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

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.