Update on sport mental health assessment tool-1 false negative rates from the 2024 Paris Olympic and Paralympic Games

Introduction: The Sport Mental Health Assessment Tool-1 (SMHAT-1) was developed to screen elite athletes for mental health concerns. Previous work demonstrated high false negative rates (FNRs) for the initial triage step of the tool, but given the novelty of the deployment of the SMHAT-1 during large multisport, multinational competitions, replication of these findings was justified and required. This study, therefore, aimed to recalculate classification performance metrics at the triage step and investigate potential reasons for the high FNRs observed. Methods: All athletes (n=847) completed steps 1 and 2, including an additional Posttraumatic Stress Disorder questionnaire, and FNRs were calculated. Exploratory analysis, including an exploratory factor analysis (EFA), was used to investigate the latent constructs being captured. Results: Classification performance metrics indicated FNRs ranging from 0% (Patient Health Questionnaire-9 (PHQ9) and PHQ9 Item 9) to 63.16% (Brief Eating Disorder in Athletes Questionnaire (BEDAQ)), consistent with previous findings. The EFA identified nine latent factors in step 2, with each instrument appearing to mostly favour its own independent factor, highlighting a range of distinct latent constructs. An exploratory mixed graphical model revealed some step 2 clusters that were not closely linked with the Athlete Psychological Strain Questionnaire (APSQ) items. Conclusions: These findings confirm previous concerns regarding the APSQ's sensitivity and underscore the challenge of using a single triage tool to capture the broad spectrum of mental health issues assessed by the SMHAT-1. Future work should consider a bespoke triage tool to better capture the diverse mental health needs of elite athletes.