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Mental health screening: severity and cut-off point sensitivity of the Athlete Psychological Strain Questionnaire in male and female elite athletes
  1. Simon Rice1,2,
  2. Lisa Olive1,3,
  3. Vincent Gouttebarge4,5,6,
  4. Alexandra G Parker2,7,
  5. Patrick Clifton8,
  6. Peter Harcourt8,
  7. Michael Llyod9,
  8. Alex Kountouris9,
  9. Ben Smith10,
  10. Beau Busch11,
  11. Rosemary Purcell1,2
  1. 1Orygen, Parkville, Victoria, Australia
  2. 2Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3School of Psychology, Deakin University, Burwood, Victoria, Australia
  4. 4Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
  5. 5Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, Netherlands
  6. 6Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
  7. 7Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
  8. 8Australian Football League, Melbourne, Victoria, Australia
  9. 9Cricket Australia, Melbourne, Victoria, Australia
  10. 10AFL Players’ Association, Melbourne, Victoria, Australia
  11. 11Professional Footballers Australia, Melbourne, Victoria, Australia
  1. Correspondence to A/Prof. Simon Rice; simon.rice{at}


Objectives To examine the sensitivity/specificity of the Athlete Psychological Strain Questionnaire (APSQ) in both male and female elite athletes, and also assess internal consistency and convergent/divergent validity, and determine discriminative validity relative to current injury status.

Methods Data were provided by 1093 elite athletes (males n=1007; females n=84). Scale validity and reliability values were benchmarked against validated measures of general psychological distress and well-being. ROC curve analysis determined a range of optimal severity cut-points.

Results Bias-corrected area under curve (AUC) values supported three APSQ cut-points for moderate (AUC=0.901), high (AUC=0.944) and very high (AUC=0.951) categories. APSQ total score Cronbach coefficients exceeded those observed for the Kessler 10 (K-10). Gender ×injury status interactions were observed for the APSQ total score and K-10, whereby injured female athletes reported higher scores relative to males and non-injured female counterparts.

Conclusion By providing a range of cut-off scores identifying those scoring in the marginal and elevated ranges, the APSQ may better facilitate earlier identification for male and female elite athletes vulnerable to mental health symptoms and developing syndromes. Use of the APSQ may support sports medicine practitioners and allied health professionals to detect early mental ill health manifestations and facilitate timely management and ideally, remediation of symptoms.

  • athlete
  • mental health
  • distress
  • assessment
  • injury

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  • Contributors Study conception and management of ethics approval process was undertaken by RP, AGP, SR. Planning and support for data collection and refining measures was undertaken by RP, AGP, SR, PC, PH, ML, AK and BS. Interpretation of data was led by RP, AGP and SR with support from LO, VG, PC, PH, ML, AK, BS and BB. Data analysis was undertaken by SR. Writing of the manuscript was led by SR with all authors contributing to multiple drafts of the manuscript. All authors approved the final submitted version.

  • Funding Simon Rice was supported by a Career Development Fellowship from the NHMRC (APP1158881). This study was, in part, made possible from funding from several sporting bodies, all of whom requested anonymity.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was granted by The University of Melbourne Human Research Ethics Committee (ID: 1442705).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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