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Table 3 Study outcome measures, main findings and comments on study

From: An updated systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches, officials and parents

Authors (year of study) Mental health outcome measure(s) Main findings Comments
Ajilchi et al. (2019) [45] SEIS Significant improvement for intervention group in comparison to control for emotional intelligence following MSPE (p < 0.0005) Small sample (n = 30); not a diverse sample; no blinding of participants or research personnel; no follow-up data
Bapat et al. (2009) [59] SQ; KQ; ?V Significant reduction in levels of stigma (p < 0.001); increase in knowledge about mental disorders (p < 0 .01); increased confidence to help someone with mental disorder (p < 0.001) Small sample size (n = 40); no control group; no effect sizes reported; no follow-up data
Breslin et al. (2017) [8, 60] RIBS; MAKS; ?3 Significant improvement for intervention group in comparison to control on mental health knowledge, confidence in ability to help someone, and intention to offer help to individuals with a mental health problem (all findings p < 0.001) No randomisation method; no follow-up data; no effect sizes reported; intended behaviour was reported rather than actual behaviour
Breslin et al. (2018) RIBS; MAKS; SWEMWBS; BRS Significant improvement for intervention group in comparison to control on mental health knowledge (p < 0.001) and intention to offer help to someone with mental health disorder (p < 0.01). No significant improvement in well-being or resilience post-intervention. No randomisation method; no follow-up data; intended behaviour rather than actual behaviour; high attendance due to scheduled class; one session insufficient to influence resilience
Chowba et al. (2020) [46] MHL; SSSH; PSTIG; PBS; IS;ATSPPH; ISC Significant promotion of mental health literacy, intentions to seek counselling (p < 0.0001), self-stigma and attitudes toward seeking help (p < 0.01) from pre-post intervention with sustained improvements at 1-month follow up. Particularly large effect on MHL. Personal, public and implicit stigma did not differ significantly. No control group; small sample size(n = 33); magnitude of effect sizes encouraging
Donohue et al. (2015) [62] SCL-90-R;BDI;SARI;TLFB;RAB Psychiatric functioning mean scores improved from baseline to post. Improved scores remained stable at 1- and 3-month follow-up; depressive mean scores decreased from baseline to post-intervention and remained stable at follow-up. Improvements were shown for all relationship domains. Small sample size (n = 7); no values provided for study effects (i.e. p value or effect); no control group
Donohue et al. (2018) [47] SCL-90;BDI;SIC-LOS;SARI;TFLB;RAB;OHSO Participants in The Optimum Performance Program in Sports (TOPPS) reported greater improvements in overall mental health, mood and life outside sport significant up to 8 months follow-up than those with Psychological services as usual (SAU). Greater improvements in happiness with significant others and their contributions to sport from baseline to 4 months (p < 0.05). TOPPS more efficacious in reducing substance abuse yet neither programme reduced risky sexual behaviour. Most outcome measures do not assess wellness beyond absence of pathology; no impact on risky sexual behaviour- complement further programmes with evidence based prevention
Dowell et al. (2020) [48] RCADSAS;RCADDS;SDQCPS;AGS;YLOT;GC-6;SDQPBS;NES Participants showed significant reduction in anxiety from pre-post intervention (p < 0.05) and marginally significant reduction in depressive symptoms with no difference between urban and rural areas. No significant effects on anger, optimism or gratitude. Significant improvements in secondary outcomes of prosocial behaviour and managing negative emotions. Grit increased significantly within urban population but not rural. No control group; Preliminary findings as a result
Dubuc-Charbonneau and Durand-Bush (2015) [49] PSS;WEMWBS;SSRQ Significant reduction in stress, increase in well-being and capacity to self-regulate (p < 0.05). Small sample size (n = 8); narrow range of eligible sports; no long-term follow-up
