Validation of the Patient Health Questionnaire-4 for longitudinal mental health evaluation in elite Para athletes

Abstract

Background: Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented. Objective: Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes. Design: A 43-week prospective observational cohort study. Setting: Online questionnaire, provided weekly via web browser and mobile app. Participants: Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games. Interventions: Not applicable. Main Outcome Measures: Weekly PHQ-4 scores, stress level, and mood. Results: With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1–1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p