Athlete Mental Health Screening: Free Digital SMHAT-1
The first sport-specific mental health screening tool, developed by the IOC and digitised with IOC authorisation. Screens six domains in 10–15 minutes. Automated scoring. Guided workflows. Free.
IOC Authorised
Free
10–15 Minutes
Start Mental Health Screening
Free Online SMHAT-1
Quick signup – just name and email. Screens six mental health domains with automated scoring. Guided workflows. Instant threshold flagging.
Free
What is SMHAT-1?
The Sport Mental Health Assessment Tool 1 (SMHAT-1, also known as SMHAT1) is the first internationally standardised, sport-specific mental health screening tool. Developed by the IOC Mental Health Working Group - a panel of 11 international experts convened after the 2018 IOC consensus meeting on mental health in elite athletes - it provides a structured three-step pathway from triage through screening to clinical management.
Learn more about SMHAT-1 →Why Is SMHAT-1 Built for the Sport Context?
Unlike generic mental health questionnaires (PHQ-9, GAD-7), the SMHAT-1 begins with the Athlete Psychological Strain Questionnaire (APSQ) - a sport-specific triage instrument that captures performance concerns, self-regulation difficulties, and external coping. It then combines six validated screening instruments covering anxiety, depression, sleep, alcohol, substance use, and disordered eating.
What Gap Does SMHAT-1 Address?
One-third of elite athletes experience anxiety or depression symptoms, yet fewer than one in four who need help actually seek it. The SMHAT-1 removes the burden from athletes to self-identify by embedding mental health screening into routine clinical care - the same approach that transformed concussion management with the SCAT.
SMHAT-1 results in ScreenIT: Automated scoring with instant threshold flagging across six screening domains.
What Is the SMHAT-1 Three-Step Pathway?
SMHAT-1 uses a clinically validated three-step process: triage, disorder-specific screening, and clinical management.
Step 1
Triage
The 10-item Athlete Psychological Strain Questionnaire (APSQ) assesses sport-specific distress. Score ≥17 triggers Step 2. ScreenIT administers Steps 1 and 2 together - matching the evidence-based protocol used by Team USA for 1,066+ Olympic athletes.
Step 2
Screening
Six validated instruments screen for anxiety (GAD-7), depression (PHQ-9), sleep disturbance (ASSQ), alcohol misuse (AUDIT-C), substance use (CAGE-AID), and disordered eating (BEDA-Q). Each instrument has published clinical thresholds.
Step 3
Clinical Assessment
Positive screens progress to clinical assessment by a sports medicine physician or licensed mental health professional. Severity and complexity guide referral decisions - from brief intervention to specialist care.
The Team USA study (n=1,066 Olympic/Paralympic athletes) found that 67.5% of athletes who screened positive on Step 2 instruments would have been missed if only the APSQ triage had been used. ScreenIT administers all instruments simultaneously, ensuring no athlete falls through the gap.
What Are the Six SMHAT-1 Screening Domains?
SMHAT-1 screens across six mental health domains using validated instruments with published clinical thresholds.
Anxiety
GAD-7
7 items, scored 0–21. Threshold: ≥10 (moderate). Sensitivity 89%, specificity 82%.
Depression
PHQ-9
9 items, scored 0–27. Threshold: ≥10 (moderate).
Sleep Disturbance
ASSQ
Sleep Difficulty Score 0–17. Threshold: SDS ≥8 (moderate). Developed specifically for elite athletes.
Alcohol Misuse
AUDIT-C
3 items, scored 0–12. Threshold: ≥4 (men) / ≥3 (women). Score of 0 indicates no alcohol use.
Substance Use
CAGE-AID
4 yes/no items, scored 0–4. Threshold: ≥2. Extends original CAGE alcohol screening to include drug use.
Disordered Eating
BEDA-Q
9 items, scored 0–18. Threshold: ≥4. Sensitivity 82.1%, specificity 84.6%.
Why Choose Digital SMHAT-1?
ScreenIT transforms SMHAT-1 from a paper screening tool into a powerful clinical workflow. Part of our complete assessment library.
Automated Scoring
Instant Clinical Thresholds
Automatic calculation across all six screening instruments. Instant flagging when scores exceed published clinical thresholds. Eliminates manual tallying.
Guided Workflow
Evidence-Based Protocol
Administers Steps 1 and 2 simultaneously - matching the protocol used by Team USA for Olympic athletes. Step-by-step prompts for each instrument.
Longitudinal Tracking
Monitor Over Time
Compare results across pre-season, in-season, post-injury, and career transition timepoints. Track mental health alongside concussion assessments in the same patient record.
Privacy by Design
Honest Reporting
Research shows athletes report more honestly on digital tools than paper - reducing the gender reporting bias that causes males to under-report symptoms on traditional screening.
