Athlete Mental Health Screening: Free Digital SMHAT-2
The second edition of the IOC Sport Mental Health Assessment Tool, published in July 2026, as a guided digital workflow. Every athlete screened across seven symptom clusters, scored against the IOC thresholds, with the next step shown. Free.
IOC 2026 Edition
Free
10-Minute Universal Screen
Start Mental Health Screening
Free Online SMHAT-2
Quick signup – just name and email. Universal screening, conditional screening and the clinical assessment in one record, scored automatically against the IOC thresholds.
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What is SMHAT-2?
The International Olympic Committee Sport Mental Health Assessment Tool 2 (IOC SMHAT2, also written SMHAT-2) is the second edition of the IOC's standardised mental health screening tool for elite athletes aged 16 and over. Developed by the IOC Mental Health Working Group and published in the British Journal of Sports Medicine in July 2026, it identifies athletes who may be experiencing mental health symptoms or disorders, so that those who need support or treatment are referred in time.
Learn more about SMHAT-2 →What Changed From SMHAT-1?
The APSQ triage step is gone: every athlete now completes the universal screening. Disordered eating is screened with the EDE-QS instead of the BEDA-Q, alcohol with the full 10-item AUDIT instead of the AUDIT-C, and cannabis and nicotine use with two single questions. Post-traumatic stress moves forward into the conditional screening step.
Why Screen Every Athlete?
In SMHAT-1 data from 1,035 elite athletes analysed by the IOC Mental Health Working Group, the APSQ triage missed 35% of athletes above threshold for alcohol misuse, 34% for disordered eating and 23% for sleep disturbance. SMHAT-2 replaces the triage with a universal screen of about 10 minutes, a time the working group judged reasonable next to the other screening elite athletes already complete.
What Are the Three Steps of SMHAT-2?
SMHAT-2 moves from universal screening, to conditional screening when a score calls for it, to a clinical assessment by a sports medicine physician or licensed mental health professional.
Step 1
Universal Screening
Athlete Form 1: 45 questions every athlete answers, in about 10 minutes. Five questionnaires (GAD-7, PHQ-9, ASSQ, EDE-QS, AUDIT) and two single questions on cannabis and nicotine use.
Step 2
Conditional Screening
Athlete Form 2, about 5 minutes. Anxiety or depression at or above threshold opens the PC-PTSD-5 trauma screen. Any cannabis or nicotine use opens the CAGE-AID substance use screen.
Step 3
Clinical Assessment
The medical form, 30-45 minutes, for a sports medicine physician or licensed mental health professional. Severity, complexity, diagnostic uncertainty and treatment response guide the plan, with optional Athlete Form 3 screenings.
Any answer above “Not at all” on PHQ-9 item 9, which asks about thoughts of self-harm, calls for direct action under SMHAT-2. ScreenIT shows the clinician a red alert in the instrument’s own words: take immediate action, according to the mental health emergency plan.
What Does the SMHAT-2 Universal Screening Cover?
Seven key symptom clusters, each with an IOC threshold that decides the next step.
Anxiety
GAD-7
7 items over the last 2 weeks, scored 0-21. A score of 10 or more leads to Step 2 and Step 3.
Depression
PHQ-9
9 items over the last 2 weeks, scored 0-27. A score of 10 or more leads to Step 2 and Step 3. Item 9 at 1 or more needs direct action.
Sleep Disturbance
ASSQ
The Athlete Sleep Screening Questionnaire, built for athletes. A sleep difficulty score of 8 or more goes straight to Step 3.
Disordered Eating
EDE-QS
12 items over the past 7 days. A score of 15 or more goes straight to Step 3. New in SMHAT-2, replacing the BEDA-Q.
Alcohol Misuse
AUDIT
10 items over the past year, scored 0-40. A score of 8 or more goes straight to Step 3. The full AUDIT replaces SMHAT-1's 3-item AUDIT-C.
Cannabis and Nicotine Use
Two Single Questions
Yes or no, for use in the last 6 months. A yes to either leads to the CAGE-AID at Step 2, then Step 3.
Why Choose Digital SMHAT-2?
ScreenIT turns the SMHAT-2 forms, scoring table and routing into one guided record. Part of our complete assessment library.
Automated Scoring
IOC Thresholds Applied
Every questionnaire totalled automatically and set against its IOC threshold in a Universal Screening table that shows the action for each cluster.
