ArticleBMJ open2025
Epidemiological assessment of mental health screening protocols for high school athlete participation in the USA, 2021.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine state-level variation in mental health screening practices for high school athletes in the USA and evaluate associations between screening protocols and adolescent depression-related and suicide-related outcomes.
designCross-sectional study of preparticipation examination (PPE) forms and Youth Risk Behaviour Surveillance System (YRBSS) data.
settingHigh school athletics across all 50 US states and the District of Columbia.
participants732 676 high school students who completed the 2021 YRBSS survey (grades 9-12). PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of depressive symptoms and suicide-related behaviours, measured using YRBSS items on sadness/hopelessness, suicide ideation, planning, attempts and suicide attempts resulting in injury. State-level PPE forms were reviewed for presence and depth of mental health screening, including Patient Health Questionnaire-4 (PHQ-4) and eating disorder (ED) risk questions.
resultsScreening practices varied widely, ranging from no mention of mental health in some states to required evaluations with formal referral protocols in others. Of 732 676 students, 503 861 (68.7%) reported feeling sad or hopeless, 608 416 (83.0%) seriously considered suicide and 64 072 (8.8%) attempted suicide in the past year. States with required screening protocols had higher reported rates of depressive symptoms (71.0% vs 68.7%, p<0.001) but lower suicide attempt rates (8.0% vs 8.8%, p<0.001) compared with states with no screening. Use of PHQ-4 and ED risk questions was associated with lower suicide attempt prevalence (8.4% vs 8.8%, p<0.001).
conclusionsHigh school athletes represent a vulnerable group in need of structured and standardised mental health screening. State-level screening policies were associated with lower suicide attempt rates, though causal inference is limited by the cross-sectional design. Standardised use of validated mental health tools may support early identification and intervention for at-risk adolescents.
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