1 Mental Health in Sports: The Impact of Mental Health Literacy by Ana Morett Salas A proposal submitted in partial fulfillment of the requirements for the degree of MASTER OF EDUCATION with an emphasis in SPORT COACHING LEADERSHIP WEBER STATE UNIVERSITY Ogden, Utah December 4, 2025 Approved Ryan Zimmerman, Ph.D. Chad Smith, Ph.D. Riley Jensen, M.S. 2 Problem Statement Mental health in sports has become a common conversation topic in recent years, and rates of mental health concerns have increased following the COVID-19 pandemic (Levine et al., 2022). However, mental health in sports remains often overlooked, due to persistent stigma (McLane et al., 2024). Athletes are expected to display mental toughness and resilience, often at the cost of addressing and treating mental challenges (Lebrun et al., 2020). Many athletes prefer to remain silent about mental health issues, fearing that help-seeking will result in lost playing time or perceptions of weakness in a culture that praises toughness (Bissett et al., 2020). The “win at all costs” and macho culture undermines the human behind the performer, prioritizing results over the well-being of individuals and fostering a stigmatized environment that limits support for athletes (Henriksen et al., 2019; Kvillemo et al., 2023). The pressure to perform and deliver results, along with the intense training programs athletes undergo, can contribute to issues such as anxiety, depression, burnout and stress (Murphy & Sullivan, 2021). As the level of competition increases, mental health becomes a greater concern due to the rising physical and psychological demands (Sankey et al., 2023). In addition to anxiety, depression, burnout and stress, eating disorders and body dissatisfaction are also prevalent mental health concerns among athletes (Chrisman et al. 2024; Lebrun et al., 2020; Mazzer & Rickwood, 2014). Unfortunately, the intense physical and psychological demands can lead to suicidal ideation or actions, as athletes struggle to cope with overwhelming expectations (Ferguson et al., 2019). It is essential to recognize that mental health is just as important as physical health, as it affects not only athletic performance but also overall quality of life. Athletes are significantly impacted by their sport; therefore, their sport-related well-being serves as an indicator of their 3 overall well-being (Simons & Bird, 2022). At the same time, studies point out that athletes with good mental health have a better chance of performing well over the long term than those who are dealing with mental health issues (Henriksen et al., 2019). While coaches are becoming more aware of their vital role in supporting athletes’ mental health, many report low confidence in how to provide effective support and fear causing unintentional harm (Bissett et al., 2020). As a result, a significant number of coaches have expressed the need for training, mental health education, and structured guidelines to more effectively support their athletes and cultivate an inclusive, supportive environment (Breslin et al., 2017; Chrisman et al., 2024; McLane et al., 2024). The aim of this project, therefore, is to develop a comprehensive mental health training framework specifically designed for collegiate sports coaches. This framework will provide practical guidance, foundational knowledge, and actionable strategies to help coaches better support athletes’ mental health, while fostering a safe, inclusive and stigma-free environment as well as reducing feelings of inadequacy and mental health illiteracy among coaches. To evaluate the effectiveness of the proposed mental health training framework, this project will incorporate both pre- and post-intervention measures. Coaches will complete the Mental Health Literacy Scale (MHLS; O’Connor & Casey, 2015) survey prior to and following the training to assess changes in their knowledge, attitudes, and perceived ability to support athletes’ mental health. These measures will provide meaningful data to determine whether the training framework improves coaches’ mental health literacy, reduces stigma, and improves their confidence in providing support. Literature Review Sport-Related Stressors and Mental Health Concerns Among Athletes 4 Athletes are a vulnerable population, and the prevalence of mental health symptoms among them may be equivalent to or even exceed that of non-athletes (McLane et al., 2024). Student-athletes belong to three cohorts recognized as being at high risk for mental health disorders: emerging adults (18-24 years old), post-secondary students, and high-level athletes (Murphy & Sullivan, 2021). They experience both the stressors inherent to everyday life and the demands associated with their high-pressure sporting environments (Lebrun et al., 2020). Athletes are also exposed to unique psychological stressors not typically faced by non-athletes such as injury, intense training demands, media scrutiny, sport retirement, and performance pressures (Bissett et al., 2020). Furthermore, as the level of competition increases, mental health concerns tend to become more prevalent (Sankey et al., 2023). Additionally, athletes often juggle multiple commitments (Chrisman et al., 2024), such as balancing and managing academic and social challenges (Beasley et al., 2024; Kvillemo et al., 2023). Because they handle so many responsibilities, interpersonal relationships play a crucial role in their overall well-being. Conflict with coaches or lack of support from them can be a significant contributing factor (Baumann et al., 2024), while tension between teammates is also a strong stressor (Simmons & Bird, 2022). Moreover, social and contextual factors play an important role in athletes’ mental health (Gerber et al., 2024). Therefore, spending extended time away from family and friends can negatively affect athletes’ mental health (Breslin et al., 2022). Purcell et al. (2019) further support this, noting that frequent travel and exposure to unfamiliar environments can heighten mental health challenges and impact overall well-being. Athletes are positively influenced by strong social interactions and the sense of belonging and identity they attain from their environments (O’Leary et al., 2022). 