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ObjectiveThe Sport Mental Health Assessment Tool 1 (SMHAT-1) was introduced as a critical component to the athlete health evaluation. However, the effectiveness of the initial triage step questionnaire (Athlete Psychological Strain Questionnaire (APSQ)) has yet to be analysed within a National Olympic and Paralympic Committee delegation. This study evaluated the ability of the APSQ to identify athletes at risk for mental health concerns.MethodsAthletes completed the APSQ and all subsequent screening questionnaires of the SMHAT-1 as part of their Tokyo and Beijing Olympic and Paralympic Games health history screening. Each questionnaire was scored according to published guidelines, and the false-negative rate (FNR) for the APSQ identifying athletes that were positively screened on the subsequent questionnaires was computed.Results1066 athletes from 51 different Olympic and Paralympic and Summer and Winter sports completed the SMHAT-1. The FNRs for all athletes who were positively screened on a subsequent questionnaire with an APSQ score of <17 ranged from 4.8% to 66.7%. The global FNR for being positively screened onanyquestionnaire was 67.5%. Female, Paralympic and Winter athletes scored higher on one or more questionnaires compared with male, Olympic and Summer athletes, respectively (p<0.05).ConclusionDue to the high FNR of the APSQ detecting a potential mental health concern, we recommend athletes complete the APSQ and all subsequent questionnaires of the SMHAT-1 rather than using only the APSQ as an initial screening test.

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