Ashley N. Triplett

Purpose: To estimate the financial impact of injury and illness among Team USA athletes who participated in the Paris 2024 Olympic Games and evaluate the cost‐effectiveness of a feasible illness prevention program. Methods: All Team USA athlete‐events at the Paris 2024 Olympic Games were analyzed. Precompetition betting markets were used to derive the expected performance. Counterfactual finish distributions were generated using a Markov ranking model. Injury‐ and illness‐associated performance decrements were estimated relative to expected medal placement outcomes and translated into expected financial losses across 3 domains: Operation Gold performance incentives, athlete stipends, and estimated commercial value. Losses were summarized at the athlete‐event, athlete, and Team USA levels. A cohort Markov cost‐effectiveness model evaluated a potential illness prevention program using probabilistic sensitivity analysis. Results: Across 808 Team USA athlete‐events, 186 injuries and 108 illnesses were recorded. Total injury‐ and illness‐attributable financial losses were estimated at $1,014,210 under conservative commercial value assumptions ( B = $10,000), including $462,409 attributable to injuries and $551,802 attributable to illnesses. Median athlete‐event‐level financial loss was $3000 (75th percentile: $5094; 90th percentile: $7758), whereas median athlete‐level loss was $4710 (90th percentile: $15,617; maximum: $62,915), indicating substantial right skewness and concentration of losses. Illness events were associated with higher mean financial losses per event than injuries ($5109 vs $2486). An illness prevention program costing $200 per athlete and reducing illness risk by 40% was cost‐saving, averting $220,721 in expected losses at a total cost of $117,000, yielding net savings of $103,721, and remaining cost‐saving in 95.2% of probabilistic simulations. Conclusions: Injury and illness at the Olympic Games are associated with substantial and highly concentrated financial losses, with illnesses accounting for a disproportionate share of the total impact on Team USA athletes. Level of Evidence: Level IV, retrospective cohort study with counterfactual performance modeling.

Objectives: The purpose of this study was to understand Paralympic athletes’ positive and negative experiences associated with their participation in Paralympic sport. Design: Phenomenological qualitative study contextualised using the socioecological framework Setting: Online. Participants: 19 Team USA Paralympic sport athletes (females, n=11; males, n=8; age, 31±9 y) representing 11 sports and 4 categories of eligible permanent medical conditions recognised by the International Paralympic Committee impairment classifications: (1) muscle and movement (impaired passive range of motion and impaired muscle power); (2) bone-related conditions (limb deficiency, short stature and leg-length discrepancy); (3) visual impairments and (4) central nervous system disorders (hypertonia and ataxia). Results: The resulting codebook included three themes titled: (1) Journey to Becoming a Paralympic Athlete; (2) Challenges of Paralympic Sport Participation and (3) Advantages of Paralympic Sport Participation. Athletes described Paralympic participation as shaped by interconnected personal, social, organisational and policy-level influences. Inclusive sport environments, family/community support and rehabilitation experiences facilitated athletic identity development and participation pathways, although many participants reported delayed awareness of Paralympic opportunities. Challenges included financial strain, healthcare accessibility, travel demands, chronic injury management and balancing sport demands with employment, education and family responsibilities. Despite barriers, athletes described physical, psychological and social benefits including improved self-acceptance, resilience, belonging and professional growth. Conclusions: This study highlights the dual reality of Paralympic sport participation: a journey characterised by resilience, achievement and community, yet marked by persistent inequities and systemic barriers. Inclusive sport environments, social support and increased institutional recognition contribute to athlete well-being and performance; however, addressing the identified challenges is essential for advancing equity and inclusion in high-performance sport. Future research should aim to quantify the barriers and benefits experienced by Paralympic athletes in relation to their health and wellness.