5 What is more, rates of mental health concerns have increased following the COVID-19 pandemic (Levine et al., 2022), and according to McLane et al. (2024), rates were 1.5 to 2 times higher than those historically reported prior to the pandemic in 2020. The most common mental health disorders among athletes consistently identified in the literature are depression and anxiety (e.g., Henriksen et al., 2019; O’Connor et al., 2023; Warden et al., 2023), followed closely by eating disorders, stress, burnout, and suicide (e.g., Chrisman et al., 2024; Hebard et al., 2023; Mazzer & Rickwood, 2014). Other mental health disorders mentioned include substance use (e.g., Breslin et al., 2017; Russell et al., 2023), sleep disturbances (e.g., Baumann et al., 2024; Kvillemo et al., 2023), panic attacks (e.g., Chrisman et al., 2024; Mazzer & Rickwood, 2014), and mood or behavioral changes (e.g., Lebrun et al., 2020; Purcell et al., 2019). It is essential to note that untreated mental health disorders can lead to worsening symptoms, decreased athletic performance, and a loss of interest or motivation (Bissett et al., 2020). Stigma and Mental Health in Sports Due to the competitive nature of sports, which emphasizes both physical strength and mental resilience, athletes are often expected to display emotional toughness—a trait that is frequently celebrated (McLane et al., 2024). However, this expectation can come at the expense of their mental health, creating barriers that prevent open discussions about mental health issues, seeking help, and acknowledging personal struggles. Because toughness and resilience are deeply rooted beliefs in the sports world, both athletes and athletic staff often believe that experiencing mental distress signifies weakness (Hegarty et al., 2018). In recent research, Beasley et al. (2024) identified stigma as a primary barrier to effective help-seeking behaviors, as athletes tend to exhibit high rates of internalized mental health stigma. Similarly, Lebrun et al. (2020) discussed stigmatization within sports and noted that athletes are often unwilling to show 6 any sign of vulnerability to coaches, teammates, or competitors. Many athletes fear that displaying weakness will affect their relationships with coaches and teammates, influence how they are perceived, and potentially reduce their playing time (Beasley et al., 2024; Bissett et al., 2020). Individuals between the ages of 10 and 24 who experience mental health-related issues tend not to seek formal help and this age group has the lowest rate of mental health service use across their lifespan (Duffy et al., 2019). Similarly, Ferguson et al. (2019) reported that more than one-third of adolescents experiencing mental health challenges never seek professional help. Common reasons for this reluctance include negative attitudes toward treatment and helpseeking, poor mental health literacy and high levels of stigma. Unfortunately, negative attitudes toward help-seeking are even more prevalent among athletes than in the general population (Purcell et al., 2019), as they have traditionally been held to overwhelming expectations of physical strength and mental toughness (Breslin et al., 2022). Consequently, athletes may attempt to ignore or suppress emotional responses (Chrisman et al., 2024), as competitive sporting environments can create cultures that actively promote toughness and discourage signs of weakness (O’Leary et al., 2022), where performance and competition are prioritized above wellbeing (Tézier et al., 2025). Coaches’ Role in Supporting Athlete Mental Health One of the recurrent themes in prior research is the crucial role coaches play in supporting their athletes’ mental health. Across studies, coaches generally agree that promoting mental health is part of their role, including raising awareness, having open conversations, early detection, facilitating help-seeking, and referring individuals to the appropriate resources (e.g., Lebrun et al., 2020; Mazzer & Rickwood, 2024; O’Connor et al., 2023). Coaches are pivotal in 7 improving team culture due to the proximity, frequency, and influence they have with their athletes (Murphy & Sullivan, 2021). Creating an inclusive and supportive environment is part of the coaches’ role and Henriksen et al. (2019) believe that mental health promotion should be stated explicitly in procedure and protocol manuals for athletic performance, where help-seeking is a core function of training and self-care (Gerber et al., 2024). Creating inclusive and supporting environments encourage athletes to perform at their best, be who they are, ask for help, and access support resources for themselves and their teammates (McLane et al., 2024). Many authors agree that having open conversations about mental health issues can help decrease stigma levels (e.g., Hebard et al., 2023; McLane et al., 2024; Murphy & Sullivan, 2021), and influence athletes’ willingness to discuss mental health struggles and seek professional care (Beasley et al., 2024). Using modeling language and behaviors that explicitly communicate that mental health is important supports athletes’ help-seeking actions (O’Connor et al., 2023). In addition to creating a supportive team culture, coaches play a key role in recognizing when there is an issue and facilitating help-seeking for their athletes. Mazzer and Rickwood (2014) argue that a coach’s role is to be a useful resource of support by identifying concerns and facilitating help-seeking, as coaches serve as key gatekeepers and integral figures in an athlete’s life (O’Leary et al., 2022). Coaches have a responsibility to notice changes in their athletes’ mental state and behavior (Baumann et al., 2024), due to regular contact, coaches can detect behavioral changes that may serve as warning signs, facilitating early intervention (Lebrun et al., 2020). Recognizing and responding to