High School Preparticipation Evaluation Screenings

Abstract

7.7 million high school students participate in sports annually and are required to have a physical. Given the focus on illness and injury, physicians may be more likely to focus on physical health than mental health. ACSM recommends the Preparticipation Evaluation, 4th Edition (PPE-4), which is the standard assessment tool and includes guidelines for assessing mental health. However, little is known about the inclusion of mental health recommendations in state PPE forms. Screening mental health among athletes may prevent psychological and performance-related difficulties. PURPOSE: This study examines the inclusion of mental health in PPE forms in the US. We describe the mental health content of state PPE forms and consistency with the PPE-4. The content of the PPE-4 suggests that eating disorder symptoms be assessed using yes/no questions and other topics (e.g., mood, anxiety, stress, home safety, and substance use) be included as physician reminders (e.g., open-ended). METHODS: PPE forms were retrieved via the National Federation of State High School Associations website (n=47; 4 states did not have forms). Two raters independently coded PPE forms to evaluate adherence to the PPE-4. PPE forms were coded as whether mental health issues were not addressed, addressed as a question, or addressed as a reminder. RESULTS: There was acceptable agreement between coders (kappa range: 0.7-1.0; M=0.9). 55.3% of forms included a question about history of an eating disorder, 83.0% included a question pertaining to worry about weight, 83.0% included a question about presence/frequency of menstrual period, and 70.2% included a question about attempts at weight loss/gain. The physician reminders were used in less than 60.0% of forms. 46.8% of forms provided a reminder to physicians to assess substance use and safety at home. Stress was included as a reminder on 59.6% of forms. 59.6% of states included a reminder to assess for sad, hopeless, depressed, or anxious mood, with only 8.5% including a question about mood or anxiety. CONCLUSIONS: The PPE-4 is used to ensure safe participation in high school sports, but most state forms omit questions related to mental health. Future studies should examine physician assessment of mental health during PPE, as well as the course of treatment following a positive screen for mental health issues.