Objectives: Longitudinal data on injury and illnesses in Para athletes is limited. Therefore, the aim was to illustrate the epidemiology of health problems concerning demographic factors and sporting exposure in an elite Para athlete cohort. Design: Prospective cohort study. Methods: All German Paralympic squad athletes were invited to participate in this study. Between 2019 and 2021 health problems were monitored via a weekly online questionnaire (Oslo Sports Trauma Research Centre questionnaire on health problems). Additionally, primary sporting activity, training exposure, and subjective training intensity per week were recorded. Epidemiological descriptive statistics, hazard ratios and odds ratios were analysed. Results: Over an observation period of 124 weeks, 122 Para athletes (48% females; mean age: 28 years) reported 438 (248 substantial) health problems, equally paired into illnesses and injuries. Females demonstrated a two-fold risk of sustaining a substantial health problem (hazard ratio = 1.8; 95 % confidence interval: 1.2-2.8). A lower risk of sustaining a substantial health problem is associated with more than 5 years of elite training (odds ratio = 0.9; 95% confidence interval: 0.8-0.9). At any given time, 10.5% (95% confidence interval: 9.6-11.5) of the participants reported a substantial health problem and prevalence was elevated during weeks of competition (9.8 %; 95% confidence interval: 4.2-15.4). During training camps new overuse injuries were mainly reported (41.2 %), whilst acute injuries peaked during competitions (31.8 %). Changes to the normal training intensity were associated with more substantial health problems (odds ratio range = 1.5-4; 95 % confidence interval range = 1.1-4.8). Conclusions: Monitoring of female athletes, and those with less than five years of experience is substantial. Health problem patterns varied during the season. Education of coaches and medical staff is necessary to safely guide the Para athletes. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

OBJECTIVE:There is a lack of prospective data on mental health of elite Para athletes. The objective was to identify and follow elite Para athletes at risk of mental health problems. METHODS:In a 124-week prospective cohort study, mental health of German elite Para athletes was monitored using the Patient Health Questionnaire-4 (PHQ-4). In case of positive screening (PHQ-4≥5) over 2 weeks, a follow-up contact was conducted by a sports psychiatrist, who asked the athletes about their mental condition and sources for their mental distress and offered support. RESULTS:7543 PHQ-4 scores were obtained from 122 Para athletes with a mean weekly response rate of 84%. The PHQ-4 screening was considered positive for symptoms of depression or anxiety with a prevalence of 6.7%, affecting 48.4% (n=59) of all participants at some point during the study period. In 76.6% (n=49) of all follow-up contacts, athletes (n=34) reported at least one mental health problem, most frequently mental distress (n=31), followed by symptoms of depression (n=19) including acute suicidality (n=1). The most common mental stressors cited were related to education and problems with the team, coaches or federation. At follow-up, almost two-thirds of the athletes were either already in professional psychiatric or psychological care (25%) or were recommended to seek such care (32.8%). CONCLUSION:Our screening and follow-up system revealed high rates of mental health problems in elite Para athletes. Programmes for early identification with mental health monitoring under the supervision of mental health professionals should be considered by sports federations for Para athletes.

BACKGROUND:Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented.OBJECTIVE:Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes.DESIGN:A 43-week prospective observational cohort study.SETTING:Online questionnaire, provided weekly via web browser and mobile app.PARTICIPANTS:Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games.INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:Weekly PHQ-4 scores, stress level, and mood.RESULTS:With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1-1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p < .001). Internal consistency of the PHQ-4 was satisfying, Cronbach's α being 0.839. There were significant cross-sectional as well as longitudinal correlations of PHQ-4 and stress level as well as mood values (p < .001). 39.7% of all athletes (n = 31) had at least one positive screen for mental health symptoms.CONCLUSIONS:The PHQ-4 was shown to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ-4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow-up.

IntroductionThe COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures.MethodsThe mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age.ResultsSeventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p <0.0001; 0.39 < r <0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and a stress level, respectively. Reduced physical activity was significantly (p <0.0001) associated with higher PHQ-4 values in the general population sample.DiscussionLower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population.