behavioral changes can contribute to strategies that increase access to and coverage of mental health support for athletes (O’Connor et al., 2023), 8 whereas failure to do so may result in the athlete continuing to suffer indefinitely (Hegarty et al., 2018). The Coach-Athlete Relationship and Mental Health Another theme that emerged across prior research is the importance of the coach-athlete relationship (Ferguson et al., 2019). Hummell et al. (2022) state that the quality of this relationship is a key determinant of a positive sport experience. When coaches build trusting relationships with their athletes, athletes feel more comfortable and are more willing to communicate mental health concerns (Duffy et al., 2019). Trust is essential in the coach-athlete relationship, Mazzer and Rickwood (2014), suggest it can be developed by encouraging participation in group activities, being approachable, and maintaining open communication. Many coaches also use their own past experiences as an asset to build rapport with their athletes (Lauwerier et al., 2020). Coaches are particularly influential because they interact with athletes in many situations (Gerber et al., 2024). Thoughtful and respectful communication about both sport and life issues can help develop an effective coach-athlete relationship. Supporting this, Murphy and Sullivan (2021) state that “student-athletes feel supported when there is open and honest communication, and when the sporting staff is present and available” (p. 510). Ferguson et al. (2019) mention that a good-quality coach-athlete relationship is characterized by respect and appreciation for each other. Since coaches are viewed as role models, athletes feel more comfortable communicating mental health issues with coaches rather than with parents or family members (Bissett et al., 2020; Mazzer & Rickwood, 2014). In many cases, coaches are able to communicate with athletes in ways that other stakeholders are not able to, making them suitable gatekeepers for connecting athletes to the appropriate help (Bissett et al., 2020). However, some athletes may be reluctant to share mental health struggles with their 9 coach because they fear it will be perceived as weakness, disrupt the relationship dynamic, or affect their playing time (Beasley et al., 2024; Hegarty et al., 2018). A positive coach-athlete relationships is a key component of coaching effectiveness, as it is associated with better sport performance, lower injury rates, higher general happiness, and intrinsic forms of motivation (Gerber et al., 2024). Ultimately, a coach-athlete relationship based on trust can determine whether an athlete seeks help or not. Research shows that the way a coach acts, communicates, and reacts has a direct effect on athletes, influencing both their mood and mental health (Kvillemo et al., 2023). Sankey et al. (2023) suggest that coaches should adopt a holistic coaching approach, as it positively affects the well-being of athletes as well as communication and trust between them. Transformational leadership is positively associated with coach-athlete relationship quality too (Karayel et al., 2024). Transformational leadership involves leaders consistently inspiring and influencing team members’ behaviors to achieve collective objectives (Yildirim et al., 2023). Coaches must be aware of how they behave and communicate with their athletes, as it can significantly affect their mental health. Henriksen et al. (2019) suggest that a coaches’ relationship and the environment they create can nourish or malnourish athletes’ mental health. It is imperative that coaches who recognize athletes struggling with mental health challenges tailor their feedback to ensure they are not unintentionally harming them (Hegarty et al., 2018). Similarly, Gerber et al. (2024) recommend that training be tailored to match the age and developmental needs of athletes, promoting healthy psychosocial development and supporting autonomy. Mental Health Literacy and Guidelines in Sports 10 Mental health literacy of coaches or, particularly, the lack thereof, is a theme mentioned across prior research. Although most coaches recognize that mental health support is part of their role, some do not feel comfortable intervening because they do not believe they are qualified to do so and mention that other professionals are better equipped to assist with mental health concerns (Mazzer & Rickwood, 2014). Due to the lack of mental health literacy and established guidelines, some coaches are unsure on what to do because they do not want to negatively affect their athletes and make things worse (Bissett et al., 2020; Sankey et al., 2023). Although some mental health education resources are available to coaches, these have been deemed too basic, superficial and unrelated to the sports context (Warden et al., 2023). Lebrun et al. (2020) argue that coaches need more suitable and content-specific knowledge and tools to address mental health concerns and appropriately support their athletes. To maximize the impact of mental health literacy programs, Purcell et al. (2019) suggest that such programs should also be offered to athletes’ families and friends to enhance their ability to identify symptoms and encourage help-seeking, as some parents also mentioned that not knowing what to do was the most common barrier to facilitating help-seeking behaviors (Breslin et al., 2022). In their study, Hegarty et al. (2018) note that there are no minimum standards of education or training for collegiate coaches, which suggests that some coaches may have never received education regarding athlete mental health. Coaches often recognize their lack of knowledge and confidence in leading conversations about mental health (Russell et al., 2023) and express a desire to learn more, as they are uncertain about what helps their athletes and how to provide the necessary support (Breslin et al., 2017; Ferguson et al., 2019). Studies show that developing coaches’ knowledge and competence may encourage behaviors such as promotion, prevention, and early