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Mind Over Motion β€” Athlete Mental Health Screening Toolkit

Mind Over Motion

Athlete Mental Health Screening Toolkit
Clinical Decision Support
For Licensed Clinicians Only
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Suggested workflows

Pre-surgical screening Tools 1, 2, 4, 5 β€” PHQ-9, GAD-7, ASSQ, Protocol
Return-to-sport clearance Tools 3, 7, 8 β€” TSK-11, ACL-RSI, RTP Framework
REDs screening Tool 6 β€” Red Flag Checklist (all sexes)
Sleep assessment Tool 4 β€” ASSQ (training room or clinic)
Scope & referral guide Tool 9 β€” When to refer and to whom
Tool 1 Β· Depression Screen

PHQ-9: Patient Health Questionnaire-9

Depression severity screening. Validated in athletic populations. Takes approximately 3 minutes to administer.

i
Scope: Administration and interpretation is within scope for all licensed clinicians (MD, DO, PA, NP, PT, ATC, LCSW, PhD/PsyD). Prescribing SSRIs depends on individual licensure and state regulations.
Clinical relevance for athletes Athletes with pre-existing depression show approximately 2.8Γ— longer rehabilitation timelines and 40% higher rates of chronic post-surgical pain. Pre-operative PHQ-9 β‰₯ 10 associates with significantly worse 2-year KOOS outcomes following ACL reconstruction (Ghayour-Minaie et al., JBJS 2022).
Instructions: Over the last 2 weeks, how often has the patient been bothered by the following? Select one response per item.
0Not at all 1Several days 2More than half the days 3Nearly every day

Safety assessment required

Patient endorsed thoughts of self-harm or death (item 9). Conduct an immediate safety assessment regardless of total score. Document findings and follow your institution's safety protocol. If imminent risk, do not leave patient alone; facilitate emergency evaluation.

Total score
β€”/27
Awaiting input
Complete all 9 items to see recommendation

Patient should answer every item. Partial scores are not clinically meaningful.

ScoreSeverityClinical action (athletic population)
0–4MinimalNo action required. Rescreen at next visit if clinical concern persists.
5–9MildWatchful waiting. Optimize pre-op factors if surgical candidate (sleep, expectations, brief CBT). Rescreen in 2 weeks.
10–14ModerateConsider psychiatric consultation before elective surgery. Consider CBT referral. Active monitoring. SSRI initiation may be appropriate if within scope.
15–19Moderately severeDefer elective surgery pending psychiatric evaluation. Psychiatry referral. Weekly monitoring.
20–27SevereUrgent psychiatric referral. Assess for suicidal ideation. Do not proceed with elective procedures until stabilized.
Source & licensing
Primary citation: Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. Public domain. Released by Pfizer for use without permission or licensing fees. Attribution requested when publishing data derived from the instrument.
Clinician signature: Date:
Tool 2 Β· Anxiety Screen

GAD-7: Generalized Anxiety Disorder-7

Anxiety severity screening. Differentiates clinical anxiety from performance anxiety. Takes approximately 2 minutes.

i
Scope: All licensed clinicians can administer and interpret. Elevated scores (β‰₯ 10) with comorbid pain warrant caution on opioid prescribing given the anxiety-pain-opioid risk triad.
Instructions: Over the last 2 weeks, how often has the patient been bothered by the following? Select one response per item.
0Not at all 1Several days 2More than half the days 3Nearly every day
Total score
β€”/21
Awaiting input
Complete all 7 items to see recommendation

Patient should answer every item. Partial scores are not clinically meaningful.

ScoreSeverityClinical action
0–4MinimalNo action required. Monitor if clinical concern arises.
5–9MildWatchful waiting. Consider relaxation techniques or brief CBT. Rescreen in 4 weeks.
10–14ModerateConsider CBT referral. Differentiate performance anxiety from GAD. Caution with opioid prescribing if comorbid pain.
15–21SeverePsychiatry referral. Consider pharmacotherapy evaluation. Active SI screening.
Source & licensing
Primary citation: Spitzer RL, Kroenke K, Williams JBW, LΓΆwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. Public domain. Free for use without permission or licensing fees. Attribution requested.
Clinician signature: Date:
Tool 3 Β· Kinesiophobia

TSK-11: Tampa Scale for Kinesiophobia

Measures fear of movement and re-injury. Essential for return-to-sport readiness assessment, especially post-ACLR. Takes approximately 3 minutes.

