Keywords: Student-athletes, intercollegiate athletics, mental health stigma, help-seeking attitudes, depression, anxiety, life stress, and structural equation modeling.

Applied sport psychology knowledge has advanced rapidly in recent years. Traditionally, literature focused primarily on a narrow range of topics associated with performance enhancement, giving rise to a model of helping labelled psychological skills training. Although the psychological skills training model has considerable value, the literature has broadened to address a greater diversity of athlete and team issues; a greater range of methods; and a greater recognition of the knowledge, skills, and attributes practitioners need to help clients. The first edition of the Routledge Handbook of Applied Sport Psychology was seminal work, bringing together the full range of knowledge and skills sport psychology practitioners needed to help clients. The second edition continues that vision and draws on the full range of related disciplines, including sport and exercise psychology, clinical psychology, and counselling psychology. This comprehensive range of topics provides professionals what they need to build strong relationships with athletes and enhance clients’ performance, mental health, well-being, happiness, and meaning in life. This new volume is the guide to the theory and practice of applied sport psychology. Adopting a holistic definition of the role of the sport psychology practitioner, it introduces the most effective tools and skills that sport psychology practitioners need to help their clients and explains how effective counselling, assessment, and therapeutic models add necessary dimensions to professional practice. This book is divided into seven thematic sections, addressing: Counselling Assessment Theoretical and therapeutic models Psychosocial issues presenting in individual athletes Psychosocial issues presenting in teams Inclusion in sport psychology Mental skills interventions

Introduction: Adolescents and young adults experience a high level of mental health conditions.These disorders appear to be increasing in number and severity. The prevalence rate for 18-25-years-olds is 8.7% in 12 months. Mental health conditions are treatable, yet many people do not seek professional help. Seeking help from a professional source is particularly important for preventing, early detection, treatment, and recovery from mental health conditions. Purpose: The purpose of this mixed-methods study is to demonstrate the prevalence of depression, explore student-athletes attitudes towards seeking mental health help, understand what factors may influence help-seeking behaviors, and explore the athlete's perceptions of the role that athletic trainers play in the assessment and referral process. Methods: An exploratory, concurrent mixed methods design was used. Survey data from the ATSPPH-SF and PHQ-9 were collected from collegiate student-athletes. A phenomenological approach will guide the qualitative research process. Semi-structured interviews will be audiotaped, transcribed, and analyzed using an interpretive thematic analytical approach. Study Participants: National Collegiate Athletic Association (NCAA) student-athletes participating at the Divsion III (DIII) level. Results: The prevalence of depression was almost 42% in the study population. There was no relationship between PHQ-9 scores and sex. Attitudes towards seeking help were generally positive. Females tend to have more favorable attitudes than males, but this finding was not statistically significant. There was no relationhship between PHQ-9 scores and ATSPPH-SF scores. Barriers to help-seeking included perceived seriousness, stigma, lack of time, accessibility, prefer to handle issues on own, and cost. Facilitators to help-seeking included perceived and nee-problems that were serious enough to warrant help and a supportive network. Clinical Importance: As we continue to address the mental health crisis, it is imperative to understand what prevents student-athletes from seeking professional psychological help and develop supportive programs to help them overcome these barriers. Certified athletic trainers, coaches, and other athletic personel need to understand the seriousness of untreated mental health conditions and be educated to recognize when an athlete may be struggling with issues beyond their control. Knowing when to refer a student-athlete to a professional is essential in preventing potential unnecessary and irreversible consequences.

The negative effects of disclosing a history of mental illness and the need for mental health services are well documented in the professional literature (Corrigan, 2005). Being labeled as "mentally ill" can lead to negative stereotypes placed on the individual that lead to prejudice and discrimination (Corrigan, 2004). These negative effects of disclosing psychological disturbances have led to some individuals being hesitant to seek help, even if the individuals or those close to them feel it is needed (Thornicroft, 2006). College students are a vulnerable population due to the likelihood that they will experience their first psychological disturbance during their college years (Eisenberg, Golberstein, & Gollust, 2007), making access to mental health care crucial. College student-athletes may be even more at-risk for certain psychological disturbances, based on their unique demands and environmental stressors they face (Pinkerton, Hintz, & Barrow, 1989). College student-athletes appear to be underutilizing the mental health services available to them on college campuses (Watson & Kissinger, 2007). Prior studies have shown that college student-athletes are less likely to seek out mental health treatment than other college students (Watson, 2005). The purpose of this study was to see whether or not college student-athletes would exhibit more negative attitudes than student-nonathletes towards mental illness. This study also compared the attitudes toward seeking psychological help between athletes and non-athletes (using a measure developed for use with student-athletes and student-nonathletes by Watson, 2005). Scales that measure social distance, perceived devaluation and discrimination towards mental illness were used to operationalize stigma towards mental illness. The scales this study used to measure social distance (Martin et al., 2000) and perceived discrimination towards mental illness (Link, 1987) had never been used before in a student-athlete population. The potential roles that athletic identity, race, and gender play in treatment-seeking comfort were also examined.