intervention, as individuals tend to feel more competent, autonomous, and 11 connected when an environment is properly structured (Duffy et al., 2019). A coaches’ beliefs about their own capabilities can have a significant impact on their engagement with athletes’ mental health concerns (O’Leary et al., 2022). However, the effectiveness of these interventions depends on how well coaches are able to provide appropriate knowledge, foster positive attitudes, and apply the necessary skills in health promotion initiatives (Hebard et al., 2023; Lauwerier et al., 2020). Although some sports organizations are trying to address this issue, there remains a lack of standardized approaches for integrating mental health training into sports coaching. Incorporating mental health education into sports coaching would not only equip coaches with the tools and knowledge to support their athletes but also allow them to foster a stigma-free and more inclusive environment. As mental health becomes an increasingly prominent topic in the sports world, it is essential that coaches are prepared to meet the needs of their athletes. Methods Design The current study will employ a pre-post quasi-experimental design to evaluate the effectiveness of the mental health training framework for collegiate sports coaches. A quantitative approach will measure changes in coaches’ mental health literacy, attitudes, and perceived ability to support athletes. Coaches will complete the Mental Health Literacy Scale (MHLS) both prior to and following the training. Pre-intervention scores will establish baseline knowledge and confidence, while post-intervention scores will assess changes resulting from the training. Because participants are not randomly assigned to different conditions, this study follows a quasi-experimental design. Comparing pre- and post-intervention measures will 12 provide preliminary evidence of the framework’s impact on improving coaches’ mental health literacy, reducing stigma, and enhancing their confidence in providing support to athletes. Participants NCAA Division I coaches in the western United States, employed as full-time collegiate coaches at the time of data collection (Spring 2026), will participate in the quantitative study. Eligible participants will hold head coaching positions across multiple men’s and women’s sports. Approximately 30-50 head coaches from 8-10 institutions are expected to be recruited. All participants will voluntarily complete both pre- and post-intervention surveys as part of their involvement in the study. Pseudonyms will be used for the names of participants and institutions to protect confidentiality. Testing Instruments Quantitative data will be collected using the Mental Health Literacy Scale (MHLS; O’Connor & Casey, 2015; Appendix A). The MHLS will be administered to assess coaches’ knowledge, attitudes, and beliefs regarding mental health and help-seeking. The MHLS is a comprehensive tool developed to measure mental health literacy in adults, including the ability to recognize specific disorders, knowledge of how to seek mental health information, knowledge of risk factors and causes, knowledge of self-treatments and professional help available, and attitudes that promote recognition and appropriate help-seeking. The MHLS consists of 35 items rated on a Likert-type scale, with response options varying by item. For the present study, Items 9 and 10 were removed because they were developed for use in Australia and are not applicable within a United States context. All remaining items were retained in their original order. Items with a 4-point scale are rated from “very unlikely/unhelpful” (1) to “very likely/helpful” (4), while items with a 5-point scale are 13 rated from “strongly disagree/definitely unwilling” (1) to “strongly agree/definitely willing” (5). The researchers calculated Cronbach’s alpha coefficients to determine internal consistency, which ranged from .87 to .91 (O’Connor & Casey, 2015). The MHLS will be administered twice: once prior to participation in the mental health training framework and again immediately following completion of the training. Comparing pre- and post-intervention scores will allow for the assessment of changes in coaches’ mental health literacy, providing preliminary evidence of the training framework’s effectiveness in improving knowledge, reducing stigma, and enhancing confidence in supporting athletes. Procedure Upon receiving approval from the institutional review board at Weber State University, an initial email (Appendix B) will be sent to Athletic Directors of the Division I institutions in the western United States. The email will briefly explain the purpose of the study and request permission to contact the head coaches of their institutions. Once permission is granted, head coaches will be sent an email (Appendix C) inviting them to participate in the study. The email will consist of information regarding the study, a link to the informed consent form (Appendix D), a demographic questionnaire (Appendix E), and the pre-intervention Mental Health Literacy Scale (MHLS). Following completion of the pre-intervention survey, head coaches will participate in the mental health training. Upon completing the training, they will complete the post-intervention MHLS to assess changes in mental health literacy, attitudes, and perceived ability to support athletes. Data Analysis 14 Descriptive statistics, including means, standard deviations, and frequency distributions will be calculated to summarize participant demographics and overall MHLS scores. To evaluate the effectiveness of the mental health training framework, paired-samples t-tests will be conducted to compare pre- and post-intervention scores, with an alpha level set at .05. Short Description of the Training Framework Approximate Length: 2-3 hours (15-20 minutes per module) Number of Modules: 6-7 Modules Module Content: Self-paced Canvas course with short modules • Module 1: Understanding Mental Health in Sports o Define mental health in the sports