Fogaca (2019) [50] ACSI-28;BAI;BDI;WHOQOL Significant increase in coping ability and reduction in anxiety (p < 0.05). Small effect sizes (n2p < 0.3). Neither depression nor quality of life showed significant change. No randomisation method; not a diverse sample
Glass et al. (2019) [51] DASS-21;SWLS;FFMQ;AAQ-II Participants in control group showed significant increases in depressive symptoms whereas there was a slight but non-significant decrease in the intervention group. Significant increase in life satisfaction (p < 0.05) and observing aspect of mindfulness (p < 0.01). No significant change in acceptance and action. Relatively small sample size (n = 52); high attrition rate; limited engagement as participants with unfamiliar people
Gross et al. (2018) [44] CCAPS-62;AAQ-II;DERS;MAAS MAC group had significant effect on substance use, distress, anxiety and hostility compared to PST (p < 0.05). MAC had a significant impact on emotional regulation and acceptance (p < 0.05). PST had a significant impact on mindfulness compared to MAC (p < 0.05). Small sample size (n = 18); Low sample diversity; No no-treatment control group; PST not developed for mental health purpose
Gulliver et al. (2012) [63] ATSPPH-SF;GHSQ;AHSQ;D-Lit;A-Lit;DSS;GASS No significant interaction effect for help-seeking attitudes, intentions or behaviour from baseline to follow-up. However, significant positive interaction effects were observed for depression (p < 0.05) and anxiety literacy (p < 0.01), and anxiety stigma (p < 0.05) from baseline to follow up relative to control group Effect sizes for the significant positive interaction effects differed for treatment condition (literacy condition, feedback condition and help-seeking) in comparison to control, ranging from small to medium to large. Caution is advised when interpreting findings as the sample size was small
Hurley et al. (2018) [18] A-LIT;D-LIT;K6; PCPH Participants in the intervention group significantly improved their depression and anxiety literacy; knowledge of help-seeking options and confidence to provide support for someone experiencing a mental health disorder to a greater extent than those in a matched control group. These improvements were maintained at 1 month follow-up (all findings p < 0.05). Intervention did not significantly reduce distress or improve attitudes to facilitate mental health promotion and help-seeking. Attitudes rather than actual behaviour reported; no randomisation method
Hurley et al. (2020) [52] A-LIT; D-LIT; MHLS; GHSQ; PCPH; PSSN; K6 Parental depression and anxiety literacy, intentions to seek help for adolescent and attitudes toward mental health and help-seeking did not significantly improve in intervention compared to control rather improvements were observed in both at follow-up. Intervention group displayed improved knowledge and confidence to assist (p < 0.001) and were more likely to seek formal help, felt increased social support and reduced distress (p < 0.05). Longer term follow up not feasible; low retention of participants; no randomisation method
Laureano et al. (2014) [53] CSE; FORQ; AFM-2 Intervention group showed that sum of coping self-efficacy, fortitude and overall well-being improved significantly (p < 0.01). After adjustment for pre-test difference fortitude differences were no longer significant and overall happiness less significant (p < 0.1). Demographic information not gathered; no longer term follow up; no randomisation method
Liddle et al. (2019) [40] PCHB; OMHE; IPH; D-LIT; A-LIT; GHSQ; CPH; MHLS; K6 Intervention improved depression and anxiety literacy post-intervention with significant anxiety effects sustained over 1 month (p < 0.01), improving stigmatising attitudes also were retained (p < 0.001). Intentions to provide help improved but were not sustained. Help-seeking intentions did not improve. Both groups were more likely to seek support from informal sources. Control group not matched in age; no longer term follow-up
Longshore and Sachs (2015) [64] MAAS;TMS;STAI;PANAS;BRUMS No significant interaction effect reported for anxiety, mindfulness awareness or experience, or moods. A significant interaction effect was reported for a reduction in negative affect (p < 0.05, ES = 0.21) Small sample size (n = 20). Despite largely nonsignificant results, mean scores showed positive trends, and effect sizes were generally small to moderate. Interviews with participants showed positive changes in coaches’ personal life and mindfulness
