Delaying Mental Health Screening After Pre-participation Evaluation Improves Athlete Reporting

Mental health is an important component wellness in scholastic athletes who are at critical ages with high rates of mental health symptom onset. We previously reported that identified screening, rather than anonymous survey, showed significantly less symptom reporting in NCAA athletes. The reason behind this is unclear but important to address for accurate mental health screening. PURPOSE: To examine the effect of delayed-identified screening on mental health symptoms reported by NCAA athletes during depression, anxiety and eating disorder screening. METHODS: NCAA athletes at participating institutions completed screening instruments for depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-7, GAD-7) and SCOFF (sick, control, one, fat, food). During anonymous screening athletes completed assessments without reporting their identity. Identified screening was completed in conjunction with pre-participation forms. Delayed screening was completed after pre-participation evaluation during the season with identity reporting. All screening was completed electronically on the REDCap platform. Positive screening was determined as a PHQ-9 ≥ 10, GAD-7 ≥ 10, and SCOFF ≥2. RESULTS: 2,460 NCAA Athletes completed screening anonymously (570), identified (1640) or delayed (250). There was increased reporting of clinical symptoms in delayed-identified screening rather than identified screening for depression (3.2% vs 1.0%, p < 0.0001), anxiety (6.8% vs 2.6%, p < 0.001) and disordered eating (6.8% vs 2.6%, p = 0.03). However, symptom reporting remained significantly below that reported in anonymous screening for depression (3.2% vs 11.9%, p = 0.002) and anxiety (15.3% vs 6.8%, p = 0.001). Eating disorder screening was not significantly different from anonymous reporting (11.3% vs 6.8%, p = 0.05). CONCLUSION: Delaying mental health screening in athletes increases the number of athletes reporting clinically significant symptoms. Athletes concern that reporting mental health symptoms will affect medical eligibility may be part of reduced reporting. Separating mental health screening from the setting of eligibility determination should be considered.