Baseline concussion assessments can identify mental disorders: SCAT-5 and other screening tools in South African club rugby

ABSTRACT

Objectives

Although mental health screenings are not routinely conducted in rugby, the Sport Concussion Assessment Tool – Fifth Edition (SCAT-5) is widely performed and measures affective, cognitive, sleep, and physical symptoms. This study investigated the psychometric properties of the SCAT-5 to explore its potential as a mental health screening tool.

Methods

During preseason for the 2021 Western Province Super League A in South Africa, clinicians conducted mental health assessments of 71 adult male rugby union players. The SCAT-5 Symptom Evaluation, Baron Depression Screener for Athletes (BDSA), Athlete Psychological Strain Questionnaire (APSQ), Center for Epidemiologic Studies–Depression (CES-D), and Generalized Anxiety Disorder-7 (GAD-7) were compared to each other and to fully structured diagnostic interviews by mental health professionals using the Mini International Neuropsychiatric Interview (MINI) 7.0.2.

Results

Lifetime MINI-defined mental disorders were common, being identified in 33.8% (95% CI 22.79–46.17%). Only 4.29% of participants had a previous diagnosis. Exploratory Factor Analysis indicated a mental health construct of depression/anxiety being measured by the SCAT-5. The SCAT-5 had strong internal consistency (α = 0.94) and showed moderate convergent validity with the CES-D (r = 0.34; p = 0.008) and GAD-7 (r = 0.49; p < 0.0001). The area under the curve for the ability of the SCAT-5 to identify current disorders was 0.87 (p = 0.003), on par with the CES-D and GAD-7.

Conclusion

Since the SCAT-5 has the potential to identify depression and anxiety, it may allow mental health screening without the need for additional measures. Follow-up studies should further explore its discriminative ability in larger samples.

KEYWORDS:

• Mental health screening
• psychometrics
• brain concussion
• depression
• anxiety
• athletes
• team sports

Acknowledgments

The authors thank the participants from FBRFC and UCTRFC for their assistance in the study through a very challenging year for sports. Thank you to Rasmita Ori and Leigh Gordon for their recommendations for improving the protocol; Marc Blockman and the Human Research Ethics Committee for the recommendations on the protocol; David Sheehan for permission to use the MINI for this research; Yoliswa Mtingeni for her assistance in conducting the MINIs; Demi Davidow and the medical and coaching staff at UCTRFC; and the FBRFC medical and coaching staff for their assistance.

Author contributions

JWB conceptualised and designed this study as part of his MMed (Psychiatry), under the supervision of LSA and JAJ. JAJ was the principal investigator. JWB wrote the proposal. JWB and LSA analysed the data. All authors contributed to the interpretation of the data and writing of the manuscript. All authors approved the final version.

Availability of data and material

Data from the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.