Understanding the relationship between sport-related psychological safety and mental toughness in male elite athletes

doi:10.21203/rs.3.rs-5315778/v1

Background

The importance of mental health in elite sport has gained recognition, highlighting the need for supportive, highly competitive performance environments. This study investigates the relationship between psychological safety and mental toughness in elite sport, focusing on the mediating role of psychological distress, to advance understanding of how mental health can be maintained in competitive environments where mental toughness is often prioritized.

Methods

A cross-sectional study was conducted using a web-based survey of 541 Japanese male rugby players, including the Kessler Distress Scale (K10), a 15-item mental toughness scale (MT), and the Sport Psychological Safety Inventory (SPSI). Mediation analysis was conducted to assess the direct and indirect association of SPSI with MT through K10, with the significance of the mediation effect evaluated using a Sobel test. A sensitivity analysis was also performed to ensure robustness, adjusting for covariates.

Results

The analysis included 220 Japanese players with no missing values (response rate: 40.6%). The regression analysis revealed that higher scores on the SPSI scores were associated with lower K10 scores (β = -0.367, p < 0.001). In turn, K10 scores were negatively associated with MT (β = -0.286, p < 0.001), while SPSI scores were positively related to MT (β = 0.539, p < 0.001). The Sobel test confirmed the indirect effect of SPSI on MT through K10 (z = 2.818, p < 0.01), indicating significant mediation. In the sensitivity analysis, the indirect effect remained significant after adjusting for covariates (z = 2.97, p < 0.001).

Conclusion

A psychologically safe environment in sports might enhance mental toughness among elite athletes both directly and indirectly by reducing psychological distress. These results highlight the potential association between psychological safety in sports and both mental health and mental toughness, as both constructs have been linked with improved performance outcomes in prior research. The findings underscore the necessity for sports organizations to implement targeted interventions and policies that promote psychological safety and mental health support.

Psychological Safety in Sports

Mental Toughness

Mental Health

Mediation Analysis

athletes

Mental toughness is generally recognized as the capacity to perform under pressure while maintaining a positive attitude (1,2). It significantly influences the performance and well-being of elite athletes(3). Mentally tough athletes exhibit resilience, focus, and quick recovery from setbacks(4,5). This attribute is widely recognized in the sports world, with various approaches developed and implemented to promote mental toughness in the field (6). Mental toughness is adaptable and can be enhanced through targeted psychological interventions, making it a valuable focus for sports trainers and psychologists (7). In competitive environments such as sports, the enhancement of mental toughness is often prioritized over mental health.

The importance of mental health in elite sports has gained recognition from international sports organizations, including the International Olympic Committee (8,9). Epidemiological research has highlighted a high prevalence of mental health symptoms and disorders among both current and former elite athletes, with studies reporting significant rates of anxiety, depression, and substance abuse(9–11). Research emphasizes the need for mental health support systems within sports organizations to address these issues effectively(12). Mental health problems can be profoundly associated with athletes' daily functioning and career transitions (13,14). Our previous studies showed a similar higher prevalence of mental health symptoms in Japanese elite sport settings (15,16) and also revealed significant cultural nuances in the perception and management of mental health problems within these contexts (17).

Creating psychological safety in relation to mental health elite sports settings has been conceptualized to involve at least three core components: a mentally healthy environment, mental health literacy, and low mental health-related stigma(18,19). A mentally health environment in elite sport is one in which athletes can express their vulnerabilities and seek help for mental health concerns without fear of negative consequences (such as selection, or other forms of team exclusion) (20). Mental health literacy involves understanding and recognition of the key signs or symptoms of mental ill-health and appropriate support pathways (21–24). Low mental health-related stigma helps to normalize mental health experiences, encourage help-seeking behaviors and make mental health conversations a regular part of the sports environment (25–27). Psychological safety for mental health in sports is expected to have the potential to produce better subjective psychological distress and promote overall athlete well-being, which may in turn influence performance. Studies have proposed models outlining how psychologically safe environments contribute to better mental health outcomes by fostering an atmosphere where athletes feel safe to show their authentic selves and seek help without fear of negative consequences. For instance, Walton et al. (19) proposed a model that highlights key elements such as minimizing psychological harm, supporting mental health needs, and promoting help-seeking behaviors. The model suggests that when athletes perceive their environment as safe, they are more likely to express their vulnerabilities and seek assistance, leading to enhanced mental health outcomes.