Mohammed et al. (2018) [54] MAAS; DASS; POMS Mindful awareness was higher immediately post session in intervention than control and further increased after 8 weeks in the intervention group (p < 0.001). Decrease in depression, tension, fatigue and confusion mood states after sessions and time (p < 0.005). There was a notable decrease in anxiety and stress across sessions, however only stress was maintained over time (p < 0.05). Small sample size (n = 20); type of injury should be taken into consideration
Pierce et al. (2010) [65] ?1;?2 Leaders: Significant positive change in recognition of mental illness (p < 0.001), confidence that antidepressant medication can be helpful (p < 0.01) and confidence in helping someone with mental health problem (p < 0.001). Players: no significant changes Leaders: Small sample size (n = 36), no control group. Players: Unclear information on their attendance and involvement in the intervention. No effect sizes reported
Sebbens et al. (2016) [66] D-Lit; A-Lit; ?3 A significant interaction effect was recorded for the intervention group in comparison to control on depression and anxiety literacy and confidence to help at time 2 (2 weeks post-intervention) (p < 0.001) but not at time 3 (4 weeks post-intervention) No randomisation method; no effect sizes reported; intended behaviour was reported rather than actual behaviour
Sekizaki et al. (2019) [55] K6; GHQ-12; GSES Increase in K6 scores for depression in control group but remained the same in intervention. Statistically significant reaction observed for group x time for distress (p < 0.01) but there was no significant pre- and post-intervention changes. No significant interactions occurred in GHQ-12 or self-efficacy Non-blinded; short intervention period
Slack et al. (2015) [67] SGMT; RSMT Positive mean score changes were recorded for all three referees’ general and referee-specific mental toughness scores in the intervention phase in comparison to baseline No values provided for study effects (i.e. p value); no control group; qualitative data strengthened the evaluation of program; referees’ performance increased
Shannon et al. (2019) [56] MAAS; PCS; PSS; WEMWBS Mindful awareness was not directly enhanced by the intervention in Model 1 (mindfulness M1) resulting in no indirect effects on competence, stress and well-being. In Model 2 (competence M1), the intervention was directly related to positive changes in competence, resulting in indirect effects on mindful awareness, stress and well-being (all findings p < 0.05). Indirect effects for intervention group on stress through competence and mindful awareness and on well-being through competence, mindful awareness and stress in sequence (p < 0.05). Key contribution was inclusion of SDT to test mechanisms of change; Effect sizes small; Lack of long-term follow-up; No randomisation method; Low adherence to full program
Tester, Watkins and Rouse (1999) [68] SCQ Overall mean improvement of 44% (6–11-year-olds) and 18% (12–16-year-olds) in post-test scores in comparison to baseline for self-concept No values provided for study effects (i.e. p value, effect size); no control group
Van Raalte et al. (2015) [69] MHRES;MHRK Significant positive changes were observed for mental health referral efficacy (p < 0.001, ES = 0.1) and knowledge (p < 0.01, ES = 0.04) for the intervention group in comparison to control group Intervention was tailored for the population. Qualitative data showed positive feedback for intervention acceptability
Vella et al. (2020) [57] D-LIT; A-LIT; CDRS; MHLS; GHSQ; SDS; IB; MDSPSS; K6; MHC Significant improvements in depression and anxiety literacy (p < 0.001), intentions to seek formal help (p < 0.01), confidence to seek information, resilience and wellbeing (p < 0.05). No significant group by time effects were found for stigma, intentions to seek informal help, implicit beliefs, perceived familial support or psychological distress. High baseline scores limit effects through ceiling effect; longer term follow-up required; large sample size (n = 1004); no account for variations in implementation
