Mental illness recognition and referral are required components of professional athletic training (AT) education however ATs often report feeling underprepared to assist with mental-health emergencies.


Determine frequency and confidence of use, satisfaction of education related to mental illness recognition and referral.


Cross-sectional design.


Online survey.

Patients or Other Participants:

226 ATs (age=35.5±9.9, years of practice=11.9±9.0, 86 male/140 female).

Main Outcome Measure(s):

The independent variables were professional AT-program, professional psychosocial courses, highest-education, psychosocial CEUs, clinical-practice setting, years of experience. For each skill, individuals identified the average frequency with which the skill is performed each year, rated confidence in performing the skill, and rated satisfaction with professional-education related to the skill.


Anxiety was reported as most frequently recognized and referred. Majority of respondents reported they felt moderately/extremely confident in managing anxiety, panic attacks, depression, suicidal-ideation, and eating disorders but less confident or unconfident in managing psychosis and substance-use disorder. Majority of respondents reported feeling dissatisfied or only slightly satisfied with their education related to mental health recognition and referral. There were significant associations between years of clinical practice and self-reported frequency of referral for anxiety disorder (χ2(87)=117.774, p=.016), and suicidal thoughts/actions (χ2(87) =179.436, p<.001). For confidence there were significant positive associations between years of practice and self-reported recognition of anxiety disorders (χ2145)=195.201, p=.003), referral for anxiety disorders (χ2145)=15.655, p=.048), referral for panic attacks (χ2145)=19.790, p=.011). There were also significant associations between number of CEUs and self-reported confidence in recognizing suicide (χ2(15)=26.650, p=.032), referring for suicidal concerns (χ2(18)=40.456, p=.002), recognizing substance use (χ2(18)=33.649, p=.014), and referring substance use (χ2(18)=30.918, p=.029). There were no significant associations related to satisfaction.


Significant associations indicated that ATs with fewer years of clinical practice (who completed professional programs more recently) reported higher confidence in mental health recognition and referral than those who had completed professional programs longer ago. We recommend that real-time interactions with individuals with mental health concerns or emergencies be incorporated into professional education programs, and increased emphasis on continuing education related to these topics.

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