Operationalizing positive masculinity: a theoretical synthesis and school-based framework to engage boys and young men.

Scholars have consistently documented the relationship between conformity to traditional masculine norms and maladaptive psychosocial outcomes among boys and young men. Given current social commentary, including debate around 'toxic masculinity', intervention is needed to encourage boys to embody healthy expressions and identities of masculinity. Whilst new approaches grounded in positive masculinity show promise, the construct requires further definition and phenomenological clarity. Here we review divergent perspectives on positive masculinity, and forward a refined definition, specific to psychosocial health promotion among boys and young men. We then outline the theoretical basis of a positive masculinity framework to guide the content of future interventions, aiming to achieve positive identity development among boys and young men for the good of all. This framework represents a necessary unification of scholarship around male adolescent development, education and health. Future health promotion interventions may benefit from applying the framework to support a positive psychosocial trajectory among boys and young men, with a focus on connection, motivation and authenticity.

Determinants of anxiety in elite athletes: a systematic review and meta-analysis.

OBJECTIVE: To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels. RESULTS AND SUMMARY: We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=-0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=-0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)-higher anxiety in athletes who had experienced one or more recent adverse life events. CONCLUSION: Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

The Mental Health of Elite-Level Coaches: A Systematic Scoping Review.

BACKGROUND: Elite-level coaches are exposed to multiple performance, organisational and personal stressors which may contribute to reduced mental health and wellbeing. This systematic scoping review examined the current body of evidence to explore what is known about the mental health of elite-level coaches (i.e. wellbeing and mental ill-health), the risk and protective factors that influence coach mental health, and the relationship between mental health and coaching effectiveness. METHODS: The review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken and updated in September 2022 using six electronic databases. RESULTS: 12,376 studies were identified and screened, with 42 studies satisfying the inclusion criteria. Despite the paucity of high-quality research, findings indicated that 40% of the included studies examined themes connected to wellbeing, with 76% assessing the nature or prevalence of mental ill-health in elite-level coaches. Among studies exploring mental ill-health, coach burnout was the primary focus, while scant research examined symptoms associated with clinical disorders (e.g. anxiety and depression). Overall, psychological outcomes for elite-level coaches were shaped by risk and protective factors operating at the individual, interpersonal, organisational and societal level. Preliminary evidence was also found to suggest that poor mental health may contribute to reduced coaching effectiveness. It is proposed that coaching effectiveness could therefore be employed as a 'hook' to engage elite-level coaches in greater consideration of their mental health needs. CONCLUSION: Alongside the development of methodologically robust research, there is a need to examine dynamic individual (e.g. psychological skills), interpersonal (e.g. strong social supports) and organisational (e.g. workload) factors that aim to preserve the mental health and optimise the efficacy of elite-level coaches.

Mental Health Among Elite Youth Athletes: A Narrative Overview to Advance Research and Practice.

CONTEXT: Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs). EVIDENCE ACQUISITION: A narrative overview of the literature combined with the clinical and research expertise of the authors. STUDY DESIGN: Narrative overview. LEVEL OF EVIDENCE: Level 5. RESULTS: EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility. CONCLUSION: A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes "youth" and "elite" in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport. SORT: Level C.

Differential Expression of Anomalous Self-Experiences in Spontaneous Speech in Clinical High-Risk and Early-Course Psychosis Quantified by Natural Language Processing.

BACKGROUND: Basic self-disturbance, or anomalous self-experiences (ASEs), is a core feature of the schizophrenia spectrum. We propose a novel method of natural language processing to quantify ASEs in spoken language by direct comparison to an inventory of self-disturbance, the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE). We hypothesized that there would be increased similarity in open-ended speech to the IPASE items in individuals with early-course psychosis (PSY) compared with healthy individuals, with clinical high-risk (CHR) individuals intermediate in similarity. METHODS: Open-ended interviews were obtained from 170 healthy control participants, 167 CHR participants, and 89 PSY participants. We calculated the semantic similarity between IPASE items and "I" sentences from transcribed speech samples using S-BERT (Sentence Bidirectional Encoder Representation from Text). Kolmogorov-Smirnov tests were used to compare distributions across groups. A nonnegative matrix factorization of cosine similarity was performed to rank IPASE items. RESULTS: Spoken language of CHR individuals had the greatest semantic similarity to IPASE items when compared to both healthy control (s = 0.44, p < 10-14) and PSY (s = 0.36, p < 10-6) individuals, while IPASE scores were higher among PSY than CHR group participants. In addition, the nonnegative matrix factorization approach produced a data-driven domain that differentiated the CHR group from the others. CONCLUSIONS: We found that open-ended interviews elicited language with increased semantic similarity to the IPASE by participants in the CHR group compared with patients with psychosis. This demonstrates the utility of these methods for differentiating patients from healthy control participants. This complementary approach has the capacity to scale to large studies investigating phenomenological features of schizophrenia and potentially other clinical populations.

