British Journal of Sports Medicine最新文献

Objective: Sport Mental Health Assessment Tool 1 (SMHAT-1) ensures comprehensive and reliable mental health screening in athletes. However, its triage's predictive validity varies depending on the mental health domain (5%-60% false negative rates), while the full algorithm imposes a substantial time burden for routine screening. This study aimed to develop and validate a brief, clinically accurate alternative using the pool of items included in SMHAT-1.

Methods: SMHAT-1 and subsequent brief clinical interviews were administered in Polish Olympic athletes over three waves of routine medical check-ups. An ant colony optimisation algorithm that evaluates item combinations holistically rather than sequentially was trained on two datasets (N₁=1121, N₂=803) to identify the optimal item subset predicting post-interview mental health recommendations. The solution underwent independent validation in the third dataset (N₃=1134).

Results: The best solution comprised 18 items, achieved 81% accuracy in predicting the post-clinical interview mental health evaluation in the training datasets and 80% in an independent dataset, overperforming the SMHAT-1 triage on all performance indicators. The Athlete Mental Health Screen-18 (AMHS-18) demonstrated superior sensitivity (94%) and specificity (72%) at the optimal cut-off (≥19), with strong internal consistency (ω=0.82).

Conclusion: The AMHS-18 is a time-efficient, valid and reliable tool for accurate mental health screening in athletes. It offers a practical alternative to the full SMHAT-1, particularly in settings where time and resources are limited or when athletes are screened regularly. We recommend using AMHS-18 instead of SMHAT-1's triage and alternating SMHAT-1 with AMHS-18 as a starting point for routine brief clinical intake interviews.

Objectives: This study aimed to characterise the frequency of exertional heat stroke (EHS), did-not-finish (DNF) and medical encounter (MED) outcomes in elite Athletics competitions, and to evaluate their association with environmental, individual and race-related variables. Particular attention was given to the wet bulb globe temperature (WBGT), a thermal index widely used by international federations to estimate athlete heat strain.

Methods: Data were collected from 4938 athletes of both sexes participating in 80 World Athletics races held between 2019 and 2024 in five disciplines: long distance track events, marathon, racewalking, cross-country and trail-running. Spearman rank coefficient correlations, Pearson χ² tests and negative binomial (NB) regressions were used to explore associations between outcomes (EHS, DNF, MED) and environmental, individual and race-related variables. The predictive ability of these variables was assessed using leave-one-out cross-validation to identify the best-performing univariable and multivariable models.

Results: EHS frequency was 8/1000 on average and 16/1000 when the WBGT was above 28.0°C, independent of sex (p=0.297) or discipline (p=0.980). DNF and MED were higher in marathon, racewalking and trail-running than shorter disciplines (p<0.001). Among variables, the mean radiant temperature showed the strongest univariable association with EHS (R²=0.11, p<0.001), while WBGT association was weaker (R²=0.04, p=0.018). Predictive accuracy was limited, with the best model having an error of 0.5±0.7 EHS per race.

Conclusion: The risk of EHS is particularly high during elite endurance events in Athletics. While EHS was greater with higher WBGT and radiant temperatures, neither provided sufficient predictive accuracy for heat-related risk in elite endurance athletes. Future models should consider other factors such as heat acclimatisation and recent illness to enhance predictive ability.