Background Longitudinal monitoring of mental health symptoms in para athletes israre, so are strategies to prevent and detect mental illnesses in this group. Ideas to lower barriers for seeking for mental help are needed. Objective Implementation of a mental health surveillance system, using the PHQ (Patient Health Questionnaire)-4 in high-level Paralympic athletes in combination with a psychiatric/psychotherapeutic support which provided help either if athletes demanded or if PHQ-4 score exceeded 4 two weeks or longer. Design Longitudinal weekly monitoring of depression and anxiety within the German National Paralympic Team accompanied by psychiatric/psychotherapeutic intervention. Setting In preparation of the Paralympic Games in Tokyo, German athletes were invited to take part in a weekly, questionnaire-based monitoring program which included the PHQ-4 and level of stress. Patients (or Participants) Data of 78 athletes was collected for one year (05/19–04/20). Within this group 21 athletes were contacted (8 male, 13 female, 8 individual sport, 13 team sport), 4 of them more than on one occasion. Interventions (or Assessment of Risk Factors) Athletes were contacted via Email and offered support regarding mental health problems in case they requested help or if their PHQ-4 scores overreached the cut-off value of 4 in at least 2 consecutive weeks. Main Outcome Measurements Number of athletes contacted because of PHQ-4, number of athletes demanding support and number of contacts which resulted in consultation during one year. Results Twenty-one of 78 athletes were contacted, 11 times on demand, 13 times because of PHQ-4 scores. After the first contact psychiatric/psychotherapeutic support was requested 8 times, by 7 different athletes. This resulted in 7 phone calls and 1 email conversation. Seven of the 8 requests were on demand, whereas only one resulted from elevated PHQ-4 scores. Recommendations for sport psychology (n=2), psychiatrist/psychotherapy (n=4) were given six times. Help to find a local sport psychiatry/psychotherapy specialist was provided in 4 cases, questions concerning medication were answered in 1 case and support in an acute stress situation in 1 case. Conclusions The demand for psychiatric/psychotherapeutic support was high (9% of all athletes within one year). Offering an easy access to psychiatric/psychotherapeutic help seems to be an effective way to support athletes concerning mental health issues.

The purpose of this study was to bring the impact of the COVID-19 pandemic on competitive sports of german para-athletes into focus. We aimed to identify special aspects of disabled athletes during the pandemic, and their mental health. All german candidate athletes preparing for the Tokyo Summer Paralympic Games were asked to complete a questionnaire, which consisted of questions about sports participation, physical and mental health, and the occupational and personal impact of the COVID-19 pandemic. A total of 109 athletes (52 men, 57 women, mean age 29.2 (±10.4) years) completed the questionnaire between May 17th and August 30th 2020. 70% of the athletes felt that organizing their training was difficult, two-thirds of the athletes trained less than before. Half of the participants worried about their own well-being, 25% about their career, only 8% about their finances. The COVID-19 pandemic has a huge impact on sports of elite para athletes. Many athletes worried about the social impact and half of the respondents were of the opinion that people with disabilities were specially affected by the COVID-19 pandemic. Level of evidence: IV Ziel der Studie war es, Auswirkungen der COVID-19-Pandemie auf den paralympischen Leistungssport sowie die mentale Gesundheit deutscher paralympischer Athleten zu untersuchen. Alle potentiell an den paralympischen Sommerspielen in Tokyo teilnehmenden deutschen Athleten wurden eingeladen, Fragen zur Teilnahme an Training und Wettkampf, physischer und mentaler Gesundheit und persönlichen wie auch beruflichen Auswirkungen der COVID-19-Pandemie zu beantworten. Insgesamt füllten 109 Athleten (52 Männer, 57 Frauen, Durchschnittsalter 29,2 (±10,4) Jahre) zwischen dem 17. Mai und dem 30. August 2020 den Fragebogen aus. 70% der Athleten gaben an, dass die Organisation ihres Trainings deutlich erschwert war, zwei Drittel der Athleten trainierte weniger als zuvor. Die Hälfte der Teilnehmer sorgten sich um ihre eigene Gesundheit, ein Viertel um ihre Karriere und 8% um ihre Finanzen. Die COVID-19-Pandemie hat deutliche Auswirkungen auf den Sport paralympischer Athleten. Viele Athleten machten sich Sorgen über die sozialen Auswirkungen und die Hälfte der Teilnehmer waren der Meinung, dass Menschen mit Behinderung besonders von den Auswirkungen der COVID-19 Pandemie betroffen sind. Evidenzebene: IV