i
Scope: Within scope for PTs, ATCs, sport psychologists, and all physician-level providers for RTP decision-making. Document score for chart; elevated scores justify psychologically-informed rehabilitation progression.
Clinical evidence Athletes returning before 9 months post-ACLR show approximately 4Γ— higher graft re-rupture rates. TSK-11 β‰₯ 37 at clearance associates with elevated re-injury risk independent of physical readiness (JOSPT 2021). Pairs well with ACL-RSI (Tool 7) for comprehensive psychological readiness assessment.
Instructions: Read each statement aloud or provide to patient. Select how strongly the patient agrees.
1Strongly disagree 2Disagree 3Agree 4Strongly agree
Total score
β€”/44
Awaiting input
Complete all 11 items to see recommendation

Scoring starts at 11 (minimum). All items must be answered for a valid total.

ScoreInterpretationReturn-to-sport guidance
11–25Low fearStandard RTP progression. No psychological intervention required.
26–36Moderate fearEnhanced reassurance and education on re-injury rates. Consider brief CBT or motivational interviewing.
37–44High fearDefer unrestricted RTP. Structured ACT or CBT recommended before clearance. Sport psychology referral.
Source & licensing
Primary citation: Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005;117(1-2):137–144. Free for non-commercial clinical and research use with attribution. Clinicians distributing in commercial products should verify licensing.
Clinician signature: Date:
Tool 4 Β· Sleep Screen

ASSQ: Athlete Sleep Screening Questionnaire

Sleep disturbance screening developed specifically for athletic populations. Sleep dysfunction is bidirectionally linked with depression, anxiety, and overtraining syndrome.

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Scope: Administration is within scope for all team clinicians. Sleep hygiene education and training load adjustment are first-line interventions. Refer severe scores to sleep medicine or CBT-I trained clinician.
Instructions: Select the response that best describes the athlete's typical sleep over the past month.
Sleep difficulty score
β€”/17
Awaiting input
Complete all 6 items to see recommendation

All items should be answered for a valid total.

ScoreCategoryClinical action
0–4No problemReinforce sleep hygiene. No further intervention needed.
5–7MildSleep hygiene education. Address training load, caffeine timing, screen exposure. Rescreen in 4 weeks.
8–10ModerateComprehensive sleep assessment. Consider behavioral sleep intervention or CBT-I referral.
11–17SevereSleep medicine referral. Evaluate for underlying mood disorder, overtraining syndrome, or primary sleep disorder.
Source & licensing
Primary citation: Samuels C, James L, Lawson D, Meeuwisse W. The Athlete Sleep Screening Questionnaire: a new tool for assessing and managing sleep in elite athletes. Br J Sports Med. 2016;50(7):418–422. This is an abbreviated version for clinical decision support. Full ASSQ available from the Centre for Sleep & Human Performance. Attribution required.
Clinician signature: Date:
Tool 5 Β· Workflow

Pre-Surgical Psychiatric Screening Protocol

Four-step evidence-based workflow for orthopedic surgical candidates. Intended as a decision support framework, not a substitute for clinical judgment.

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Scope: PAs, NPs, and physicians can administer intake and make initial risk stratification decisions. Psychiatric consultation threshold and deferral decisions should be discussed with the supervising or attending physician per institutional policy.
Clinical evidence Pre-operative PHQ-9 β‰₯ 10 before ACL reconstruction associates with significantly worse 2-year KOOS outcomes. Pre-surgical screening and optimization improves post-operative recovery trajectories, treatment adherence, and patient-reported outcomes (Ghayour-Minaie et al., 2022; informed by AAOS guidelines and IOC Mental Health Consensus 2019).
Step 1 Β· Pre-op intake

Screen and document

  • Administer PHQ-9 (Tool 1) and GAD-7 (Tool 2)
  • Screen for prior psychiatric history and current treatment
  • Administer Pain Catastrophizing Scale (PCS) if persistent pain
  • Document substance use history (alcohol, opioids, cannabis, stimulants)
  • Assess baseline sleep quality (ASSQ, Tool 4)
Step 2 Β· Risk stratification

Classify by PHQ-9 severity

  • PHQ-9 < 5: Proceed with surgery as planned
  • PHQ-9 5–9: Optimize pre-operatively (sleep, expectations, brief CBT referral)
  • PHQ-9 10–14: Consider psychiatric consultation before elective surgery
  • PHQ-9 15–19: Defer elective surgery pending psychiatric evaluation
  • PHQ-9 20–27: Urgent psychiatric referral; no elective procedures until stabilized
  • Active suicidal ideation (PHQ-9 item 9 positive): Delay elective procedure and refer emergently regardless of total score
Step 3 Β· Pre-op optimization

