Keywords: athletes, screening, mental health
This blog is a summary of a recently published study in the BJSM (1).
Why is this study important?
There is no health without mental health. Elite athletes experience mental health symptoms at rates comparable to the general population, underscoring the need for mental health screening to receive the same systematic attention as cardiovascular, musculoskeletal, and metabolic assessments. The International Olympic Committee’s Sport Mental Health Assessment Tool 1 (SMHAT-1) was a major step forward, covering psychological distress, depression, anxiety, sleep, alcohol and drug misuse, and disordered eating. However, its triage alone misses between 5% and 60% of cases depending on the domain, meaning the full 48-item battery should be completed – creating a substantial burden for regular screening. We asked: Can we build a much shorter screener from the same items that maintains accuracy?
How did the study go about this?
We analysed over 3,000 screenings of Polish Olympic athletes collected across three waves of routine medical check-ups. Every athlete completed SMHAT-1 and then had a brief interview with a qualified sport psychologist who evaluated whether
(1) no action was required
(2) psychoeducation or a consultation was advised
(3) referral to a specialist was needed.
Using the first two waves (N = 1,924), we applied ant colony optimisation (ACO) – a computational technique inspired by how ants collectively find the shortest path to food – to evaluate thousands of item combinations, searching for the subset that best predicts psychologists’ evaluations while maintaining reliability and symptom coverage. An expert panel reviewed the top solutions and selected the most clinically meaningful one, which was independently validated in the third wave (N = 1,134).
What did the study find?
The result is the Athlete Mental Health Screener-18 (AMHS-18): 18 items drawn from all seven SMHAT-1 measures, which can be completed in under five minutes (Figure 1). At the recommended cut-off of ≥19 points, AMHS-18 achieved 94% sensitivity and 72% specificity, outperforming the SMHAT-1 triage across all indicators. Crucially, the negative predictive value was 99%: athletes scoring below this threshold almost certainly did not require specialist mental health support, giving clinicians confidence that a low score reliably rules out the need for referral. AMHS-18 correlated strongly with psychological distress (r = 0.84), depressive symptoms (r = 0.82), and anxiety (r = 0.80), while also showing meaningful associations with sleep disturbances, disordered eating, and – to a lesser extent – alcohol and drug misuse.
Figure 1: Athlete Mental Health Screener-18: can be downloaded here
What are the key take-home points?
AMHS-18 offers clinicians a practical, evidence-based tool to screen athletes’ mental health rapidly without sacrificing accuracy. Key messages for practice:
- Use AMHS-18 instead of the triage alone. It covers all SMHAT-1 mental health domains and is twice as accurate in identifying athletes who need specialist help.
- Alternate between AMHS-18 and the full SMHAT-1. A practical model is to use the full SMHAT-1 annually and AMHS-18 for interim assessments or when adverse events occur.
- Combine screening with a brief clinical interview. Questionnaires and interviews work in synergy. AMHS-18’s comprehensive coverage makes it a useful starting point for a focused conversation with the athlete.
- Adapt the cut-off to your context. We recommend ≥19 points cut-off as the starting point, but practitioners should consider probability profiles at different thresholds and calibrate within their own context.
- Plan support before you screen. AMHS-18 includes items about self-harm and suicidal ideation. Appropriate support pathways must be in place before administering the tool to ensure athlete safety.
- Leverage AMHS-18 for longitudinal monitoring. Its brevity makes repeated measurement throughout athletes’ careers feasible, enabling a shift from population-based cut-offs to individual trajectory monitoring, tracking each athlete based on their own changes over time rather than comparison to population averages.
By reducing screening time while maintaining the diagnostic rigor of the IOC framework, AMHS-18 makes regular mental health monitoring more feasible- supporting earlier detection and better care for athletes.
Figure 2: Summary Athlete Mental Health Support System
Authors :Wojciech Waleriańczyk, Katarzyna Wójcik, Katarzyna Konopka, Grzegorz Lisek, Ewa Iwaszkiewicz, Hubert Krysztofiak, Jarosław Krzywański, Bogdan Zawadzki
References:
- Waleriańczyk W, Wójcik K, Konopka K, et al. Shorter, faster, but still accurate: using ant colony optimisation to develop and validate the Athlete Mental Health Screener-18 (AMHS-18) as a brief alternative to Sport Mental Health Assessment Tool 1 (SMHAT-1). Br J Sports Med 2026. doi:10.1136/bjsports-2025-110881