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.

Student-athletes are at high risk for poor mental health. Leaders within the varsity sport environment influence athlete mental health and help-seeking. This dissertation explored the behaviors, perspectives and needs of athletes, coaches, and athletic trainers as it pertains to mental health in sport. Three studies were conducted, the first utilized the Theory of Planned Behavior to explore factors associated with coach-athlete conversations about mental health. A coach's Attitude towards having a conversation with an athlete significantly influenced their Intention to do so. Perceived Behavioral Control (PBC) significantly influenced the relationship between Social Norms and Intention. Both PBC and Social Norms had a significant relationship with the Behavior (having a conversation about mental health with an athlete). The second study applied a conceptual model from Horn's Working Model of Coach Effectiveness to explore how an athlete's perception of coach behavior impacts attitudes and help-seeking behaviors. Psychological distress levels influenced an athlete's Perception of their coach's behavior. Openness to help-seeking was significantly related to help-seeking Behaviors and influenced the relationship between personal characteristics and help-seeking. Perception of coach behaviors influenced the relationship between psychological distress and help-seeking from a coach. The last study sought to determine the acceptance of an online varsity sport-specific mental health resource. Preliminary results were promising; The PEER Network was frequently used over the study period and participants had positive and supportive feedback. Overall, results from the three studies suggest that perceived ability and social support may influence whether coach-athlete conversations about mental health occur. Due to the effects of these variables, coach mental health training should focus on improving the skills required for these conversations and normalizing mental health in sport. As an athlete's perception of coach behavior mediated the relationship between psychological distress and help-seeking, training should also focus on clear ways to show athletes that coaches are supportive of mental health. Athlete-specific training should try and improve attitudes towards help-seeking and highlight the value from seeking help. The PEER Network may be an easily accessible and context-specific way of achieving these educational goals for members of the varsity athletic community.

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.

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.

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

This study was aimed at identifying barriers and facilitators that influence help-seeking as well as the effect of implementing an integrated healthcare approach based on current recommendations. A total of 411 student-athletes from 18 intercollegiate teams at a mid-major Division I institution in the mid-Atlantic region completed a 12-item instrument comprised of ten quantitative items and two open-ended questions. The quantitative data was analyzed using SPSS software, and a constant comparative method was used to code responses from the open-ended questions. Findings suggested a prevalence of mental health challenges among student-athletes, especially overwhelming stress, struggles with time management, and anxiety. Female student-athletes seek help more often and are more satisfied with the care they receive from friends, teammates, and athletic trainers. Their male counterparts seek out peers and faculty members for support. There are also gender differences present in the perceptions of barriers and facilitators to seeking care. Qualitative findings were divided into positive help-seeking experiences, negative help-seeking experiences, and neutral/no help-seeking experiences. Conclusions drawn from this study include incorporating stronger and more frequent education on resources for student-athletes, coaches, support staff, and faculty members and establishing a peer support network within the athletics department.

Mental health within elite sport has traditionally been ignored, but recent research has shown that competitive sport can at times seriously undermine mental health and that athletes are exposed to specific stressors that hinder their mental health optimisation. Mental Health and Well-being Interventions in Sportprovides an indispensable guide for researchers and practitioners wanting to understand and implement sport-based intervention processes. This important book adopts an evidenced based approach, discussing the context of the intervention, its design and implementation, and its evaluation and legacy. With cases on depression, eating disorders, and athletic burnout, the book is designed to provide practitioners, policy makers and researchers with a cutting-edge overview of the key issues involved in this burgeoning area, while also including cases on how sport itself has been used as a method to improve mental health. Written for newcomers and established practitioners alike, the text is an essential read for researchers and practitioners in better understanding the sport setting-based intervention processes through presenting current research, theory and practice, applicable in a variety of sports settings and contexts.