context o Prevalence of mental health challenges in athletes o Impact on performance, sport satisfaction and overall well-being • Module 2: Common Athlete Mental Health Challenges o Overview of common mental health challenges among athletes • Module 3: Stigma & Help-Seeking o Understanding stigma in sports culture o Barriers to help-seeking among athletes o Myths vs. facts • Module 4: Contributing Factors (perhaps can be combined with Module 2) o Contributing factors in sport o Comparison between athlete and non-athlete population • Module 5: The Coach-Athlete Relationship and Effective Communication o Building rapport with athletes can help with help-seeking 15 o How to have open conversations about mental health o Build a trusting and safe environment for athletes o Active listening and effective communication • Module 6: Referral & Campus Resources o Internal campus resources o External resources o How to refer athletes to the right sources • Module 7: Creating and Maintaining a Supportive Team Culture o Knowledge into practice o Personal action plan o Reference resource guide Format: • Short videos • Readings • Scenario based exercises • Quizzes for knowledge check • Reflection activities To provide additional clarity regarding the structure of this training framework, a sample module has been included in Appendix F. This sample is intended to illustrate the format and content participants will engage with throughout the training. Future Impact Statement By expanding this mental health framework into workshops or online modules, athletics programs at multiple levels could equip coaches with the knowledge and tools necessary to foster 16 supportive, stigma-free environments that enhance athlete well-being, widening its impact beyond collegiate sports. 17 References Baumann, L., Schneeberger, A. R., Currie, A., Iff, S., Seifritz, E., & Claussen, M. C. (2024). Mental health in elite coaches. Sports Health: A Multidisciplinary Approach, 16(6), 1050–1057. https://doi.org/10.1177/19417381231223472 Beasley, L., Hoffman, S., & Sears, J. (2024). The mental health literacy of NCAA college coaches: Knowledge, beliefs, and resources. Journal of Issues in Intercollegiate Athletics, 17(1), 155–172. https://doi.org/10.51221/sc.jiia.2024.17.1.8 Bissett, J. E., Kroshus, E., & Hebard, S. (2020). Determining the role of sport coaches in promoting athlete mental health: A narrative review and Delphi Approach. BMJ Open Sport & Exercise Medicine, 6(1). https://doi.org/10.1136/bmjsem-2019-000676 Breslin, G., Haughey, T. J., Donnelly, P., Kearney, C., & Prentice, G. (2017). Promoting mental health awareness in sport clubs. Journal of Public Mental Health, 16(2), 55–62. https://doi.org/10.1108/jpmh-08-2016-0040 Breslin, G., Shannon, S., Cummings, M., & Leavey, G. (2022). An updated systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches, officials and parents. Systematic Reviews, 11(99). https://doi.org/10.1186/s13643-02201932-5 Chrisman, S. P. D., Bollinger, B., & Smart, M. (2024). 127. Mental health in the high school sport context: A qualitative interview study of athletes and coaches. Journal of Adolescent Health, 74(3), 68-69. https://doi.org/10.1016/j.jadohealth.2023.11.326 Duffy, J., Rooney, B., & Matthews, J. (2019). Coaches’ mental health literacy and role perceptions for supporting young people’s mental health. Journal of Applied Sport Psychology, 33(1), 45–59. https://doi.org/10.1080/10413200.2019.1646840 18 Ferguson, H. L., Swann, C., Liddle, S. K., & Vella, S. A. (2019). Investigating youth sports coaches’ perceptions of their role in adolescent mental health. Journal of Applied Sport Psychology, 31(2), 235–252. https://doi.org/10.1080/10413200.2018.1466839 Gerber, M., Gygax, B., & Cody, R. (2024). Coach-athlete relationship and burnout symptoms among young elite athletes and the role of mental toughness as a moderator. Sports Psychiatry, 3(1), 5–14. https://doi.org/10.1024/2674-0052/a000071 Hebard, S. P., Bissett, J. E., Kroshus, E., Beamon, E. R., & Reich, A. (2023). A content analysis of mental health literacy education for sport coaches. Journal of Clinical Sport Psychology, 17(2), 165–175. https://doi.org/10.1123/jcsp.2021-0011 Hegarty, E. M., Weight, E., & Register-Mihalik, J. K. (2018). Who is coaching the coach? Knowledge of depression and attitudes toward continuing education in coaches. BMJ Open Sport & Exercise Medicine, 4(1), e000339. https://doi.org/10.1136/bmjsem-2018000339 Henriksen, K., Schinke, R., Moesch, K., McCann, S., Parham, W. D., Larsen, C. H., & Terry, P. (2019). Consensus statement on improving the mental health of high-performance athletes. International Journal of Sport and Exercise Psychology, 18(5), 553–560. https://doi.org/10.1080/1612197X.2019.1570473 Hummell, C., Herbison, J. D., Turnnidge, J., & Côté, J. (2022). Assessing the effectiveness of the transformational coaching workshop using behavior change theory. International Journal of Sports Science & Coaching, 18(1), 3–12. https://doi.org/10.1177/17479541221122435 Karayel, E., Adilogullari, I., & Senel, E. (2024). The role of transformational leadership in the associations between coach-athlete relationship and team resilience: A study on elite football players. BMC Psychology, 12(1). https://doi.org/10.1186/s40359-024-02043-7 19 Kvillemo, P., Nilsson, A., Strandberg, A. K., Björk, K., Elgán, T. H., & Gripenberg, J. (2023). Mental health problems, health risk behaviors, and prevention: A qualitative interview study on perceptions and attitudes among elite male soccer players. