A qualitative analysis of Swedish sport psychology practitioners' experience of a continued professional development program.

Although sport psychology practitioners and researchers acknowledge the importance of continued professional development (CPD) for professional effectiveness and excellence, few studies have explored the influence of CPD activities on the practitioners' practice and thinking. This study examined qualified Swedish sport psychology practitioners' experiences of engaging in a CPD program and how it impacted their professional development. The Swedish Sports Confederation offers a CPD program that targets performance enhancement services and psychotherapy for sport psychology practitioners. We explored the influence of this CPD program on the professional development of 13 graduates (five females; age in years: M = 41.2, SD = 8.3) via semi-structured interviews. Our stance involved a realist ontology and constructionist epistemology. We followed the six-step Reflexive Thematic Analysis procedures to analyze data. We identified four themes of CPD: (1) Critique (participants decided to do the CPD program because of perceived gaps in their knowledge and skills), (2) Change (participants discussed several changes as a result of the CPD program), (3) Context (participants discussed the aspects of the CPD program that promoted change), and (4) Challenge (participants mentioned issues related to having completed the program). The study provides insights into the value of CPD activities for sport psychology practitioners, advances current knowledge on practitioner maturation, and illustrates how CPD fits within a practitioner's lifelong learning. Future research could investigate the professional development of mid-career sport psychology practitioners engaging in other CPD programs to confirm or extend this work.

Exploring the experiences and perceptions of coaches, athletes, and integrated support teams towards the management of three national Paralympic teams.

This study explored the experiences and perceptions of coaches, athletes, and integrated support teams towards the management of three Paralympic teams across North America and Europe. Six focus groups with athletes, three interviews with head coaches, and 10 interviews with support team members were conducted and analyzed using a reflexive thematic analysis. Our analysis resulted in three overarching themes to portray the coaches' role and behaviours in managing their (1) athletes, (2) integrated support teams, and (3) team as a collective unit. All teams were made up of a diverse group of athletes that required individualized considerations regarding age, finances, and disability. Coaches were successful when they fostered autonomy and managed interpersonal conflict by utilizing their integrated support teams to foster cohesiveness. This study provides an in-depth view of the role of the coach in managing national parasport teams by incorporating multiple perspectives from three teams around the world.

Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model.

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than 'wear a mask', different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study.

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

Monitoring mental distress in Para athletes in preparation, during and after the Beijing Paralympic Games 2022: A 22 week prospective mixed-method study.

It is common in elite sport to monitor athletes' training load, injuries and illnesses, but mental distress is rarely included. An improved understanding of the epidemiology of mental distress among elite Para athletes and how their coaches perceive such monitoring would allow us to better develop and implement preventive measures. The purpose of this study was therefore to (1) prospectively describe elite Para athletes' mental distress, before, during and after the Beijing Paralympic Games (Paralympics Games 22 = PG22); and to (2) gain a better understanding of if and potentially how awareness of athletes' mental distress changed, through weekly monitoring, and influenced how coachers perceive athletes' mental distress and if they accounted for this before, during and after PG22. A mixed-method study design was used, in which prospective mental distress (depression and anxiety) data were collected weekly from 13 [Swedish] elite Para athletes in preparation, during and after PG22. Data were screened and evaluated weekly by a physiotherapist and a sports psychologist, and coaches also received weekly reports. A focus-group interview with the coaches were conducted post Paralympics to address coaches' awareness about mental distress and athlete health monitoring in Parasport. For data analyses, descriptive statistics was used for the quantitative data and a content analysis was conducted for the qualitative data. The results reveled the following proportion of datapoints indicating symptoms of anxiety and depression: before PG22 (15.8 and 19.1%); during PG22 (47.6 and 38.2%); and after PG22 (0 and 11.8%). The qualitative results indicated that coaches perceived athlete health monitoring as helpful for increasing their awareness of mental distress, and as a useful tool to initiate support for their athletes as well as improving their coaching. In summary, this cohort of elite Para athletes reported a high proportion of mental distress during the Winter Paralympic Games in Beijing. The results also show that it is important and feasible to monitor Para athletes' mental distress to detect and manage early symptoms of mental distress.

COVID-19-related impact on mental health and career uncertainty in student-athletes-Data from a cohort of 7,025 athletes in an elite sport high school system in Sweden.

