Mental health in Para athletes-interaction with physical health problems in prospective monitoring.

Background: Evaluation of health problems in the Para athlete cohort is well-established. Nonetheless, analyses of the association between mental health and injury, illness or variability of training and competition are spare. Therefore, the purpose of this prospective observational study was to assess this potential relationship in a cohort of Para athletes.

Methods: Continuous health monitoring of German Paralympic athletes using the Oslo Sports Trauma Centre (OSTRC) questionnaire and Patient Health Questionnaire-4 (PHQ-4) on a weekly basis. Additionally, primary sporting activity, training exposure, and subjective training intensity per week were recorded. PHQ-4 scores in relation to substantial health problems were analyzed [mean (M) and 95% confidence interval (95%CI)]. A regression tree analysis was used to analyze the relationship between the independent variables age, sex, impairment type, and sport, as well as the stress level, mood, PHQ-4 sum score, subjective training intensity, training exposure, main weekly activeness, type of health problem, and if it was a substantial health problem, 4 consecutive weeks and dependent variable, the PHQ-4 sum score in the fifth week.

Results: Over an observation period of 124 weeks, 122 Para athletes reported a total of 438 health problems and a mean PHQ-4 score of = 1.3 (95%CI: 1.3-1.4). Highest mean score was observed during illnesses (M = 2.6; 95%CI: 2.2-3). The regression tree identified the leading PHQ-4 score and current mood or stress level as the primary predictors, while all other independent variables did not contribute to the model's prediction.

Conclusion: The findings suggest a potential impact of physical health concerns on mental health, though these, and variations in training or competition were not identified as predictors for the mental health status in a Para athlete cohort. In addition, mean PHQ-4 scores remained below clinical cut-off values, suggesting the need for individualized support to ensure adequate management.