Mental toughness and mental health are not mutually incompatible. A nuanced understanding of mental toughness includes resilience and the ability to manage mental health effectively(28). A supportive environment, including psychological safety, fosters both physical and mental health, enhancing overall athlete performance and well-being (29). This holistic approach aligns with recent shifts in how mental health is understood in high-performance settings, reflecting a progressive movement towards comprehensive athlete wellness (30).Based on these premises, this study investigates whether psychological safety towards mental health in elite sport is directly and indirectly related to mental toughness through psychological distress. By employing mental toughness as the dependent variable and psychological distress as the explanatory variable, this approach might underscore the importance of mental health, which has often been overlooked in highly competitive environments where the emphasis has traditionally been placed on enhancing mental toughness. In addition, we hypothesize that psychological safety (SPSI) positively correlates with mental toughness (MT), with psychological distress (K10) playing a pivotal mediating role.Through this research, we seek to provide deeper insights into how a supportive environment can promote athlete performance and well-being, informing targeted interventions and policies to foster healthier, more resilient athletic communities.

Study Design and Setting

This research was structured as a web-based cross-sectional study, adhering to the STROBE guidelines(31) pertinent to observational cross-sectional analyses. The survey was disseminated through the Japan Rugby Players' Association (JRPA) via team representatives attending routine meetings. The survey's introduction outlined the study's goals, procedures, and the voluntary nature of participation, ensuring informed consent. To maintain data integrity, the survey enforced a one-time access policy per participant, utilizing IP address filtering. Participants accessed the survey on tablets or laptops, with data collection timed to occur in the pre-season phase, specifically between November and December 2022. They were thoroughly briefed about the research objectives, data handling practices, and their right to participate or withdraw without any repercussions. This briefing was conducted via the survey's introductory page, which reassured participants of their anonymity. Each participant was assigned a device for the survey, which required approximately 15 minutes to complete. This study received approval from the Research Ethics Committee at the National Center of Neurology and Psychiatry (approval number: B2022-003).

Participants

Participants comprised 541 male rugby players, all above the age of 18, associated with the JRPA and actively competing in the Japan Rugby League One. The analysis focused exclusively on data from Japanese players who completed the Japanese version of the survey in its entirety.

Measurements

Subjective psychological distress

To evaluate the general psychological distress among participants, we employed the Kessler Distress Scale (K10)(32). This well-established 10-item instrument measures the frequency of symptoms commonly associated with anxiety and depression experienced over the prior four weeks. Responses are quantified on a five-point Likert scale, with scores ranging from 10 to 50. The internal consistency of the scale in the present study, as measured by Cronbach’s alpha, was 0.935, demonstrating the reliability of the K10 in assessing psychological distress within our sample.

Mental toughness (MT)

To quantify mental toughness, this study employed a 5-factor, 15-item scale designed to capture distinct dimensions of mental toughness in elite athletes(33). The scale comprises factors such as Fortitude, Commitment to the Sport, Psychological Conditioning, Self-Control, and Resilience. Examples of the items include “I feel confident in my ability to handle intense competition” (Fortitude), “I am committed to my sport, even in setbacks” (Commitment), “I maintain a positive outlook during competitions” (Psychological Conditioning), “I can stay calm under pressure” (Self-Control), and “I quickly recover from setbacks and regain focus” (Resilience). Responses were recorded on a five-point Likert scale from 1 (‘Strongly Disagree’) to 5 (‘Strongly Agree’), with scores ranging from 15 to 75. Cronbach’s alpha confirmed satisfactory reliability across all factors (α = 0.901), validating the scale as an effective tool for measuring mental toughness in the current sample.

Psychological Safety for Mental Health in Sports Environments

To assess psychological safety within sports environments, this study employed the Sport Psychological Safety Inventory (SPSI)(18). This instrument comprises an 11-item scale segmented into three subscales: Mentally Healthy Environment, Mental Health Literacy, and Low Self-Stigma. Responses were collected using a five-point Likert scale, where 0 indicates 'strongly disagree' and 4 represents 'strongly agree'. Items intended for reverse scoring were adjusted before analysis to ensure that higher scores consistently reflect greater perceived psychological safety. Thus, the total scores can range from 0 to 44, with higher scores indicating a stronger perception of sport-related psychological safety. The SPSI was translated into Japanese with attention to linguistic accuracy and cultural relevance. The translation was initially performed by the first author, Y.O., leveraging his expertise in both the source and target languages. This initial version was then refined to improve clarity and ease of understanding, particularly for the professional athletes participating in the study. A bilingual expert subsequently conducted a back-translation of the revised Japanese version into English to verify translation accuracy. The final Japanese version of the SPSI was validated by the original developers of the inventory, S.M.R. and R.P., who confirmed its fidelity and endorsed its use in this study. In this sample, the Cronbach's alpha for the SPSI was 0.755.

