International Olympic Committee Sport Mental Health Assessment Tool 2 (IOC SMHAT2): development, content validity and feasibility
British journal of sports medicine · 2026
IOC's SMHAT2 restructures elite athlete mental health screening into three steps, but this paper doesn't show the numbers proving it screens better than version 1.
The paper
Tool development/validation study describing the 7-stage creation of the IOC SMHAT2 mental health screening tool for elite (professional, Olympic, Paralympic, collegiate) athletes aged 16+; sample sizes for the content validity and feasibility testing stages are not reported in the abstract.
What they found
The IOC SMHAT2 was built as a three-step screening and assessment pathway: universal screening (five disorder-specific questionnaires plus two single questions), conditional screening (two further questionnaires), then clinical assessment by a physician or mental health professional. No sensitivity, specificity, misclassification rates, content validity indices, or feasibility metrics are given in the abstract.
The appraisal
This is a consensus-style development paper, not an outcomes trial, so conventional risk-of-bias tools don't apply directly, but the methodology (literature review, user feedback, misclassification analysis of SMHAT-1 data, then content validity and feasibility testing of the new version) is a reasonable iterative design process. The problem for appraisal is that none of the actual quantitative results from stages 3, 4 or 6, the misclassification rates, content validity scores, or feasibility data, are reported here, so there's no way to judge from this abstract whether SMHAT2 actually performs better than SMHAT-1.
The gap
Prospective diagnostic accuracy data (sensitivity, specificity, predictive value against clinician-confirmed diagnosis) in a large, diverse elite athlete sample, and a head-to-head misclassification comparison against SMHAT-1.
Landmark context
This directly updates the original IOC Sport Mental Health Assessment Tool-1 (SMHAT-1), part of the IOC's 2019 consensus statement on mental health in elite athletes; SMHAT2 is positioned as an evidence- and practice-informed revision rather than a break from that framework.
What to do Monday
Clinicians working with elite, Olympic, Paralympic or collegiate athletes should know SMHAT2 exists and is coming as the IOC's three-step update, but it's built for administration by sports medicine physicians and licensed mental health professionals, not something physios or S&C coaches score or interpret themselves. Don't switch protocols from SMHAT-1 on this paper alone since no comparative performance data are shown; keep your existing referral pathway to team medical/psych staff sharp in the meantime.
In practice
This applies to any physio or S&C coach embedded in an elite, Olympic, Paralympic or collegiate programme where the medical team may eventually adopt SMHAT2, but nothing in your day-to-day changes yet since no diagnostic accuracy data is published and the tool is doctor/mental-health-professional administered, not something you run in clinic or on the training floor. In the clinic, keep the two single screening questions as a natural part of your subjective history (sleep, mood, appetite, motivation) and refer on to the team physician or psych rather than trying to score SMHAT2 yourself. On the S&C floor your job stays the same: you're usually first to spot the early behavioural tell, dropped output, withdrawal, irritability, long before any screening tool gets used, so notice it, document it, and route it through the referral relationship you already have with medical staff. If your organisation announces a switch to SMHAT2, ask what validation data underpins it since none is in this paper, and don't let a new instrument replace the trust-based conversations that actually get athletes to disclose.
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