Address modifiable factors

  • Refer to sport psychologist or CBT-trained clinician for pre-surgical cognitive behavioral work
  • Optimize sleep hygiene pre-operatively
  • Set realistic return-to-sport timeline with patient and document shared understanding
  • Discuss opioid plan explicitly: duration, MME limit, non-opioid alternatives
  • Address catastrophizing patterns if PCS elevated
Step 4 Β· Post-op monitoring

Surveillance schedule

  • PHQ-9 at weeks 2, 6, and 12 post-op
  • Opioid usage log; track morphine milligram equivalents (MME)
  • Patient-reported sleep and mood diary
  • TSK-11 (Tool 3) if kinesiophobia suspected; flag if β‰₯ 37
  • Monthly reassessment until RTP clearance (Tool 8)
Protocol items completed
0/21
In progress
Source & licensing
Sources: Ghayour-Minaie M et al. Preoperative depression and patient-reported outcomes after orthopedic surgery. JBJS. 2022;104(18):1644–1654. Protocol informed by AAOS Clinical Practice Guidelines and IOC Mental Health Consensus (Reardon CL et al., 2019). Protocol synthesis Β© 2026 MPW Media and Consulting LLC. Clinicians must verify local institutional policy and scope before implementation.
Clinician signature: Date:
Tool 6 Β· Energy Deficiency

REDs Clinical Red Flag Checklist

Relative Energy Deficiency in Sport. Affects all sexes. Male athletes are significantly underdiagnosed.

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Scope: All team clinicians can identify red flags. Comprehensive workup (DEXA, hormone panel, nutrition assessment) requires physician coordination and interdisciplinary team (MD + RD + psychologist).
Instructions: Check all red flags present in the athlete's history or current presentation. Three or more flags triggers comprehensive REDs workup.
Red flags checked
0/14
None checked
Below threshold

No red flags identified. Continue routine monitoring. Reassess if clinical picture evolves.

Source & licensing
Primary citation: Mountjoy M et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073–1097. Free for clinical and educational use with attribution.
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Tool 7 Β· RTP Readiness

ACL-RSI: ACL Return to Sport after Injury

Psychological readiness scale specifically validated for athletes returning to sport after ACL reconstruction. Complements physical metrics (LSI, hop tests) with psychological dimension.

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Scope: Used primarily by PTs, ATCs, and sports medicine physicians making RTP clearance decisions. Typically administered at 6, 9, and 12 months post-ACLR alongside physical testing.
Clinical evidence ACL-RSI scores below 56/100 at clearance associate with decreased likelihood of return to preinjury sport level and elevated re-injury risk. Score improves predictive value when combined with TSK-11 (Tool 3) and physical testing (Webster & Feller, AJSM 2019).
Instructions: For each statement, select how confident the patient is on a scale of 0 to 10.
0Not at all confident 5Moderately confident 10Fully confident
ACL-RSI score (scaled to 100)
β€”/100
Awaiting input
Complete all 6 items to see recommendation

All items must be answered for a valid score.

ScoreReadinessClinical action
0–55Low readinessDefer unrestricted RTP. Psychological intervention recommended. Consider structured graded exposure or sport psychology referral.
56–75Moderate readinessModified RTP with continued monitoring. Address specific areas of low confidence with targeted intervention.
76–100High readinessPsychologically ready for RTP. Confirm physical readiness via Tool 8 framework.
Source & licensing
Primary citations: Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):9–15. Also: Webster KE, Feller JA. Expectations for return to preinjury sport before and after ACL reconstruction. Am J Sports Med. 2019;47(3):578–583. Free for clinical and research use with attribution. This implementation is a 6-item short form adapted for rapid clinical screening; full 12-item ACL-RSI is the published validated instrument.
Clinician signature: Date:
Tool 8 Β· RTP Framework

Return-to-Sport: 4-Domain Mental Readiness Framework

Physical clearance β‰  mental clearance. All four domains should be addressed before RTP clearance.

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Scope: Best used collaboratively between PT/ATC, sports medicine physician, and (when needed) sport psychologist. Final RTP decision rests with the supervising physician per most institutional policies.
Clinical evidence Approximately 63% of athletes physically cleared for RTP report significant re-injury fear at clearance (JOSPT 2021). This framework integrates psychological readiness into RTP decision-making alongside physical metrics.
Instructions: Check completed items in each domain. All domains should be adequately addressed before clearance.

