Faculty Bibliography

BACKGROUND:Public awareness of concussion has grown significantly over the past 2 decades, driven largely by media coverage of sports-related injuries. This has paralleled a rise in traumatic brain injury (TBI)-related emergency department visits, underscoring the need for specialized concussion care centers. Despite this, most existing programs focus on sports or pediatric populations, leaving critical care gaps. RECENT FINDINGS/RESULTS:The NYU Langone Concussion Center was established in 2013 to address these gaps by providing interdisciplinary care for both sports-related and non-sports-related concussions. Approximately 60% of cases seen at the center are not sports related. This article outlines the center's inception, operational model, patient demographics, and evolution over the past decade. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Lessons learned from the NYU Langone model offer valuable guidance for developing comprehensive concussion programs that can serve diverse urban populations. Key strategies include cross-specialty collaboration, flexible infrastructure, and systems-level integration to address heterogeneous mechanisms of injury and outcomes.

This consensus statement represents an update to Mental Health in Elite Athletes: International Olympic Committee Consensus Statement (2019) To advance a more standardised, evidence-based approach to mental health in elite athletes, an International Olympic Committee (IOC) Consensus Group critically evaluated the current science via a systematic literature review, sought consensus using Delphi methodology and provided recommendations relevant to this topic. Key themes include that mental health symptoms and disorders are (1) common among elite athletes; (2) may have sport-related aetiologies and manifestations; and (3) can impact performance. Routine screening for and monitoring of mental health symptoms and disorders in elite athletes using validated instruments is recommended. Management strategies should promote mental well-being in addition to preventing and treating mental health symptoms and disorders. These strategies should address all contributors to mental health symptoms, including factors within the environments in which athletes train and compete. Treatment may include psychotherapy, medication and other culturally or contextually appropriate modalities. With appropriate support and treatment, many athletes experiencing mental health symptoms and disorders can continue to train and compete safely, but sometimes modification of sport participation may be necessary. Elite athletes who are transitioning out of sport, elite Para athletes and elite young (adolescent) athletes are relatively understudied and may have distinct mental health concerns, in addition to those impacting elite athletes in general.

OBJECTIVE:To describe the evidence- and practice-based processes that led to the International Olympic Committee Sport Mental Health Assessment Tool 2 (IOC SMHAT2). METHODS:Seven stages were conducted including: (1) reviewing the scientific literature related to the use (eg, uptake by physicians) of the IOC SMHAT-1; (2) gathering the view (eg, experience with the tool, advice for improvements) of IOC SMHAT-1 users; (3) exploring the misclassification and measurement properties of the IOC SMHAT-1; (4) performing misclassification analysis of available IOC SMHAT-1 data; (5) designing the initial IOC SMHAT2; (6) evaluating the content validity and feasibility of the initial IOC SMHAT2; and (7) finalising the IOC SMHAT2. RESULTS:The IOC SMHAT2 was developed for sports medicine physicians and other licensed/registered health professionals with the objective of identifying elite athletes (defined as professional, Olympic, Paralympic or collegiate level; 16 years of age and older) potentially experiencing mental health symptoms and disorders. The IOC SMHAT2 is comprised of a three-step approach: (1) universal screening as step 1, including five disorder-specific screening questionnaires and two single questions; (2) conditional screening as step 2, including two disorder-specific screening questionnaires; and (3) an aid to clinical assessment and treatment as step 3 that should be conducted by sports medicine physicians or licensed/registered mental health professionals. CONCLUSION/CONCLUSIONS:Based on scientific and anecdotal reflections on its first version, we developed the IOC SMHAT2 as a second updated version of the tool to identify elite athletes potentially experiencing mental health symptoms and disorders.

We sought to generate recommendations for the tennis community regarding the provision of mental healthcare and the promotion of mental wellness among elite tennis athletes, including junior tennis athletes. Recommendations were generated using a multimethod approach that included an in-person summit held during the 2022 US Open Tennis Championships in New York, New York, USA, and an asynchronous Delphi consensus process. Participants (n=83) were purposively selected to ensure diverse representation from all seven governing bodies of tennis and the broader tennis ecosystem, including: current and former elite adult and junior players, coaches, sport administrators, parents, physiotherapists, athletic trainers, physicians (sports medicine, psychiatry, neurology), other licensed mental health providers, epidemiologists and other academic subject matter experts. The summit included expert presentations and cross-organisation group discussion, which were used to generate provisional consensus statements. Statements were rated anonymously and refined iteratively based on synthesis of open-ended feedback until predetermined numeric thresholds were reached. The summit also included discussion of implementation challenges and priorities. As a result of this process, 2 foundational principles and 25 actionable recommendations were adopted, covering 5 domains: (1) standards of care, (2) education, (3) media and social media, (4) safeguarding and (5) research. The foundational principles emphasised that mental health must be prioritised by tennis governing bodies and that these bodies should collaborate across the tennis ecosystem. This output is a starting point for coordinated mental health efforts in tennis. More broadly, this pragmatic process is a replicable model for cross-organisational collaboration in other high-performance sports.

OBJECTIVE:To systematically map and synthesise the scientific literature on substance use patterns among elite athletes, encompassing recreational substances, performance-enhancing drugs (PEDs) and polysubstance use. DESIGN/METHODS:This study was a scoping review conducted in accordance with the Joanna Briggs Institute (JBI) methodological framework and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol was prospectively registered on the Open Science Framework. DATA SOURCES/METHODS:A comprehensive search was conducted in PubMed/MEDLINE, PsycINFO, Scopus and SportDiscus from inception to March 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES/METHODS:Eligible studies were peer-reviewed original research articles examining substance use, misuse or substance use disorders among elite athletes, including collegiate, professional, Olympic, Paralympic or national-level competitors. Both recreational substances (eg, alcohol, cannabis, nicotine, prescription drugs) and PEDs were included. RESULTS:From 3292 unique records screened, 119 studies met inclusion criteria. Alcohol was the most extensively studied substance, particularly among National Collegiate Athletic Association collegiate athletes, with consistent evidence of heavy consumption in certain sports, especially those with strong social and team-based norms. PED studies revealed marked sport-specific patterns, largely informed by anti-doping surveillance data, but offered limited insight into psychosocial mechanisms. Research on other substances and polysubstance use was heterogeneous, fragmented, and methodologically variable. Across all domains, the literature was dominated by cross-sectional designs, self-reported data and Western populations. CONCLUSION/CONCLUSIONS:The existing evidence base demonstrates substantial substance-related vulnerability among elite athletes but is characterised by significant conceptual, methodological and geographical gaps. Future research should prioritise longitudinal and theory-driven designs, broader representation of professional and non-Western athletes, integration of mental health frameworks and rigorous evaluation of prevention and intervention strategies. TRIAL REGISTRATION NUMBER/BACKGROUND:The review protocol was prospectively registered on the Open Science Framework (OSF) (DOI: 10.17605/OSF.IO/3PJDN) on 8 January 2025.