Global Athlete Mental Health Screening: Cross-cultural validity of the Athlete Psychological Strain Questionnaire

Abstract

Introduction: Mental health screening is important across sports cultures, yet recommended tools primarily exist in English. Several translations of the Sport Mental Health Assessment Tool-1 have been published and supported by validation studies; however, it is the Athlete Psychological Strain Questionnaire (APSQ) score that determines whether athletes should continue with the screening process. Objectives: We aimed to investigate the validity of the Romanian APSQ within a representative population and examined the associations between the APSQ score and a range of well-being measures. Methods: 206 Romanian-speaking elite athletes from Romania's national and Olympic teams completed an online questionnaire that included demographic and relevant questions, followed by the APSQ-Ro, the second step of SMHAT-1, and the WHO-5 Well-Being Index. Results: The APSQ-Ro demonstrated good internal consistency, suitable parameters for factorial analysis, a one-factor model with acceptable fit indices, and significant divergent validity with the WHO-5. The APSQ cut-off demonstrated a good sensitivity for depression, anxiety, and sleep disturbances, though with low specificity for all mental health problems assessed during SMHAT's second step. When analysing the range of APSQ values, good diagnostic ability (as measured by the area under the curve values) was detected for anxiety and depression. In contrast, poor overall AUC values and AUC at threshold were both identified for drug use and disordered eating. Conclusions: The limited diagnostic capacity for certain problems and the non-significant correlation between the explored variables may be attributed to several factors, including cultural influences.