Vidic et al. (2018) [58] PSS Study demonstrated decreases in overall mean perceived stress levels from pre-test to post-test but these findings were not statistically significant (p = 0.44) Lack of control group; small sample size (n = 18); no randomisation method
Summary Broad range of measures used to assess mental health outcomes Significant findings for all mental health outcomes measured (n = 4); significant findings on at least one outcome measure (n = 22). Non-significant findings (n = 3). Actual behaviour change for help-seeking (n = 0) Small sample size (n = 10), no control group (n = 8), randomisation (n = 9), follow-up measures included (n = 9)
  1. SEIS Self-rated emotional intelligence, SQ Stigma questionnaire, KQ Knowledge questionnaire, ?V No name given to confidence measure for vignette, ?3 No name given to measure with questions around mental health confidence to help, RIBS Reported and Intended Behaviour Scale, MAKS Mental Health Knowledge Scale, SWEMWBS Short Warwick Edinburgh Mental Well-being Scale, BRS Brief Resilience Scale, MHL Mental health literacy, SSSH Self-stigma of seeking help, PSTIG Personal stigma, PBS Public stigma, IS Implicit stigma, ATSPPH Attitudes toward seeking professional psychological help, ISC Intentions to seeking counselling, SCL-90 Global Severity Index of Symptom Checklist 90, BDI Beck Depression Inventory, SIC-LOS Sport Interference Checklist Life Outside Sport, SARI Student athlete relationship index, RAB Sexual Risk Scale of Risk Assessment Battery, OHSO Overall happiness with significant others, RCADSAS Revised Children’s Anxiety and Depression Scale Anxiety Subscale, RCADSSS Revised Children’s Anxiety and Depression Scale Depression Subscale, SDQCPS Strength and Difficulties Questionnaire Conduct Problems Subscale, AGS Academic Grit Scale, YLOT Youth Life Orientation Test Optimism Subscale, GC-6 Gratitude, SDQPBS Strength and Difficulties Questionnaire Prosocial behaviour Subscale, NES Multidimensional Self-Efficacy Scale for Children Negative Emotions Subscale, PSS Perceived Stress Scale, SSRQ Short Version of the Self-Regulation Questionnaire, ACSI-28 Athletic Coping Skills Inventory, BAI Beck Anxiety Inventory, DASS-21 Depression, Anxiety, and Stress Scales, SLWS Satisfaction with Life Scale, FFMQ Five Facet Mindfulness Questionnaire, AAQ-II Acceptance and Action Questionnaire-II, CCAPS-62 Counselling Centre Assessment of Psychological Symptoms-62, DERS Difficulties with Emotion Regulation Scale, MAAS Mindful Attention Awareness Scale, A-LIT Anxiety Literacy Questionnaire, D-LIT Depression Literacy Questionnaire, MHLS Mental Health Literacy Scale, K-6 Kessler-6, PCPH Parental confidence to provide help, GHSQ General help-seeking questionnaire, PSSN Parent social support network in the sport club environment, CSE Coping Self-Efficacy Scale, FORQ Fortitude Questionnaire, AFM-2 Affectometer-2, PCHB Previous contact and helping behaviour, OMHE Own mental health experience, IPH Intentions to provide help, ISH Intentions to seek help, CPH Confidence to provide help, POMS Profile of mood states, GHQ-12 General Health Questionnaire, GSES Generalized Self-Efficacy Scale, PCS Perceived Competence Scale, CDRS Connor-Davison Resilience Scale, SDS Social Distance Scale, MDSPSS Multidimensional Scale of Perceived Social Support, IB Implicit beliefs, MHC Keyes’ Mental Health Continuum, SCL-90-R Global Severity Index of the General Psychiatric Symptoms-90-Revised, AHSQ Actual help-seeking, DSS Depression Stigma Scale, GASS Generalised Anxiety Stigma Scale, ?1 No name given to measure with questions around mental health recognition, knowledge and confidence, ?2 No name given to customised measure around attitudes and recognition of depression in clinical scenario, TMS Toronto Mindfulness Scale, STAI State and Trait Anxiety Inventory, PANAS Positive and Negative Affect Schedule, BRUMS Brunel Mood Scale, ?3 No name given to measure with questions around mental health confidence to help, SGMT Sport-general mental toughness, RSMT Referee-specific mental toughness, SCQ Song And Hattie Self-Concept Questionnaire, MHRES Mental Health Referral Efficacy Scale, MHRK Mental Health Referral Knowledge Scale