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1044601 Lauwerier, E., Van Poel, E., Van der Veken, K., Van Roy, K., & Willems, S. (2020). Evaluation of a program targeting sports coaches as deliverers of health-promoting messages to atrisk youth: Assessing feasibility using a realist-informed approach. PLoS ONE, 15(9) e0236812. https://doi.org/10.1371/journal.pone.0236812 Lebrun, F., MacNamara, À., Collins, D., & Rodgers, S. (2020). Supporting young elite athletes with mental health issues: Coaches’ experience and their perceived role. The Sport Psychologist, 34(1), 43–53. https://doi.org/10.1123/tsp.2019-0081 Levine, O., Terry, M., & Tjong, V. (2022). The collegiate athlete perspective on return to sport amidst the COVID-19 pandemic: A qualitative assessment of confidence, stress, and coping strategies. International Journal of Environmental Research and Public Health, 19(11), 6885. https://doi.org/10.3390/ijerph19116885 Mazzer, K. R., & Rickwood, D. J. (2014). Mental health in sport: Coaches’ views of their role and efficacy in supporting young people’s mental health. International Journal of Health Promotion and Education, 53(2), 102–114. https://doi.org/10.1080/14635240.2014.965841 McLane, L., Oliva-Lozano, J. M., Kerulis, M., Cost, R., Bartley, J., & Chiampas, G. (2024). Examining the value of mental health awareness training for soccer coaching license candidates. Apunts Sports Medicine, 59(224), 100459. https://doi.org/10.1016/j.apunsm.2024.100459 20 Murphy, J., & Sullivan, P. (2021). Factors associated with coach–athlete conversations about mental health in intercollegiate sport. International Journal of Sports Science & Coaching, 16(3), 509–518. https://doi.org/10.1177/1747954121993455 O’Connor, M., & Casey, L. (2015). The Mental Health Literacy Scale (MHLS): A new scalebased measure of mental health literacy. Psychiatry Research, 229(1-2), 511-516. https://doi.org/10.1016/j.psychres.2015.05.064 O’Connor, J., Grove, C., Jeanes, R., Lambert, K., & Bevan, N. (2023). An evaluation of a mental health literacy program for community sport leaders. Mental Health & Prevention, 29, 18. https://doi.org/10.1016/j.mhp.2023.200259 O’Leary, C., Rooney, B., Donohue, B., & Matthews, J. (2022). Sports coaches’ depression literacy, and engagement in prevention and early intervention behaviors: A moderated mediation analysis. Journal of Applied Sport Psychology, 35(5), 755–774. https://doi.org/10.1080/10413200.2022.2126908 Purcell, R., Gwyther, K., & Rice, S. M. (2019). Mental health in elite athletes: Increased awareness requires an early intervention framework to respond to athlete needs. Sports Medicine - Open, 5(46). https://doi.org/10.1186/s40798-019-0220-1 Russell, S., Kelly, V., Polman, R., & Warren-James, M. (2023). The effectiveness of online mental health first aid training in community rugby: A mixed-methods approach. International Journal of Environmental Research and Public Health, 20(7), 5391. https://doi.org/10.3390/ijerph20075391 Sankey, C., Wallace, L., & Caperchione, C. M. (2023). Understanding the role of coaches in supporting the mental health of elite athletes. Journal of Science and Medicine in Sport, 26(8), 399–404. https://doi.org/10.1016/j.jsams.2023.06.012 21 Simons, E. E., & Bird, M. D. (2022). Coach-athlete relationship, social support, and sport-related psychological well-being in National Collegiate Athletic Association Division I studentathletes. Journal for the Study of Sports and Athletes in Education, 17(3), 191–210. https://doi.org/10.1080/19357397.2022.2060703 Tézier, B., Barros, K., Geidne, S., Bardid, F., Grieco, S., Johnson, S., Kokko, S., Lambe, B., Lefebvre, A., Lane, A., Ooms, L., Seghers, J., Sevdalis, V., Whiting, S., Vuillemin, A., & Van-Hoye, A. (2025). The health promoting sports coach: Theoretical background and practical guidance. BMC Sports Science, Medicine and Rehabilitation, 17(1). https://doi.org/10.1186/s13102-025-01056-y Warden, S., Doncaster, G., Greenough, K., & Smith, A. (2023). Examining sports coaches’ mental health literacy: Evidence from UK athletics. Sport, Education and Society, 29(7), 908–922. https://doi.org/10.1080/13573322.2023.2214160 Yildirim, S., Yildiz, A., Türkeri Bozkurt, H., Bilgin, E., Yüksel, Y., & Koruç, Z. (2023). The associations of transformational leadership and team cohesion on the psychological health of young football players through basic psychological needs. Science and Medicine in Football, 8(3), 222–231. https://doi.org/10.1080/24733938.2023.2194287 22 Appendix A: Mental Health Literacy Scale The purpose of these questions is to gain an understanding of your knowledge of various aspects to do with mental health. When responding, we are interested in your degree of knowledge. Therefore when choosing your response, consider that: Very Unlikely = I am certain that it is NOT likely Unlikely = I think it is unlikely but am not certain Likely = I think it is likely but am not certain Very Likely = I am certain that it IS very likely 1 If someone became extremely nervous or anxious in one or more situations with other people (e.g., a party) or performance situations (e.g., presenting at a meeting) in which they were afraid of being evaluated by others and that they would act in a way that was humiliating or feel embarrassed, then to what extent do you think it is likely they have Social Phobia Very Unlikely Unlikely Likely Very Likely 2 If someone experienced excessive worry about a number of events or activities where this level of concern was not warranted, had difficulty controlling this worry and had physical symptoms such as having tense muscles and feeling fatigued then to what extent do you think it is likely they have Generalized Anxiety Disorder Very Unlikely Unlikely Likely Very Likely 3 If someone experienced a low mood for two or more weeks, had a loss of pleasure or interest in their normal activities and experienced changes in their appetite and sleep then to what extent do you think it is likely they have Major Depressive Disorder Very Unlikely Unlikely Likely Very Likely 4 To what extent do you think it is likely that Personality Disorders are a category of mental illness Very Unlikely Unlikely Likely Very Likely 5 To what extent do you think it is likely that Dysthymia is a disorder Very Unlikely Unlikely Likely Very Likely 6 To what extent do you think it is likely that the diagnosis of Agoraphobia includes anxiety about situations where escape may be difficult or embarrassing Very Unlikely Unlikely Likely Very Likely 23 7 To what extent do you think it is likely that the diagnosis