Paper SMHAT-1
Manual scoring across 7 instruments
Relies on APSQ triage alone (67.5% false negative rate)
No longitudinal comparison across timepoints
Paper forms risk confidentiality in team settings
Manual threshold checking for each domain
Difficult to integrate with concussion assessment records
Digital SMHAT-1 - ScreenIT
Instant automated scoring across all instruments
Steps 1+2 administered together (evidence-based protocol)
Automatic longitudinal tracking across seasons
Privacy-secured digital delivery (AES-256, TLS 1.2+)
Instant threshold flagging with clinical guidance
Integrated with SCAT6 and SCOAT6 in the same patient record
How Does SMHAT-1 Complete the Concussion Assessment Picture?
Already using ScreenIT for SCAT6 or SCOAT6? Mental health screening completes the clinical picture.
What Is the Bidirectional Link Between Concussion and Mental Health?
Concussion and mental health are bidirectionally connected. Athletes with a prior concussion have a 46% higher risk of mental health disability (Burns et al., 2022). Multiple concussions significantly increase depression risk, with a dose-response relationship (Guskiewicz et al., 2007; Burns et al., 2022). Pre-existing mental health conditions are among the strongest predictors of persistent post-concussion symptoms (Amsterdam Consensus, 2023). Without baseline mental health data, clinicians cannot distinguish pre-existing symptoms from concussion symptoms.
Why Use One Platform for All Assessments?
ScreenIT is the only platform offering SCAT6, SCOAT6, and SMHAT-1 in a single patient record. Administer concussion assessments and mental health screening through the same guided interface – with automated scoring, longitudinal tracking, and instant PDF reports across all tools.
How Does SCOAT6 Already Include Mental Health Screening?
The SCOAT6 office concussion assessment includes optional GAD-7 and PHQ-2 screening. The SMHAT-1 extends this with a comprehensive six-domain assessment – adding sleep, substance use, disordered eating, and the sport-specific APSQ triage. For teams already conducting concussion follow-ups, adding SMHAT-1 builds on existing clinical infrastructure.
Frequently Asked Questions About SMHAT-1
What is SMHAT-1?
The SMHAT-1 (also written SMHAT1; Sport Mental Health Assessment Tool 1) is the first internationally standardised, sport-specific mental health screening tool. Developed by the IOC Mental Health Working Group and published in the British Journal of Sports Medicine in 2021, it screens six mental health domains in 10–15 minutes using a structured three-step pathway: triage, disorder-specific screening and clinical assessment.
Who can administer SMHAT-1?
SMHAT-1 is designed for licensed healthcare professionals working with athletes. Steps 1 and 2 are self-report questionnaires completed by the athlete; the results are reviewed and acted on by a qualified clinician trained in mental health assessment. It is not a self-assessment for athletes to use on their own.
Why does ScreenIT administer Steps 1 and 2 together?
The Team USA study (n=1,066 Olympic/Paralympic athletes) found that 67.5% of athletes who screened positive on Step 2 instruments would have been missed if only the APSQ triage (Step 1) had been used. ScreenIT administers all instruments simultaneously to ensure no athlete falls through the gap.
Is the digital SMHAT-1 free?
Yes. ScreenIT offers the SMHAT-1 completely free with no credit card required and no time limits. The free tier includes the full digitised workflow with automated scoring across all instruments, guided workflows, and instant threshold flagging.
Does ScreenIT have IOC authorisation for SMHAT-1?
Yes. ScreenIT has IOC authorisation to digitise the SMHAT-1. The digital version maintains full alignment with the IOC toolkit protocols, including the same validated screening instruments and clinical guidance.
What Is the Evidence for SMHAT-1?
Primary Sources
IOC Consensus Statement: Reardon et al. (2019), BJSM 53(11):667–699
SMHAT-1 Development: Gouttebarge et al. (2021), BJSM 55(1):30–37
Team USA Implementation: Anderson et al. (2023), BJSM
Polish Olympic Study: Waleriańczyk et al. (2024), BJSM 59(1):56–63
APSQ Development: Rice et al. (2020), Int J Sport Exerc Psychol
IOC Toolkit: IOC Mental Health in Elite Athletes Toolkit (2021)
Concussion–Mental Health: Guskiewicz et al. (2007), Med Sci Sports Exerc 39(6); Burns et al. (2022), J Clin Transl Res 8(3)
Last Reviewed
Content last reviewed: February 2026. Based on SMHAT-1 published January 2021.
Start Free Athlete Mental Health Screening
The IOC's sport-specific mental health screening tool, digitised with IOC authorisation. Six screening domains. Automated scoring. Guided workflows. Instant reports - completely free.
Start Mental Health Screening
Free Online SMHAT-1
Complete online with automated scoring and instant threshold flagging.
Free
IOC-Authorised Digital Format