Objectives: Mental health consequences and behavior change has been described in elite athletes following the vast impact of the COVID-19 pandemic on the world of sports. However, most study samples have been of limited size, and few studies have assessed student-athletes. This study aimed to analyze perceived mental health impact, measured as clinical degree of depression and anxiety, worry about one's sport and about one's career, and behavioral change with respect to video gaming behavior, in high-school athletes in Sweden. Methods: Data on anxiety and depression as well as on perceived behavioral changes during COVID-19 were collected from students at sports high schools in Sweden (N = 7,025) in February 2021, during the ongoing COVID-19 pandemic. Results: Sixteen and 14% met criteria of moderate/severe depression and anxiety, respectively. Many respondents reported feeling mentally worse during the pandemic (66%), and were worried about the future of their sport (45%) or about their own future in sports (45%). Increased gaming behavior during COVID-19 was reported by 29%. All mental health variables were significantly more common in women, except increased gaming (more common in men). Being worried about one's career was less common in winter sports, more common in team sports and more common in older student-athletes, and associated with both depression and anxiety in regression analyses. Discussion: Self-reported mental health impact of COVID-19 is substantial in student-athletes, and even more so in women and in team sports. The lower impact in winter athletes suggests a moderating effect of the seasons in which the COVID-19 outbreak occurred.

Safe and Healthy Para sport project (SHAPE): a study protocol of a complex intervention within Para sport.

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Understanding exercise addiction, psychiatric characteristics and use of anabolic androgenic steroids among recreational athletes - An online survey study.

Background: The purpose of this paper was to explore maladaptive behaviors among physically active individuals, including exercise dependence and use of anabolic steroids. Both exercise addiction (EA) and use of anabolic androgenic steroids (AAS) correlate to high amounts of exercise and EA have been linked to eating disorders and other mental health problems. Methods: An internet survey was spread through fitness-related social media. Inclusion criteria were age ≥ 15 years and exercise frequency ≥ thrice weekly. Exercise addiction inventory identified those at-risk of EA (rEA). Characteristics of rEA were compared to those not at risk. In a separate analysis, AAS users were compared to AAS-naïve individuals. Results: In total, 3,029 participants completed the questionnaire. Of these, 11% screened positive for being rEA, and 23% for ED. Factors associated with EA included daily exercise, social phobia, eating disorders and OCD. Risk consumption of alcohol was a negative predictor. Thirty seven participants had taken AAS the last year. These were mainly men, bodybuilders/powerlifters and more often used amphetamines and opioids. Discussion: This exploratory study supports EA being strongly associated with eating disorders. Identified associations between EA and compulsive or anxiety disorders warrant further research to clarify if these associations arise prior to, together with, or secondary to EA.

Prevalence and comorbidity of psychiatric disorders among treatment-seeking elite athletes and high-performance coaches.

Objectives: Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric outpatient settings. Methods: Descriptive overview of EA and HPC with psychiatric disorders at two publicly funded psychiatric outpatient treatment clinics in Stockholm and Malmö, Sweden. Co-occurring psychiatric disorders were illustrated using Venn diagrams for EA and HPC, and male and female EA separately, among patients from the Stockholm clinic (SC) that used standardised diagnostic interviews. Results: Overall, most patients were EA (n=221) compared with HPC (n=34). The mean age was 23.5 (±5.9) years for EA and 42.8 (±8.8) for HPC. Anxiety disorders were most common at the SC in EA and HPC (69% vs 91%, respectively). Stress-related disorders were found in 72% of HPC compared with 25% of EA. Affective disorders were found in 51% of EA and 52% of HPC. Eating disorders were common among EA (26%), especially females (37%). Substance use disorders were found in 17% of HPC. Comorbidity was generally common between affective and anxiety disorders. Conclusion: Stress and adjustment disorders were found in nearly three of the four HPC compared with one in four EA. Eating disorders were prevalent in around one in four athletes and about one in six HPC had a substance use disorder.

What Do We Know About Research on Parasport Coaches? A Scoping Review.

The purpose of this scoping review was to provide a broad overview of the literature pertaining to parasport coaches, including information regarding the size and scope of research, the populations and perspectives obtained, and the type of methods used to conduct the research. Data were collected and analyzed using a six-stage framework for conducting scoping reviews. The results revealed that the majority of articles were based on interviews, and an overwhelming majority of the participants were men coaching at the high-performance level in North America. Three of the most frequent topics were becoming a parasport coach, being a parasport coach, and having general parasport coaching knowledge. Articles ranged in date from 1991 to 2018, with 70% of empirical articles published from 2014 onward, indicating an emerging interest in this field of research. This review has the potential to advance the science and practice of parasport coaching at all levels.