of Bipolar Disorder includes experiencing periods of elevated (i.e., high) and periods of depressed (i.e., low) mood Very Unlikely Unlikely Likely Very Likely 8 To what extent do you think it is likely that the diagnosis of Drug Dependence includes physical and psychological tolerance of the drug (i.e., require more of the drug to get the same effect) Very Unlikely Unlikely Likely Very Likely When choosing your response, consider that: • • • • Very Unhelpful = I am certain that it is NOT helpful Unhelpful = I think it is unhelpful but am not certain Helpful = I think it is helpful but am not certain Very Helpful = I am certain that it IS very helpful 11 To what extent do you think it would be helpful for someone to improve their quality of sleep if they were having difficulties managing their emotions (e.g., becoming very anxious or depressed) Very Unhelpful Unhelpful Helpful Very Helpful 12 To what extent do you think it would be helpful for someone to avoid all activities or situations that made them feel anxious if they were having difficulties managing their emotions Very Unhelpful Unhelpful Helpful Very Helpful When choosing your response, consider that: • • • • Very Unlikely = I am certain that it is NOT likely Unlikely = I think it is unlikely but am not certain Likely = I think it is likely but am not certain Very Likely = I am certain that it IS very likely 13 To what extent do you think it is likely that Cognitive Behavior Therapy (CBT) is a therapy based on challenging negative thoughts and increasing helpful behaviors Very Unlikely 14 Unlikely Likely Very Likely 24 Mental health professionals are bound by confidentiality; however there are certain conditions under which this does not apply. To what extent do you think it is likely that the following is a condition that would allow a mental health professional to break confidentiality: If you are at immediate risk of harm to yourself or others Very Unlikely Unlikely Likely Very Likely 15 Mental health professionals are bound by confidentiality; however there are certain conditions under which this does not apply. To what extent do you think it is likely that the following is a condition that would allow a mental health professional to break confidentiality: if your problem is not life-threatening and they want to assist others to better support you Very Unlikely Unlikely Likely Very Likely Please indicate to what extent you agree with the following statements: Strongly disagree Disagree Neither agree nor disagree 16. I am confident that I know where to seek information about mental illness 17. I am confident using the computer or telephone to seek information about mental illness 18. I am confident attending face to face appointments to seek information about mental illness (e.g., seeing the GP) 19. I am confident I have access to resources (e.g., GP, internet, friends) that I can use to seek information about mental illness Please indicate to what extent you agree with the following statements: Agree Strongly agree 25 Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 20. People with a mental illness could snap out if it if they wanted 21. A mental illness is a sign of personal weakness 22. A mental illness is not a real medical illness 23. People with a mental illness are dangerous 24. It is best to avoid people with a mental illness so that you don't develop this problem 25. If I had a mental illness I would not tell anyone 26. Seeing a mental health professional means you are not strong enough to manage your own difficulties 27. If I had a mental illness, I would not seek help from a mental health professional 28. I believe treatment for a mental illness, provided by a mental health professional, would not be effective Please indicate to what extent you agree with the following statements: Definitely Probably Neither Probably unwilling unwilling unwilling willing nor willing 29. How willing would you be to move next door to someone with a mental illness? 30. How willing would you be to spend an evening socialising with someone with a mental illness? 31. How willing would you be to make friends with someone with a mental illness? 32. How willing would you be to have someone with a mental Definitely willing 26 illness start working closely with you on a job? 33. How willing would you be to have someone with a mental illness marry into your family? 34. How willing would you be to vote for a politician if you knew they had suffered a mental illness? 35. How willing would you be to employ someone if you knew they had a mental illness? Scoring Total score is produced by summing all items (see reverse scored items below). Questions with a 4-point scale are rated 1- very unlikely/unhelpful, 4 – very likely/helpful and for 5-point scale 1 – strongly disagree/definitely unwilling, 5 – strongly agree/definitely willing Reverse scored items: 10, 12, 15, 20-28 Maximum score – 160 Minimum score - 35 27 Appendix B: Email to Athletic Directors Hello _________, My name is Ana Morett, and I am a former women’s tennis student-athlete (2019-2024) at Weber State University. Currently, I have the great honor of serving as a Graduate Assistant for the team while completing my master’s degree in Sports Coaching Leadership. I am writing to request your permission to contact the head coaches at your institution regarding participation in my thesis research study on mental health literacy among Division I coaches. Participation in this study would involve: • Completing a pre-training online survey (Mental Health Literacy Scale), approximately 10-15 minutes. • Completing a self-paced mental health training course, approximately 2-3 hours total. • Completing the post-training online survey (the same survey as the pre-test), approximately 10-15 minutes. All coaches and institutions will remain completely anonymous, and all data will be kept confidential. Participants may ask questions at any time and will have access to the study’s findings once the project is complete. The results from this research project will be used for