Prevalence and Correlates of Mental Health Symptoms and Well-Being Among Elite Sport Coaches and High-Performance Support Staff.

BACKGROUND: There is growing understanding of mental health needs in elite athletes, but less is known about the mental health of coaches and support staff who work within elite sport settings. This study examined the prevalence and correlates of mental health symptoms in elite-level coaches and high-performance support staff (HPSS) and compared rates against published elite athlete samples. A cross-sectional, anonymous, online survey was administered to coaches and HPSS working in Australia's high-performance sports system. Main outcomes were scores on validated measures of psychological distress, probable 'caseness' for a diagnosable psychological condition, alcohol consumption and sleep disturbance. RESULTS: Data were provided by 78 coaches (mean age = 46.4 years, 23.8% female) and 174 HPSS (mean age = 40.0 years, 56.7% female). Overall, 41.2% of the sample met probable caseness criteria, 13.9% reported high to very high psychological distress, 41.8% reported potential risky alcohol consumption and 17.7% reported moderate to severe sleep disturbance, with no statistically significant differences between coaches and HPSS. The most robust correlates of psychological distress and probable caseness were dissatisfaction with social support and dissatisfaction with life balance, while poor life balance was also associated with increased alcohol consumption and poor social support with sleep disturbance. Coaches and HPSS reported similar prevalence of mental health outcomes compared to rates previously observed in elite athletes, with the exception of higher reporting of alcohol consumption among coaches and HPSS. CONCLUSIONS: Elite-level coaches and HPSS reported levels of psychological distress and probable caseness similar to those previously reported among elite-level athletes, suggesting that these groups are also susceptible to the pressures of high-performance sporting environments. Screening for mental health symptoms in elite sport should be extended from athletes to all key stakeholders in the daily training environment, as should access to programs to support mental health and well-being.

Psychological safety in elite sport settings: a psychometric study of the Sport Psychological Safety Inventory.

Objectives: Effectively supporting the mental health of elite athletes and coaches requires validated tools that assess not only individual-level factors but organisational-level influences. The aim of this study was to develop a bespoke scale assessing perceived psychological safety within high-performance environments. Methods: 337 elite athletes (M=24.12 years) and 238 elite-level coaches and high-performance support staff (HPSS; M=41.9 years) identified via the Australian Institute of Sport provided data across a range of mental health and well-being domains. Exploratory factor analysis (EFA; n=169 athletes) with parallel analysis identified the Sport Psychological Safety Inventory (SPSI) factor structure. Confirmatory factor analysis (CFA) validated the identified structure in separate validation subsamples of athletes (n=168) and coaches/HPSS (n=238). Results: EFA identified the 11-item, 3-factor SPSI. Factors assessed domains of the Mentally Healthy Environment, Mental Health Literacy and Low Self-Stigma. All scale items loaded strongly on their specific domain. CFA model fit indices validated scale structure for athletes and coaches/HPSS. Internal consistency and convergent and divergent validity were evident. Logistic regression indicated that incrementally higher Mentally Healthy Environment scores reduced the likelihood of athletes scoring in the 'moderate' range of general and athlete-specific distress, with a stronger endorsement of the Low Self-Stigma subscale reducing the likelihood of being identified for athlete-specific distress. Conclusion: Psychometric properties of the SPSI support scale utility among athletes and coaches/HPSS in elite sports settings, though further psychometric efforts are needed. This brief measure may support benchmarking efforts across elite sporting contexts to improve mental health culture and broader well-being among athletes and coaches/HPSS.

Exploring Teacher and Parent Perspectives on School-Based Masculinities in Relation to Mental Health Promotion.

The capacity for boys' and young men's mental health promotion to act via shifting masculine norms that are linked to poor mental health outcomes, highlights the need to improve the extent to which school-based programs can promote mental health through leveraging more positive embodiments of masculinity. To-date, the perspectives of parents and teachers on such processes are understudied. This qualitative study presents teacher and parent views regarding adolescent masculinities and avenues for school-based developmental programming for boys and young men. In this study, 16 individual qualitative interviews were undertaken with 10 parents (six females, four males), and six teachers (three females, three males), recruited from an independent all-boys' grammar school in Melbourne, Australia. Thematic analysis of parents' and teachers' perspectives indicated their perception of the role of context-dependent "public" and "private" masculinities, the influence of Australian masculinity norms, and the role of private boys' school cultures in the development of adolescent masculinities. Additionally, strategies for development encompassed participants' appetite for boys' exposure to positive role models, in addition to consistent and relevant developmental programming to support positive masculinity development. Findings have implications for efforts to support prosocial masculine identity development via school-based initiatives, as an avenue to promoting mental health of boys and young men.