Guided Routing
The Right Next Step
Athlete Form 2 opens only the screens the scores call for, and the record moves on to the clinical assessment when nothing has triggered it.
Clinical Assessment
Step 3 in the Same Record
Severity, complexity, diagnostic uncertainty, treatment response and recommendations for each problem, with the optional Form 3 screenings added by ticking them.
One Patient Record
Alongside SMHAT-1
SMHAT-2 sits beside SMHAT-1, SCAT6 and SCOAT6 in the athlete's record, so earlier SMHAT-1 results stay where they were.
Paper SMHAT-2
Totals summed by hand across up to nine questionnaires
Step 2 and Step 3 routing worked out from the table
A separate Excel calculator with hidden sheets
Paper forms risk confidentiality in team settings
Results filed away from concussion records
Digital SMHAT-2 - ScreenIT
Automatic scoring against the IOC thresholds
Next step shown from the scores
Item 9 alert on the clinician's screen
Privacy-secured digital delivery (AES-256, TLS 1.2+)
PDF report, in the same record as SCAT6 and SCOAT6
Already Using SMHAT-1?
Both editions are available in ScreenIT, so each clinic can move to SMHAT-2 when it suits its season.
Does SMHAT-2 Replace SMHAT-1?
Not in ScreenIT. SMHAT-2 is added beside SMHAT-1, which is unchanged. An athlete's earlier SMHAT-1 results stay in their record and keep their own scoring.
What Is Different in Practice?
There is no APSQ to pass first. Every athlete answers the full universal screen, sleep, eating and alcohol scores above threshold go straight to the clinical assessment, and a trauma screen follows raised anxiety or depression.
Where Does It Fit With Concussion Care?
The IOC suggests SMHAT-2 in pre-season and after significant events, injury and illness among them. Run in the same record as SCAT6 and SCOAT6, a pre-season result gives a mental health baseline to read post-concussion symptoms against.
Frequently Asked Questions About SMHAT-2
What is SMHAT-2?
The SMHAT-2 (IOC SMHAT2; Sport Mental Health Assessment Tool 2) is the second edition of the IOC’s standardised mental health screening tool for elite athletes aged 16 and over. Developed by the IOC Mental Health Working Group and published in the British Journal of Sports Medicine in July 2026, it uses three steps: universal screening, conditional screening and clinical assessment.
Who can use SMHAT-2?
Sports medicine physicians and other licensed or registered health professionals. The clinical assessment at Step 3 should be carried out by a sports medicine physician or a licensed mental health professional. Physical therapists and athletic trainers can use it when working with a sports medicine physician, who stays responsible for diagnosis and intervention. It is not a self-assessment for athletes.
How long does SMHAT-2 take?
The IOC estimates about 10 minutes for Athlete Form 1, about 5 minutes for Athlete Form 2 when it is triggered, and 30-45 minutes for the clinical assessment.
Is the digital SMHAT-2 free?
Yes. SMHAT-2 is free on every ScreenIT plan, with no credit card required and no time limit. Trend charts across timepoints are part of the paid plans.
Does SMHAT-2 replace SMHAT-1 in ScreenIT?
No. Both editions are available. SMHAT-2 sits beside SMHAT-1, and an athlete’s earlier SMHAT-1 results stay in their record unchanged.
What Is the Evidence for SMHAT-2?
Primary Sources
SMHAT-2 Development: Gouttebarge et al. (2026), BJSM 60:1131-1142, doi:10.1136/bjsports-2025-111408
The Instrument: IOC SMHAT2, online supplemental material 4 to Gouttebarge et al. (2026)
IOC Consensus Statement: IOC consensus statement on mental health in elite athletes (2026)
SMHAT-1 Development: Gouttebarge et al. (2021), BJSM 55(1):30-37
Last Reviewed
Content last reviewed: October 2026. Based on the IOC SMHAT2 published July 2026.
Start Free Athlete Mental Health Screening With SMHAT-2
The IOC's 2026 sport mental health assessment tool as one guided record. Seven symptom clusters. IOC thresholds applied. Clinical assessment included. Free.
Start Mental Health Screening
Free Online SMHAT-2
Universal screening, conditional screening and the clinical assessment, scored automatically.
Free
The IOC SMHAT2 is developed by the IOC Mental Health Working Group. Not a diagnostic tool.