Potentially Prolonged Psychological Distress from Postponed Olympic and Paralympic Games during COVID-19-Career Uncertainty in Elite Athletes.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the world of sports due to periods of home quarantine, bans against public gatherings, travel restrictions, and a large number of postponed or canceled major sporting events. The literature hitherto is sparse, but early indications display signs of psychological impact on elite athletes due to the pandemic. However, beyond acute effects from lockdown and short-term interrupted athletic seasons, the postponed and still uncertain Olympic and Paralympic Games may represent a major career insecurity to many athletes world-wide, and may lead to severe changes to everyday lives and potentially prolonged psychological distress. Given the long-term perspective of these changes, researchers and stakeholders should address mental health and long-term job insecurity in athletes, including a specific focus on those with small financial margins, such as many female athletes, parasports athletes, athletes in smaller sports, and athletes from developing countries. Implications and the need for research are discussed.

Impact of Job Insecurity on Psychological Well- and Ill-Being among High Performance Coaches.

BACKGROUND: The evaluative nature of high performance (HP) sport fosters performance expectations that can be associated with harsh scrutiny, criticism, and job insecurity. In this context, (HP) sport is described as a highly competitive, complex, and turbulent work environment. The aim of this longitudinal, quantitative study was to explore whether HP coaches' perceptions of job insecurity and job value incongruence in relation to work would predict their psychological well- and ill-being over time. METHODS: HP coaches (n = 299) responded to an electronic questionnaire at the start, middle, and end of a competitive season, designed to measure the following: job insecurity, values, psychological well-being (vitality and satisfaction with work), and psychological ill-being (exhaustion and cynicism). Structural equation model analyses were conducted using Mplus. RESULTS: Experiencing higher levels of job insecurity during the middle of the season significantly predicted an increase in coaches' psychological ill-being, and a decrease in their psychological well-being at the end of the season. However, value incongruence did not have a significant longitudinal impact. CONCLUSIONS: These findings cumulatively indicate that coaches' perceptions of job insecurity matter to their psychological health at work. Consequently, it is recommended that coaches and organizations acknowledge and discuss how to handle job security within the HP sport context.

Psychological Distress and Problem Gambling in Elite Athletes during COVID-19 Restrictions-A Web Survey in Top Leagues of Three Sports during the Pandemic.

COVID-19 and lockdown strategies may affect mental health and addictive behavior differently in the population, and elite athletes are among the professions clearly affected by the pandemic. This study in top elite athletes aimed to study current perceived psychological influence from COVID-19 and symptoms of depression, anxiety and changes in alcohol drinking, gambling behavior and problem gambling in the midst of the COVID-19 lockdown. This web survey included athletes in top leagues of soccer, ice hockey and handball in Sweden (N = 327, 62% men). A total of 66% and 51% were worried about the future of their sport or about their own future in sports, respectively. Feeling worse psychologically during the pandemic was common (72% of women, 40% of men, p < 0.001); depression criteria were endorsed by 19% of women and three percent of men (p < 0.001); anxiety criteria by 20% of women and five percent of men (p < 0.001). Reporting increased gambling during the pandemic was associated with gambling problem severity. Moderate-risk or problem gambling was seen in 10% of men and none of the women (p < 0.001). Depression and anxiety were associated with feeling worse during the COVID-19 pandemic and with concern over one's own sports future. In conclusion, COVID-19-related distress is common in elite athletes and associated with mental health symptoms. Gambling increase during the pandemic was rare, but related to gambling problems, which were common in male athletes. The calls for increased focus on COVID-19-related concerns in athletes and on problem gambling in male athletes.

Elite Football Coaches Experiences and Sensemaking about Being Fired: An Interpretative Phenomenological Analysis.

BACKGROUND: Chronic job insecurity seems to be a prominent feature within elite sport, where coaches work under pressure of dismissals if failing to meet performance expectations of stakeholders. The aim of the current study was to get a deeper understanding of elite football coaches' experiences of getting fired and how they made sense of that process. METHOD: A qualitative design using semi-structured interviews was conducted with six elite football coaches who were fired within the same season. Interpretative phenomenological analysis was chosen as framework to analyze the data. RESULTS: The results reflected five emerging themes: Acceptance of having an insecure job, working for an unprofessional organization and management, micro-politics in the organization, unrealistic and changing performance expectation, and emotional responses. CONCLUSION: All coaches expressed awareness and acceptance regarding the risk of being fired. However, they experienced a lack of transparency and clear feedback regarding the causes of dismissal. This led to negative emotional reactions as the coaches experienced being evaluated by poorly defined expectations and by anonymous stakeholders. Sports organizations as employers should strive to be transparent during dismissal. In addition, job insecurity is a permanent stressor for coaches and should be acknowledged and targeted within coach education.

