Screening minds is not screening bodies: What biomedical and psychological screening can learn from each other

Abstract: Introduction: Athlete mental health screening has become an established component of sports medicine, largely adopting the protocols, population cut-off scores, and surveillance logic from biomedical screening. However, it has done so, without the decades of iterative recalibration that made such logic and the subsequent decisions reliable. The challenge runs deeper: biomedical and psychological screening differ not only in maturity but in the structure of what they measure and what results can mean. Methods: In this conceptual position, we examine the assumptions and challenges underlying current mental health screening frameworks. Drawing on parallels with cardiac screening in athletes, we argue that mental health screening faces a distinct epistemological challenge: questionnaire scores reflect latent, context-dependent constructs rather than direct indicators of pathology, limiting the certainty that can be inferred from a positive screen. Discussion: We identify four structural differences consequential for practice: what a positive result means, what screening can confirm about ill- and well-being, the effect of repetition and measurement protocols, and the function of feedback. Together, they show that athlete mental health screening cannot be a direct transplant of biomedical screening. Conclusion: We propose that addressing these four differences would define a second generation of athlete mental health screening, one that reads positive functioning alongside symptoms, tracks intraindividual change rather than relying solely on population cut-offs, standardises the conditions of measurement, and treats feedback as integral to validity. Otherwise, the field risks building screening systems that generate numbers but not meaning, and losing the trust on which those systems depend.