Abstract
CONTEXT: Mental health screenings are recommended during preparticipation physical examinations. The Mental Health-Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in three consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS. OBJECTIVE: To assess the validity of the MHRS for mental health screening in collegiate student- athletes. DESIGN: Cross-sectional study. SETTING: University athletic program. PATIENTS: 515 NCAA Division II student-athletes (20±1 years old). MAIN OUTCOME MEASURES: Participants completed the MHRS, PHQ-9 for depression, and GAD-7 for anxiety. A stratified sample underwent a neuropsychiatric interview (MINI). Descriptive statistics and Pearson correlations were performed. An area under the curve (AUC) analysis compared the MHRS to the MINI. Validity was determined using sensitivity, specificity, Youden's index, predictive values, and accuracy. RESULTS: 322 student-athletes (62.5%) indicated 'yes' to one or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more 'yes' answers than men (p<0.001). Average scores were 2.21±3.06 on the PHQ-9 and 2.66±3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r=0.713, p<0.001; GAD-7: r=0.745, p<0.001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The AUC score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions. CONCLUSION: Most student-athletes indicated 'yes' to at least one item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.