 5. doi: 10.1097/JSM.0000000000001411. Online ahead of print.

ABSTRACT

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.

PMID:41489855 | DOI:10.1097/JSM.0000000000001411