Objectives: The purpose of this study was to explore athletes’ perspectives on existing US Olympic & Paralympic Committee (USOPC) resources and to identify their recommendations for enhancing future initiatives aimed at promoting Paralympic athlete health, well-being and performance. Design: Phenomenological qualitative study Setting: Online. Participants: A convenience sample of 19 Team USA Paralympic athletes 18 years of age or older participated (female n=11; age 31±9 years) representing four categories of conditions recognised by the International Paralympic Committee (muscle and movement, bone-related, visual and central nervous system). Results: The resulting codebook included 2 themes and 10 corresponding categories. Theme 1, titled Resources for Paralympic Athletes, includes five categories: (1) community-level; (2) university-level; (3) USOPC; (4) National Governing Body and (5) Resources Access, Awareness and Satisfaction. Theme 2, titled Recommendations for Improvements to the USOPC, also included five categories: (1) sports medicine; (2) disability-specific needs and classification systems; (3) sports performance; (4) resources and (5) community awareness. Study participants recognised meaningful improvements in organisational support, including expanded financial assistance and mental-health services yet persistent structural inequities continue to limit equitable access to high-quality resources. Fragmented and geographically uneven sports medicine, coaching and performance infrastructures, along with ongoing challenges in classification transparency and disability-specific programming, remain key barriers to athlete development. Conclusions: Findings highlight the need for decentralised clinical and performance networks, enhanced evidence-based classification practices and more robust transition planning from collegiate to elite settings. Including athlete perspectives and strengthening equitable resources creates more accessible, consistent and performance-optimising environments within the US Paralympic system.

Injury and illness burden in sports has traditionally been quantified using severity and time-loss metrics, which focus narrowly on days missed from sport. These measures fail to capture the full spectrum of health consequences, particularly those associated with non-time-loss injuries, chronic conditions, and lingering impairments following return to play. To address this gap, we propose the disability-adjusted sporting year (DASY), a novel metric adapted from the public health framework of disability-adjusted life years (DALYs). The DASY incorporates both the immediate and long-term health impact of sport-related injuries and illnesses by summing years of sport lost (YSL) and years lived with injury (YLI), weighted by condition-specific disability weights derived from broad population surveys. By anchoring assessments in athlete health rather than sport participation alone, the DASY enables a more comprehensive, equitable, and athlete-centered approach to surveillance, clinical decision making, and policy development. This manuscript outlines the theoretical foundation, calculation framework, and potential applications of the DASY metric, with the goal of advancing how health burden is evaluated in sport. By shifting the focus from return-to-play timelines to overall health loss, the DASY aligns athlete welfare more closely with broader public health standards and offers a robust tool for comparative risk assessment across sporting contexts.

Objective: To determine if paediatric athletes exhibit differences in positive screenings on the Sport Mental Health Assessment Tool (SMHAT-1) compared with adults. Methods: Team USA Olympic and Paralympic paediatric athletes ≤21 years (n=589; 58.8% female; age=19.5±1.7 years) completed the SMHAT-1 between January 2021 and September 2024. A comparative sample of Team USA adult athletes (n=493, 54.2% female; age=27.3±4.9 years) matched for sex and sport was randomly sampled, and the percentage of athletes with a positive screening on each questionnaire was calculated. χ ² analysis compared the proportion of positive screenings between paediatric and adult samples. Piecewise linear regression assessed the association between age and total questionnaire scores. Results: The proportion of positive screenings was lower for paediatric athletes for the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) (χ ² (1)=21.2, p2 (1)=4.47, p=0.034). Increasing age of paediatric athletes was associated with higher AUDIT-C (β=0.41, p<0.001) and APSQ scores (β=0.35, p<0.001); however, a negative deviation was observed in AUDIT-C (β=−0.44, p0.05). Conclusion: Paediatric athletes produce a similar proportion of positive screenings to adults on subcomponents of the SMHAT-1, but they show a lower proportion of positive screenings for alcohol misuse and psychological strain. The changes in SMHAT-1 subcomponent scores among paediatric athletes warrant continued exploration to determine how the interaction of psychosocial development and elite sport may impact mental health.

Introduction: The Sport Mental Health Assessment Tool-1 (SMHAT-1) was developed to screen elite athletes for mental health concerns. Previous work demonstrated high false negative rates (FNRs) for the initial triage step of the tool, but given the novelty of the deployment of the SMHAT-1 during large multisport, multinational competitions, replication of these findings was justified and required. This study, therefore, aimed to recalculate classification performance metrics at the triage step and investigate potential reasons for the high FNRs observed. Methods: All athletes (n=847) completed steps 1 and 2, including an additional Posttraumatic Stress Disorder questionnaire, and FNRs were calculated. Exploratory analysis, including an exploratory factor analysis (EFA), was used to investigate the latent constructs being captured. Results: Classification performance metrics indicated FNRs ranging from 0% (Patient Health Questionnaire-9 (PHQ9) and PHQ9 Item 9) to 63.16% (Brief Eating Disorder in Athletes Questionnaire (BEDAQ)), consistent with previous findings. The EFA identified nine latent factors in step 2, with each instrument appearing to mostly favour its own independent factor, highlighting a range of distinct latent constructs. An exploratory mixed graphical model revealed some step 2 clusters that were not closely linked with the Athlete Psychological Strain Questionnaire (APSQ) items. Conclusions: These findings confirm previous concerns regarding the APSQ’s sensitivity and underscore the challenge of using a single triage tool to capture the broad spectrum of mental health issues assessed by the SMHAT-1. Future work should consider a bespoke triage tool to better capture the diverse mental health needs of elite athletes.