An Evidence-Informed Framework to Promote Mental Wellbeing in Elite Sport.

Elite athletes, coaches and high-performance staff are exposed to a range of stressors that have been shown to increase their susceptibility to experiencing mental ill-health. Despite this, athletes may be less inclined than the general population to seek support for their mental health due to stigma, perceptions of limited psychological safety within sport to disclose mental health difficulties (e.g., selection concerns) and/or fears of help-seeking signifying weakness in the context of high performance sport. Guidance on the best ways to promote mental health within sporting environments is increasing, though current frameworks and position statements require greater focus on a whole of system approach, in which the needs of athlete, coaches and high-performance staff are considered within the context of the broader ecological system in which they operate and perform. This paper synthesizes existing research, reviewed for translatability by mental health professionals working in elite sport, to provide an evidence-informed framework with real world utility to promote mentally healthy environments for all stakeholders in elite sporting organizations, from athletes through to administrators. Recommendations are provided to positively impact the mental wellbeing of athletes and support staff, which may in turn influence athletic performance. This framework is intended to provide sporting organizations with evidence-informed or best practice principles on which they can develop or progress their policies to support mental health promotion and prevent the onset of mental health difficulties. It is intended that the framework can be adapted or tailored by elite sporting organizations based upon their unique cultural, contextual and resourcing circumstances.

Athlete Experiences of Shame and Guilt: Initial Psychometric Properties of the Athletic Perceptions of Performance Scale Within Junior Elite Cricketers.

Guilt and shame are self-conscious emotions with implications for mental health, social and occupational functioning, and the effectiveness of sports practice. To date, the assessment and role of athlete-specific guilt and shame has been under-researched. Reporting data from 174 junior elite cricketers (M = 17.34 years; females n = 85), the present study utilized exploratory factor analysis in validating the Athletic Perceptions of Performance Scale (APPS), assessing three distinct and statistically reliable factors: athletic shame-proneness, guilt-proneness, and no-concern. Conditional process analysis indicated that APPS shame-proneness mediated the relationship between general and athlete-specific distress (p < 0.01), with this pathway non-contingent on sex or past 12-month help-seeking for mental health concerns (p's > 0.05). While APPS domains of guilt-proneness and no-concern were not significant mediators, they exhibited correlations in the expected direction with indices of psychological distress and well-being. The APPS may assist coaches and support staff identify players who may benefit from targeted interventions to reduce the likelihood of experiencing shame-prone states.

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs.

The current 'state of play' in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete's mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete's overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete's mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Developing young men's wellbeing through community and school-based programs: A systematic review.

Boys and young men have unique health-related needs that may be poorly met by existing programs and initiatives. The mismatch between the needs of boys and young men and current service offerings-driven largely by social determinants of health such as masculinity-may stymie health status. This is evidenced through high rates of self-stigma, accidental death or suicide, and low rates of help seeking and health literacy among populations of boys and young men. With growing interest in improving wellbeing and educational outcomes for all young people (including boys and young men), this systematic review aimed to evaluate community and school-based programs with specific focus on program features and outcomes directly relevant to young males aged 12-25 years. Five data-bases were searched; Medline, EMBASE, PsycInfo, ERIC, and ERAD. Articles were included if they evaluated an intervention or program with a general or at-risk sample of young men, and measured a psychological, psychosocial, masculinity, or educational outcome. The majority of the 40 included studies had high quality reporting (62.5%). Synthesised data included theoretical frameworks, intervention characteristics, outcomes, and key results. Of the included studies, 14 were male-focussed programs, with masculinity approaches directed towards program aims and content information. The emergent trend indicated that male-targeted interventions may be more beneficial for young men than gender-neutral programs, however, none of these studies incorporated masculine-specific theory as an overarching framework. Furthermore, only three studies measured masculine-specific variables. Studies were limited by a lack of replication and program refinement approaches. It is concluded that there is significant scope for further development of community and school-based health promotion programs that target young men through incorporation of frameworks that consider the impact of gendered social and environmental determinants of health. Evaluation of these programs will provide researchers and practitioners with the capacity for translating beneficial outcomes into best-practice policy.