Objective To determine if paediatric athletes exhibit differences in positive screenings on the Sport Mental Health Assessment Tool (SMHAT-1) compared with adults. Methods Team USA Olympic and Paralympic paediatric athletes =21 years (n=589; 58.8% female; age=19.5±1.7 years) completed the SMHAT-1 between January 2021 and September 2024. A comparative sample of Team USA adult athletes (n=493, 54.2% female; age=27.3±4.9 years) matched for sex and sport was randomly sampled, and the percentage of athletes with a positive screening on each questionnaire was calculated. ?2 analysis compared the proportion of positive screenings between paediatric and adult samples. Piecewise linear regression assessed the association between age and total questionnaire scores. Results The proportion of positive screenings was lower for paediatric athletes for the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) (x2(1)=21.2, p<0.001) and Athlete Psychological Strain Questionnaire (APSQ) (x2(1)=4.47, p=0.034). Increasing age of paediatric athletes was associated with higher AUDIT-C (ß=0.41, p<0.001) and APSQ scores (ß=0.35, p<0.001); however, a negative deviation was observed in AUDIT-C (ß=-0.44, p<0.001) and APSQ scores (ß=-0.38, p=0.002) among adults. Further, increasing age of paediatric athletes was associated with increased General Anxiety Disorder-7 (ß=0.14, p=0.045) and ASSQ (ß=0.12, p=0.029) scores; however, there was no significant deviation from this age trend in adults for either score (p>0.05). Conclusion Paediatric athletes produce a similar proportion of positive screenings to adults on subcomponents of the SMHAT-1, but they show a lower proportion of positive screenings for alcohol misuse and psychological strain. The changes in SMHAT-1 subcomponent scores among paediatric athletes warrant continued exploration to determine how the interaction of psychosocial development and elite sport may impact mental health.
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