Jarosław Krzywański

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.

Objective: Sport Mental Health Assessment Tool 1 (SMHAT-1) ensures comprehensive and reliable mental health screening in athletes. However, its triage’s predictive validity varies depending on the mental health domain (5%–60% false negative rates), while the full algorithm imposes a substantial time burden for routine screening. This study aimed to develop and validate a brief, clinically accurate alternative using the pool of items included in SMHAT-1. Methods: SMHAT-1 and subsequent brief clinical interviews were administered in Polish Olympic athletes over three waves of routine medical check-ups. An ant colony optimisation algorithm that evaluates item combinations holistically rather than sequentially was trained on two datasets (N ₁ =1121, N ₂ =803) to identify the optimal item subset predicting post-interview mental health recommendations. The solution underwent independent validation in the third dataset (N ₃ =1134). Results: The best solution comprised 18 items, achieved 81% accuracy in predicting the post-clinical interview mental health evaluation in the training datasets and 80% in an independent dataset, overperforming the SMHAT-1 triage on all performance indicators. The Athlete Mental Health Screen-18 (AMHS-18) demonstrated superior sensitivity (94%) and specificity (72%) at the optimal cut-off (≥19), with strong internal consistency (ω=0.82). Conclusion: The AMHS-18 is a time-efficient, valid and reliable tool for accurate mental health screening in athletes. It offers a practical alternative to the full SMHAT-1, particularly in settings where time and resources are limited or when athletes are screened regularly. We recommend using AMHS-18 instead of SMHAT-1’s triage and alternating SMHAT-1 with AMHS-18 as a starting point for routine brief clinical intake interviews.

Empirical research regarding the prevalence of mental health symptoms in Paralympic athletes is scarce. We aimed to evaluate the prevalence of mental health concerns in elite Paralympic athletes based on their scores in the IOC Sport Mental Health Assessment Tool 1 (SMHAT-1) and the subsequent in-person clinical intake interviews. In doing so, we also compared the prevalence of mental health symptoms and recommendations in the cohorts of Paralympic and Olympic athletes. We administered the SMHAT-1 (a state-of-the-art tool comprising screeners of psychological distress, depressive and anxiety symptoms, sleep disturbances, alcohol and other substances misuse, and disordered eating) during the routine biannual medical check-ups for all Paralympic athletes at the National Centre for Sports Medicine in Poland. Subsequently, all Paralympic athletes were interviewed by qualified sport psychologists who further evaluated the athletes’ mental health and provided recommendations. A total of 137 Paralympic athletes (87 males, 50 females) participated in the study three to eight months prior to the 2024 Paris Paralympic Games; 61% scored above the triage threshold for psychological distress. Based on the subsequent mental health evaluation, 75.2% of Paralympic athletes required no mental health action, 18.3% were advised psychoeducation or sport psychologist consultation, while 7.3% were referred to a mental health specialist—a psychotherapist and/or a psychiatrist. The proportion of mental health recommendations did not significantly differ between Paralympic and Olympic athletes. The SMHAT-1 proved a valuable basis for the subsequent brief clinical interviews, substantially elevated the efficacy of mental health evaluation, and aided in raising mental health literacy in Paralympic athletes.

Objective Several studies have used the Sport Mental Health Assessment Tool 1 (SMHAT-1) among athletes but none have combined SMHAT-1 with a subsequent clinical intake interview. The aim of this study was to evaluate the diagnostic effectiveness of SMHAT-1 supplemented by a brief, in-person clinical intake interview in evaluating the prevalence of mental health concerns in elite athletes. Methods Sections 1 and 2 from SMHAT-1 were administered in person during the routine biannual medical check-up for Olympic athletes at the National Centre for Sports Medicine in Poland. Immediately after completing the measures, all athletes were interviewed by qualified psychologists who evaluated their mental health and provided recommendations. Results A total of 1121 elite athletes (545 female, 576 male) aged 18–53 (M=24.39, SD=5.09) were evaluated 2–8 months before the 2024 Paris Olympic Games; 72.4% scored above the triage threshold and 51% were positively screened in SMHAT-1’s section 2. Based on the subsequent mental health evaluation, only 9.5% showed signs of persistent mental health concerns and required referral to a mental health specialist. In 24.2%, their distress levels/symptoms were assessed as occasional and normal in relation to demands, and they underwent a psychoeducational intervention or were advised to consult a sports psychologist. Female athletes scored significantly higher in most questionnaires. Conclusion SMHAT-1 proved a useful addition to the routine medical check-ups for elite athletes. Extending SMHAT-1 with a brief clinical intake interview substantially elevated the efficacy of the mental health evaluation, with an additional benefit of raising mental health literacy.