This study investigated the relationship between public stigma, self-stigma, and help-seeking attitudes in a sample of undergraduate student-athletes. Student-athletes appear to be at increased risk for developing mental health issues compared to their non-athlete counterparts (Etzel et al., 2006). However, student-athletes appear to underutilize available mental health services for fear of being labeled as mentally ill as well as other factors (Pinkerton, Hinz, and Barrow, 1989). The purpose of the current study is to explore two facets of stigma as a potential explanation for negative attitudes toward help-seeking and thus the underutilization of these mental health services. Sixty-six student-athletes completed a 10-minute paper-pencil survey. The survey included measures of self-stigma, public stigma, help-seeking attitudes, demographic variables, and an open-ended question regarding barriers to help-seeking. Results indicated that self-stigma mediated the relationship between public stigma and help-seeking attitudes, which replicates the mediated model found in Vogel et al. (2007). Self-stigma appears to explain how negative stereotypes about those who seek help are internalized to form negative attitudes toward help-seeking for student-athletes. Further, student-athletes noted barriers to help-seeking such as lack of time or knowledge of resources as well as fear of being labeled as mentally ill. Implications for research and practice are delineated.

Collegiate athletes experience mental health concerns at similar rates to non-athlete students, however, the student-athlete population underutilizes professional mental health help with only 10% of those in need seeking services. Criticisms of the extant research on studentathlete mental health help-seeking include studies that lack theoretical guidance, and convenience samples who are not experiencing a mental health issue. The aim of this study was to conduct a theoretically driven investigation assessing factors of help-seeking associated with the Health Belief Model and Reasoned Action Approach while sampling student-athletes who identified as currently experiencing a personal or emotional health concern. More specifically, the purpose of this study was to investigate which factors of help-seeking behavior predict the likelihood that a student-athlete will seek professional help, and to identify the differences in help-seeking factors between student-athletes with a lower likelihood of seeking help compared to those with a higher likelihood of seeking help. Participants were 269 NCAA student-athletes who completed an online survey assessing factors related to their help-seeking behavior. A multiple liner regression reveled that perceived benefits, perceived susceptibility, and perceived attitudes factors were significant predictors of the likelihood that a student-athlete would seek treatment. Results from a one-way MANOVA showed significant differences between the lower likelihood and the higher likelihood of seeking help group on the perceived seriousness, perceived susceptibility, perceived benefits, instrumental barriers, stigma-related barriers, and the perceived attitudes factors. Additional information gathered in this study suggests the most frequently reported factors which prevented student-athletes from seeking help include a belief the issues they are experiencing is not that serious, or a desire to seek help from a source other than a mental health professional. Findings from this study have implications for athletic departments, campus counseling centers, and future interventions designed to enhance mental health help-seeking.

Division I student-athletes are faced with unique and sometimes stressful college experiences. They are expected to meet the academic rigors associated with attending college while also excelling in their team sport. And yet, research reported by the NCAA (2016) indicates student-athletes are less likely to seek mental health counseling than their non-athlete counterparts for issues related to depression and anxiety. The hesitation to seek mental health counseling has been attributed to the athletic culture, influences of those close to the student-athlete, and a lack of resources. In order to best assist student-athletes with mental health related concerns, including performance anxiety, one must first hear their narratives. A mixed-methods research study was conducted to explore the prevalence of and issues associated with help-seeking behavior of college student-athletes. The results of this study indicated that while student-athletes struggled with the same mental health concerns of their non-athlete counterparts, they had an increased pressure of maintaining their student-athlete identity. The challenge in addressing their mental health needs was due to the lack of time available for anything other their academic and athletic commitments. The most desired (and possibly most effective) solution in accommodating the emotional and mental health needs of this unique student population was being able to seek mental health services within the confines of the athletic department. This location was found to be a safe place in which student-athletes spent the majority of their time and felt the most connected to the campus, peer group, and stakeholders.