The Sport Mental Health Assessment Tool-1 (SMHAT-1) screens for athlete mental health concerns, yet little is known about outcomes following positive screens. Objective: This study examined the follow-up outcomes of Team USA athletes who exceeded thresholds on the SMHAT-1 questionnaire prior to the 2024 Paris Olympic and Paralympic Games. Methods: A total of 847 SMHAT-1 assessments were completed (Paralympic, 26.7%; women, 52%). Questionnaires exceeding established thresholds were classified as a positive screen, which elicited follow-up by a Team USA mental health provider. During follow-up, mental health providers recorded follow-up outcomes using one of nine predefined outcomes. Outcomes were analysed for athletes with a single positive screen and for all unique positive screen combinations. Results: 450 (53.1%) athletes had a positive screen. The most common outcomes were: ‘discussion without further action’ (31.8%), ‘athlete already connected to outside services’ (26.0%) and ‘inability to contact the athlete’ (20.4%). However, 43.1% of follow-ups required a service to be provided to the athlete. Conclusion: While many positive screens did not require new clinical interventions, the proportion of athletes receiving follow-up care (43.1%) or were already in care (26.0%), underscores the need for diverse psychological resources to support elite athlete mental health. The inability to reach 20.4% of athletes following a positive screen suggests that alternative approaches for the deployment of the SMHAT-1 may be needed to allow for immediate clinician follow-up care. These findings support ongoing SMHAT-1 use and highlight the need for sufficient psychological services resources to meet athletes’ follow-up needs.

Objective: To (1) describe the incidence and characteristics of injuries and illnesses reported by Team USA athletes competing in the 2024 Paris Summer Olympic Games (PSOG) and Paralympic Games (PSPG); (2) compare injury and illness incidence between Olympic and Paralympic cohorts and (3) quantify the burden of respiratory and thermoregulatory illnesses under standard (post-COVID) public health conditions. Methods: The United States Olympic & Paralympic Committee (USOPC) Injury and Illness Surveillance system was used to document the details of all injuries and illnesses reported by any of the 862 athletes, alternates and guides competing for Team USA in the PSOG and PSPG. Illness and injury incidence per 1000 athlete-days (AD) and incidence ratios (IR) were calculated, both with 95% CI. Results: Team USA Paralympic athletes sustained 20.5 injuries per 1000 AD versus 14.6 among Olympic athletes (IR (95% CI): 1.4 (1.1 to 1.8)). Illness incidence was 15.7 per 1000 AD among Paralympic athletes versus 8.3 in Olympic athletes (IR (95% CI): 1.9 (1.4 to 2.6)). Among Team USA Paralympic athletes, injuries sustained outside of sport settings accounted for 38.5% (30/78) of all Paralympic injuries, the largest single setting category. The most common system affected by illness at both PSOG and PSPG was the respiratory system, with 7.4% of all athletes reporting a respiratory illness. Despite concerns ahead of the Games related to extreme heat, only two (0.3%) Olympic athletes and zero (0.0%) Paralympic athletes from Team USA reported a heat-related illness. Conclusion: Injury and illness rates were higher among Team USA Paralympic athletes compared with Olympic athletes during the Paris 2024 Games. Respiratory illnesses were the most frequent medical problem, despite a pre-Games prevention campaign, highlighting the need for stronger infection-control strategies at future Games. The absence of heat illness suggests current heat-mitigation measures were effective. Comprehensive injury-prevention and illness-prevention strategies are needed for both Olympic and Paralympic athletes, with additional attention to the environmental and accessibility risks that disproportionately affect Paralympic competitors.