# International Validity of the Athlete Psychological Strain Questionnaire (APSQ): A Scoping Review

## TL;DR

This study reviews how well the Athlete Psychological Strain Questionnaire works across different cultures to assess mental health in athletes.

## Contribution

The paper provides a comprehensive scoping review of the APSQ's validity across diverse cultural settings.

## Key findings

- APSQ showed good internal consistency and reliability across cultures.
- APSQ demonstrated convergent validity with distress scales and divergent validity with well-being scales.
- APSQ had limited accuracy in detecting sleep concerns and disordered eating in some cases.

## Abstract

Background/Objectives: Mental health screening in athletes is an essential process to support well-being and sustainable performance. The Athlete Psychological Strain Questionnaire (APSQ) represents the ten-item triage step of the Sport Mental Health Assessment Tool-1 (SMHAT-1), created by the International Olympic Committee. We aimed to gather relevant information concerning the validity of the APSQ in different cultural settings. Methods: The study was designed as a scoping review and included 19 articles from Scopus, PubMed, Embase, Web of Science, and Google Scholar databases. Articles were written in English and tested the APSQ validity. Results: Different studies used the original or the translated version of APSQ and tested its benchmarked validity against other validated questionnaires, ran confirmatory and exploratory analyses, test–retest stability, calculated diagnostic metrics, and internal consistency. Most studies agreed on the good internal consistency, with optimal Cronbach’s alpha values, test–retest reliability, three-factor solution, convergent validity with scales assessing distress, divergent validity with well-being scales as demonstrated by significant correlation coefficients. The cut-off showed good accuracy for anxiety and depressive symptoms in terms of AUC, sensitivity, and specificity, but, in some cases, a limited ability (based on the AUC) to detect sleep concerns, alcohol misuse, substance use, and disordered eating (as measured by BEDA-Q). Some authors suggested that using different cut-offs, including all questionnaires from SMHAT-1 Step 2, or using a clinical interview, might mitigate these concerns. Conclusions: Different cultural environments might influence the validity of APSQ. A structured translation and validation study is advised before implementing APSQ in a different language.