Accuracy of the Athlete Psychological Strain Questionnaire (APSQ) compared to common screening tools for mental health disorders.

Abstract

The Athlete Psychological Strain Questionnaire (APSQ) is a 10-item mental health screen in the International Olympic Committee Sport Mental Health Assessment Tool 1. This study evaluated its accuracy compared to six validated mental health screening tools in collegiate athletes. Division I collegiate athletes (n=2758) completed the APSQ alongside validated screening tools for anxiety (Generalised Anxiety Disorder-7 (GAD-7)), depression (Patient Health Questionnaire-9 (PHQ-9)), sleep disturbance (Athlete Sleep Screening Questionnaire-Sleep Difficulty Score (ASSQ-SDS)), alcohol use (Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)), substance use (Cutting down, Annoyance by Criticism, Guilty feelings and Eye openers Adapted to Include Drugs (CAGE-AID) and disordered eating (Eating Disorder Examination-Questionnaire Short (EDE-QS)) between June 2020 and June 2023. The APSQ's performance was assessed using sensitivity, specificity and area under the curve (AUC). Of 2758 completed APSQ, 720 (26.1%) screened positive. The rates of positive screens for other measures were GAD-7=7.7%, PHQ-9=11.6% (3.1% reported suicidal ideation on item 9), ASSQ-SDS=21.0%, AUDIT-C=14.5%, CAGE-AID=2.9% and EDE-QS=4.8%. Compared with the APSQ, we observed high accuracy for anxiety (GAD-7: AUC=0.92, sensitivity=90%, specificity=83%) and depression (PHQ-9: AUC=0.91, sensitivity=82%, specificity=84%). There was moderate accuracy for disordered eating (EDE-QS: AUC=0.85, sensitivity=82%, specificity=81%), while accuracy was lower for sleep disturbance (ASSQ-SDS: AUC=0.72, sensitivity=52%, specificity=84%), substance use (CAGE-AID: AUC=0.69, sensitivity=61%, specificity=79%) and alcohol use (AUDIT-C: AUC=0.64, sensitivity=46%, specificity=81%). False-negative rates ranged from 9.9% (GAD-7) to 55% (AUDIT-C). The APSQ accurately identifies athletes at risk for anxiety and depression but is less accurate for detecting other mental health issues. Adding more specific questions on sleep disturbance and alcohol use to the APSQ could further improve its accuracy.