Background Injury and illness surveillance in Paralympic athletes was implemented in the past. First studies reported high incidences but are often limited to rates per exposure. Objective Survival and risk analysis of longitudinal data on health problems and their burden were performed. Design Prospective observational study Setting Surveillance of elite Paralympic athletes from May 2019 until February 2020. Participants 85 German Paralympic athletes preparing for Tokyo 2020 were included. Six athletes dropped-out during the monitoring phase, leaving 79 athletes included in the evaluation (30 females; 49 males; age: 29.5±10.9 years). Intervention Weekly completion of the Oslo Sports Trauma Research Center questionnaire on health problems using a web application. Main Outcome Measurements Median time to first severe health problem, leading to time loss or restriction of full participation in training or competition, and hazard ratio (HR) depending on sex, age or impairment. Calculation of the burden (time loss days per athlete per year) of health problems. Results 55 participants reported with a median time of 63 days (95%CI: 35–133) a severe health problem. Women had significantly (p=0.02) shorter median time to first health problem (35 days; 95%CI: 7–105) compared to men (98 days; 95%CI: 49–294) and nearly twice as high risk to sustain a severe health problem (HR: 1.88; 95%CI: 1.1–3.24). Age or impairment comparisons showed no significant differences. Injuries at the shoulder resulted in the highest burden with 6.5 time loss days per athlete per year followed by the hand (2.9) and trunk (2.6). Respiratory infections showed the highest burden with 5.2 time loss days per athlete per year followed by genitourinary illnesses (1.9) and infectious diseases (1.8). Conclusion Sex but not age or impairment type showed significant differences on time to health problem and enhanced risks. Upper body injuries and respiratory infections generated high burden.

Sporttherapie hat sich in der Behandlung vieler psychischer Erkrankungen als nachweislich wirksame Therapieform erwiesen. Aufgrund der hohen individuellen Belastung für Betroffene sowie der immensen Kosten für das Gesundheitssystem, die durch psychische Erkrankungen entstehen, sollten alle Bestrebungen dahin gehen, eine möglichst gute Versorgung zu gewährleisten, die dem aktuellen Forschungsstand entspricht. Erste Studien ergaben jedoch bereits 2016 Hinweise darauf, dass nur ein Bruchteil der Patienten während ihrer stationären Behandlung Sporttherapie erhält. Die hier vorgestellte Studie hatte daher zum Ziel, die reale Versorgungssituation stationär psychiatrisch behandelter Patienten mit Sporttherapie in Deutschland zu erfassen und somit eine wissenschaftliche Grundlage für die Forderung nach einer Verbesserung der Versorgung zu bilden. In einer retrospektiven Analyse der Abrechnungsdaten von 4 Universitätskliniken wurden hierfür 2693 Patientendaten auf die Frage nach der Versorgungssituation mit Sporttherapie hin untersucht. Dabei zeigte sich, dass nur 23 % der Patienten während des Beobachtungszeitraums von einer Woche an Sporttherapie teilnehmen mit einer durchschnittlichen wöchentlichen Therapiedauer von 36 min. Patienten mit Schizophrenie sowie stark komorbide Patienten nahmen sogar noch seltener und weniger Sporttherapie in Anspruch. Insgesamt konnte in der vorliegenden Studie also gezeigt werden, dass die Versorgungslage mit Sporttherapie in der stationär-psychiatrischen Behandlung mangelhaft ist und somit optimiert werden sollte. Vor dem Hintergrund der guten Evidenz von Sporttherapie in der Behandlung psychischer Erkrankungen, aktueller Leitlinienempfehlungen sowie des günstigen Nebenwirkungsprofils im Vergleich zur Pharmakotherapie sollte die Etablierung von Sporttherapie in den Kliniken gezielt verbessert werden.

Die Professionalisierung im Sport von Menschen mit Behinderungen geht mit einer Zunahme gesundheitlicher Beschwerden einher. Ein Fragebogen zur Erhebung von Verletzungen und Erkrankungen wurde in die deutsche Sprache übersetzt und validiert. Zusätzlich erfolgte die Implementierung eines Fragebogens (PHQ-4) zur Erfassung der psychischen Gesundheit. Dieser wurde in einer Pilotphase an 40 Sportlern mit und ohne Behinderungen aus unterschiedlichen Sportarten getestet und zeigte mit einer Rücklaufquote von 80-97% eine hohe Akzeptanz bei den Athleten. In Zukunft soll die Erhebung auf eine mobil zugängliche Applikation umgestellt und auf das gesamte paralympische Team ausgeweitet werden. 3 Professionalisation of sports for people with disabilities is accompanied by an increase in health complaints. A questionnaire for the survey of injuries and illnesses was translated into German and validated. Additionally, a questionnaire (PHQ-4) was implemented to record mental health. This was tested in a pilot phase with 40 athletes with and without disabilities from different sports and showed a high acceptance with a response rate of 80-97%. In the future, the survey is to be converted to a mobile accessible application and extended to the entire Paralympic Team. 3