Problem Gambling in the Fitness World-A General Population Web Survey.

The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by 'fitness influencers' on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.

The prevalence of mental health problems in elite athletes.

OBJECTIVES: The first aim was to examine mental health problems (MHP) in elite athletes addressing prevalence, sex-differences, onset, recurrent episodes, help-seeking, symptoms of specific disorders and previous psychiatric diagnoses. The second aim was to investigate if sport-specific instruments could indicate clinical levels of psychiatric symptoms. DESIGN: Cross-sectional survey. METHODS: Elite athletes representing different Swedish national teams and applying for a university scholarship (n=333) answered a web-based survey. Females represented 58.9%. Mean age was 24.6(±3.1) years and 77.2% were individual- and 22.8% team-sport athletes. RESULTS: Lifetime prevalence of MHP was 51.7% (females 58.2%, males 42.3%). Point prevalence was 11.7% (females 13.8%, males 8.8%). Onset of first MHP episode peaked at age 19 with 50% of onsets between ages 17-21. Recurrent episodes were common, and females sought help more than males (females 37.8%, males 16.8%). Overall 19.5% reached the clinical cut-offs for symptoms of anxiety and/or depression (females 26.0%, males 10.2%). Previous psychiatric diagnoses existed among 8.1% (females 10.7%, males 4.4%). A depressive disorder, an eating disorder or a trauma and stress related disorder (self-reported as burnout) were most common. Finally, most sport-specific instruments (80%) demonstrated a fair diagnostic accuracy compared to clinically validated instruments. CONCLUSIONS: Lifetime prevalence of MHP was reported by more than half of the athletes. Symptoms manifested in young age and recurrent episodes were common. Sport-specific instruments indicating when symptoms reach clinical levels are potentially useful for data summary purposes on a group level, but without sufficiently high sensitivity and specificity to be recommend for applied work with athletes.

Canadian Centre for Mental Health and Sport (CCMHS) Position Statement: Principles of Mental Health in Competitive and High-Performance Sport.

The brave decision made by many Canadian athletes to share their experience with mental illness has fed a growing dialogue surrounding mental health in competitive and high-performance sport. To affect real change for individuals, sport culture must change to meet demands for psychologically safe, supportive, and accepting sport environments. This position statement addresses mental health in competitive and high-performance sport in Canada, presenting solutions to current challenges and laying a foundation for a unified address of mental health by the Canadian sport community. The paper emerged from the first phase of a multidisciplinary Participatory Action Research (PAR) project, in which a sport-focused mental health care model housed within the Canadian Centre for Mental Health and Sport (CCMHS) is currently being designed, implemented, and evaluated by a team of 20 stakeholders, in collaboration with several community partners and advisors.

Examining coaches' perceptions of how their stress influences the coach-athlete relationship.

This study extends recent coach stress research by evaluating how coaches perceive their stress experiences to affect athletes, and the broader coach-athlete relationship. A total of 12 coaches working across a range of team sports at the elite level took part in semi-structured interviews to investigate the 3 study aims: how they perceive athletes to detect signals of coach stress; how they perceive their stress experiences to affect athletes; and, how effective they perceive themselves to be when experiencing stress. Following content analysis, data suggested that coaches perceived athletes able to detect when they were experiencing stress typically via communication, behavioural, and stylistic cues. Although coaches perceived their stress to have some positive effects on athletes, the overwhelming effects were negative and affected "performance and development", "psychological and emotional", and "behavioural and interaction" factors. Coaches also perceived themselves to be less effective when stressed, and this was reflected in their perceptions of competence, self-awareness, and coaching quality. An impactful finding is that coaches are aware of how a range of stress responses are expressed by themselves, and to how they affect athletes, and their coaching quality. Altogether, findings support the emerging view that coach stress affects their own, and athlete performance.

Fatigue and recovery during and after static loading.

Subjectively assessed endurance time (ET), resumption time (RT) and perceived discomfort, pain or fatigue (PD), and objectively measured maximum force-exerting capacity were investigated for varying loads and durations of a pushing task with two repeated trials. Beyond the main results quantifying how the load scenario affected ET, RT and PD, three additional results are of note: (1) although the maximum pushing force did not change between trials, shorter ET, longer RT and higher PD indicated accumulation of fatigue in Trial 2; (2) the PD ratings showed a trend with a linear increase during loading and a curvilinear decrease during recovery; and (3) the RT and the load level for different relative loading times were found to have an unexpected U-shaped relationship, indicating lowest fatigue at the intermediate load level. These results can be used to model a more sustainable and productive work-recovery ratio.