Document Type

Article

Publication Date

11-25-2025

Abstract

Context

Mental health screenings are recommended during preparticipation physical examinations. The Mental Health–Related Survey (MHRS), a 9-item questionnaire adapted from the 18-item Mental Health Screening Form-III, is suggested in 3 consensus and/or position statements. However, there is no evidence on the effectiveness of the MHRS.

Objective

To assess the validity of the MHRS for mental health screening in collegiate student-athletes.

Design

Cross-sectional study.

Setting

University athletic program.

Patients or Other Participants

Five hundred fifteen National Collegiate Athletic Association Division II student-athletes (age = 20 ± 1 years).

Main Outcome Measure(s)

Participants completed the MHRS, the Patient Health Questionnaire for depression (PHQ-9), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7) for anxiety. A stratified sample underwent a neuropsychiatric interview (Mini-International Neuropsychiatric Interview). Descriptive statistics and Pearson correlations were performed. An area under the curve analysis compared the MHRS with the Mini-International Neuropsychiatric Interview. Validity was determined using sensitivity, specificity, Youden index, predictive values, and accuracy.

Results

Three hundred twenty-two student-athletes (62.5%) indicated yes to 1 or more items on the MHRS, suggesting they would require a mental health referral. Women indicated more yes answers than men (P < .001). Average scores were 2.21 ± 3.06 on the PHQ-9 and 2.66 ± 3.87 on the GAD-7. Using a cut score of 6, 68 individuals (13.2%) reported clinically relevant depression, and 76 (14.8%) reported anxiety. The PHQ-9 and GAD-7 scores strongly correlated with MHRS scores (PHQ-9: r = 0.713, P < .001; GAD-7: r = 0.745, P < .001). The MHRS had a specificity of 24.6%, a sensitivity of 93.9%, and overall accuracy of 40.14%. The area under the curve score was 0.762. We identified a new cutoff score for the MHRS of ≥4; however, the sensitivity of 63.6% and specificity of 76.3% raise concerns regarding how well this tool can rule out and in clinically significant symptoms of mental health conditions.

Conclusions

Most student-athletes indicated yes to at least 1 item on the MHRS, warranting a mental health referral. The MHRS showed high sensitivity but low specificity, indicating low clinical utility as a screening tool.

DOI

10.4085/1062-6050-0063.25

Rights

© 2026 by the National Athletic Trainers' Association, Inc. This article is open access under license by the publisher.

Published Citation

Keenan, L., Winkelmann, Z. K., Torres, L., Ingram, Y., & Daltry, R. (2025). Assessing the Validity of the Mental Health–Related Survey in Collegiate Student-Athletes. Journal of Athletic Training, 60(11), 791–797. https://doi.org/10.4085/1062-6050-0063.25

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