educational purposes only and will support collegiate coaches in better identifying and responding to student-athlete mental health needs. Your permission to contact your head coaches would be greatly appreciated. Please respond at your earliest convenience with either permission granted or denied. Thank you very much for your time and consideration. Sincerely, 28 Ana Morett Graduate Assistant, Women’s Tennis Weber State University (801) 548-2804 anamorettsalas@weber.edu 29 Appendix C: Email to Division I Head Coaches Hello Coach, My name is Ana Morett, and I played tennis for Weber State University from 2019-2024. I now have the privilege of serving as a Graduate Assistant for the team while completing my master’s degree in Sports Coaching Leadership. I am conducting a research project for my thesis on mental health literacy among Division I coaches, and I am reaching out to invite you to participate. Your involvement would include: • Completing a pre-training online survey (Mental Health Literacy Scale), approximately 10-15 minutes. • Completing a self-paced mental health training course, approximately 2-3 hours total. • Completing a post-training online survey (the same survey as the pre-test), approximately 10-15 minutes. Participation is completely voluntary, and all responses will remain anonymous and confidential. You may ask questions at any time and will have access to the study’s findings once it is complete. The link provided will take you to the informed consent form, followed by the demographic questionnaire and the pre-training Mental Health Literacy Scale survey. If you would like to participate, please click the link to begin the questionnaire: https://forms.gle/KqJ1x3B6TbGHpUA9A I thank you in advance for your time and consideration–I greatly appreciate your support. Sincerely, Ana Morett 30 Graduate Assistant, Women’s Tennis Weber State University (801) 548-2804 anamorettsalas@weber.edu 31 Appendix D: Informed Consent Form Study Title: Mental Health in Sports: The Impact of Mental Health Literacy Researcher: Ana Morett Faculty Advisor: Dr. Ryan Zimmerman Purpose The purpose of this study is to examine mental health literacy among Division I collegiate coaches and to evaluate the effectiveness of a mental health training program designed specifically for coaches. The results may contribute to the development of more effective mental health education for coaches and help create more supportive, stigma-free environments for student-athletes. Procedures If you agree to participate in this study, you will be asked to complete the following: • A brief demographic questionnaire, approximately 3-5 minutes • A pre-training survey (Mental Health Literacy Scale), approximately 10-15 minutes • A self-paced online mental health training module series, approximately 2-3 hours total • A post-training survey (the same survey as the pre-test), approximately 10-15 minutes Confidentiality All information collected in this study will remain confidential. Pseudonyms will be used for your name and institution to protect confidentiality, and any identifying information will not be recorded or linked to your responses. You may ask questions at any time and will have access to the study’s findings once it is complete. Statement of Consent 32 By proceeding with the survey, you acknowledge that you have read and understood this consent form, voluntarily agree to participate, and give permission for your data to be included in this research study. 33 Appendix E: Demographic Questionnaire 1. Age (Fill in the blank): ______ years 2. Gender (Check the one that applies): Male Female Non-binary Transgender Prefer not to say Other: ______ 3. Race/Ethnicity (Select all that apply): White Black/African American Native American/Alaska Native Asian Native Hawaiian/Pacific Islander Hispanic/Latino Middle Eastern/North African Prefer not to say Other: ______ 4. Highest Level of Education Completed (Check the one that applies): Bachelor’s degree Master’s degree 34 Doctoral degree Other: ______ 5. Sport Coached (Fill in the blank): ______ 6. Team Gender (Select all that apply): Men’s team Women’s team Co-ed/Mixed-gender team Prefer not to say Other: ______ 7. Years of Coaching Experience (Fill in the blank): ______ years 8. Previous Mental Health Training (if any): None Brief workshop/seminar Online course Formal certification/program Other: ______ 9. Current Team Size (Fill in the blank): ______ athletes 35 Appendix F: Sample Module Module 1 Overview Mental health in sports is a key factor in an athlete’s performance, satisfaction, and overall wellbeing. In this module, you will gain a foundational understanding of mental health in the sports context and learn why supporting mental well-being is essential for both athletes and coaches. Reading/Videos The following video shows real ways mental health can impact athletes and why it matters as much as physical health. See real athletes share how mental health affects their performance, well-being, and how many athletes struggle when they define themselves solely by their sport. Learn how coaches can make a positive difference. Mental Health of Athletes (Video) This short article introduces the mental health challenges athletes may face, their potential impact, early warning signs, and how coaches can support athletes effectively. Mental Health in Athletes: Breaking the Stigma (Reading) To Do Please answer the following questions (3-4 sentences): 1. Which sport-related pressures do you observe most commonly in athletes? 2. How might mental health challenges impact athletic performance? 3. What early signs of mental health challenges should coaches or staff be aware of? Takeaways • Athletes face many of the same mental health challenges as non-athletes, along with additional sport-specific pressures. 36 • Mental health is just as important as physical health in sports and impacts performance, enjoyment, relationships, and safety. • Recognizing common mental health challenges and early warning signs is essential for supporting athletes effectively.