Domain 1 Β· Physical readiness

Domain 2 Β· Psychological readiness

Domain 3 Β· Social and contextual readiness

Domain 4 Β· Long-term considerations

Readiness items completed
0/14
Incomplete
Source & licensing
Informed by: Ardern CL et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy. Br J Sports Med. 2016;50(14):853–864. Webster KE, Feller JA. Expectations for return to preinjury sport before and after ACL reconstruction. Am J Sports Med. 2019;47(3):578–583. Framework synthesis Β© 2026 MPW Media and Consulting LLC. For clinical reference only.
Clinician signature: Date:
Tool 9 Β· Scope & Referral

Scope-of-Practice & Referral Quick Reference

Clinical domains, your scope by discipline, when to refer, and who to refer to.

DomainYour scopeRefer whenRefer to
Depression PHQ-9, brief supportive counseling, SSRI initiation if within scope PHQ-9 β‰₯ 15, any SI, treatment-resistant, complex trauma Sports psychiatrist, clinical psychologist
Anxiety GAD-7, identify performance vs. clinical anxiety, situational beta-blockers (within scope) GAD-7 β‰₯ 15, panic disorder, PTSD, social anxiety with impairment Psychiatrist, CBT-trained psychologist
Return-to-sport TSK-11, ACL-RSI, RTP timeline coordination, readiness documentation TSK-11 β‰₯ 37 unresponsive to reassurance, PTSD pattern, persistent avoidance Sport psychologist, ACT-trained therapist
Eating disorders / REDs SCOFF/EDE-Q screening, vital signs, basic labs (CBC, BMP, CMP) Any purging, BMI < 18 in active athlete, bradycardia, electrolyte abnormalities ED specialist, registered dietitian, psychiatry
Sleep dysfunction ASSQ, sleep hygiene education, training load adjustment ASSQ β‰₯ 8, suspected primary sleep disorder, comorbid mood disorder Sleep medicine, CBT-I trained clinician
Performance & mental skills Mindfulness basics, sleep hygiene, goal-setting conversation Performance anxiety with somatic symptoms, burnout, identity disruption CMPC (AASP), sport psychologist
Substance use CAGE/AUDIT-C screening, opioid risk assessment, naloxone counseling Active dependence, failed self-management, withdrawal symptoms Addiction medicine, psychiatry

Key abbreviations

ACL-RSI β€” ACL Return to Sport after Injury
ACT β€” Acceptance and Commitment Therapy
ASSQ β€” Athlete Sleep Screening Questionnaire
ATC β€” Athletic Trainer Certified (BOC)
BMD β€” Bone Mineral Density
CBT β€” Cognitive Behavioral Therapy
CBT-I β€” CBT for Insomnia
CMPC β€” Certified Mental Performance Consultant
EA β€” Energy Availability
FFM β€” Fat-Free Mass
GAD β€” Generalized Anxiety Disorder
KOOS β€” Knee injury & Osteoarthritis Outcome Score
LSI β€” Limb Symmetry Index
MME β€” Morphine Milligram Equivalents
PCS β€” Pain Catastrophizing Scale
RD β€” Registered Dietitian
REDs β€” Relative Energy Deficiency in Sport
RTP β€” Return to Play/Sport
SI β€” Suicidal Ideation
SSRI β€” Selective Serotonin Reuptake Inhibitor
TSK β€” Tampa Scale for Kinesiophobia
TUE β€” Therapeutic Use Exemption
Source & licensing
Sources: Synthesized from IOC Mental Health Consensus (Reardon CL et al., 2019), AAPA/APA scope of practice guidelines, and BOC Standards of Professional Practice. Reference synthesis Β© 2026 MPW Media and Consulting LLC. Clinicians must practice within individual state licensure, institutional policy, and personal scope.
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Want deeper clinical context?

This toolkit is a companion to Mind Over Motion: Sports Psychology & Psychiatry for the Clinician, a 4.0 credit accredited CME course for physicians, PAs, NPs, PTs, ATs, psychologists, social workers (ASWB), and the healthcare team (IPCE).

Learn more about the course

Version 2.0 Β· Last updated April 2026

Β© 2026 MPW Media and Consulting LLC

For clinical reference only. Not a substitute for clinical judgment or formal psychiatric evaluation. Clinicians must practice within their individual state licensure and institutional scope.

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