Glucocorticoids (GCs) are included in the list of prohibited substances and methods in sport published annually by the World Anti-Doping Agency (WADA). In its 2022 update, the WADA list prohibits all injectable routes of administration of GCs for use during in-competition periods. Previously, GCs were prohibited in-competition when administered by oral, intravenous, intramuscular, or rectal routes, but local injections (in addition to topical applications) were allowed. This study first investigated the prevalence of GC use by athletes in Poland, declared in 2130 doping control forms, and the related 2130 urine samples analysed at the Polish Anti-Doping Laboratory. Second, the validity of the analytical methodology to detect GCs was evaluated with the updated WADA requirement for substance-specific minimum reporting levels and considering the proposed washout periods. Despite the new regulation in place, the use of 30 different GC preparations were declared in a total of 162 occurrences (8% of the tests) with therapeutic purposes. Laboratory analyses resulted in the presence of GCs in 16 occurrences with only two samples with a concentration triggering an adverse analytical finding. Our study allowed us to confirm that the applied methodology for the determination of GCs in urine samples (ultra-high-performance liquid chromatography–tandem mass spectrometry) remains fully valid after the latter regulation change while the challenge to assess the timing and administration route for GCs persists.

In 2022, the National Program for Influenza Prevention coalition will have its 10th anniversary; it is one of Poland’s oldest educational initiatives. The National Program for Influenza Prevention was initiated to prevent a further decline and promote influenza prevention in the A(H1N1) post-pandemic years. In this review, we summarize the structure and operational model of the coalition and identify core functional elements that make it a key non-governmental organization involved in the prophylactics of communicable diseases. The coalition-based organization can operate in a complex environment, such as vaccinations requiring scientific, economic, social, and psychological involvement, and communications with different groups. Anchored to the history of the National Program for Influenza Prevention, we review Poland’s vaccination landscape changes from the last ten years.

(1) Background: The purpose of this study was to investigate the concerns and beliefs of Olympians and elite athletes toward COVID-19 vaccination. (2) Methods: The study was framed by a quantitative method and was conducted using the PAPI (pen and paper interview) technique among 895 Polish elite athletes representing 34 sports. (3) Results: Three-quarters (76.3%) of the athletes were vaccinated against COVID-19; statistically participants were more likely to be women, and athletes who participated in the Olympic Games. Four in ten (39.2%) were in favor of vaccination. Athletes were mainly concerned that COVID-19 would exclude them from training/competition (19.3%) and could have a long-term impact on their health (17.2%). Athletes who were vaccinated reported much higher confidence in the composition of the vaccine and the doctors who recommended vaccination than unvaccinated athletes. Athletes who competed at the Olympic level were more likely than others to disbelieve that vaccines were produced too quickly and were not well tested. National-level athletes showed the highest degree of distrust in the government regarding COVID-19 vaccination, with one in six respondents distrusting doctors with respect to COVID-19 vaccination. Four in ten respondents said they were in favor of vaccination. (4) Conclusions: Athletes’ attitudes toward COVID-19 vaccination were significantly influenced by their environment—especially coaches and relatives. The power of social norms with respect to the decision to vaccinate against COVID-19 was very strong. Therefore, it is essential to build awareness about preventive policies among athletes and their social environment.