Background information/demographics

The survey included demographic items such as age, rugby experience, highest level of education, marital status, presence of a child in the household, residential status, and national team experience.

Statistical analysis

The descriptive statistics profiled the sample. This analysis investigated whether the SPSI is directly and indirectly related to MT through psychological distress (K10). The mediation model facilitated the estimation of both direct and indirect association. The indirect association of the SPSI on MT through K10 were specifically analyzed using a Sobel test to determine the significance of the mediation effect. To ensure the robustness of these findings, a sensitivity analysis was performed, incorporating various covariates such as age, rugby experience, educational attainment, marital status, whether children were present in the household, residential status, and national team experience. All analyses were conducted using Stata version 16 (StataCorp LLC, College Station, TX, US).

Characteristics of the Participants

Table 1 presents the demographic characteristics of the participants in the study. Out of the total 541 players, 347 agreed to complete the survey, resulting in a response rate of 64.1%. Among these 347 players, 220 participants who had no missing values and were born in Japan were selected as the target population for the current study (valid response rate of 40.6%). The mean age of the participants was 27.97 years, and the mean duration of rugby experience was 16.97 years. A total of 96.8% of the participants had attained university graduate education. Regarding marital status, 46.8% of the participants were married, and 34.6% had children in their families. Approximately half of the participants lived with their family or a partner. Furthermore, 12.7% of the participants had previous experience with the national team.

Main analysis

Table 2 showed direct and indirect association of a psychological safety environment for mental health on mental toughness mediated via psychological distress. For the relationship between SPSI and K10, the regression analysis showed that SPSI had a significantly negative association with K10 scores (β = -0.367, SE = 0.069, t = -5.32, p < 0.001, 95% CI [-0.503, -0.231]). Similarly, as K10 scores increased, MT score decreased (β = -0.286, SE = 0.086, t = -3.32, p < 0.001, 95% CI [-0.456, -0.116]). The direct relationship between SPSI and MT was also examined showing a significant positive relationship (β = 0.539, SE = 0.093, t = 5.77, p < 0.001, 95% CI [0.355, 0.723]). The Sobel test statistic was significant (z = 2.818, p < 0.001), indicating that the indirect effect is statistically significant. This suggests that SPSI association MT indirectly through its related on K10.

Sensitivity Analysis

Table 3 showed the results of the sensitivity analysis. For the relationship between SPSI and K10 with covariates included, the regression analysis showed that SPSI still has a significantly negative association with K10 (β = -0.370, SE = 0.071, t = -5.24, p < 0.001, 95% CI [-0.509, -0.231]). The other covariates did not show significant association with the K10 score. For the relationship between K10 and MT with covariates included, K10 continued to have a significant negative association on MT (β = -0.308, SE = 0.086, t = -3.60, p < 0.001, 95% CI [-0.631, -0.294]). The direct relationship between SPSI and MT with covariates included showed that SPSI still had a significant positive association with MT (β = 0.610, SE = 0.090, t = 6.77, p < 0.001, 95% CI [0.433, 0.788]). The Sobel test for the indirect effect of SPSI on MT through K10 with covariates included remained significant (z = 2.97, p < 0.001), reinforcing the conclusion that SPSI influences MT indirectly through its association with K10.

The current study investigated associations between mental toughness, mental health/psychological distress, and psychological safety for mental health among Japanese male rugby players. Our analysis revealed significant relationships, indicating that a psychological safety environment positively influences mental toughness both directly and indirectly through its effect on psychological distress. The sensitivity analysis, which included covariates, confirmed the robustness of these findings.

Integration of Mental Toughness, Mental Health, and Psychological Safety for Mental Health

Previous research suggests that environmental factors significantly impact mental health, which in turn affects overall performance and resilience in athletes(34). Additionally, other research provided evidence that psychological safety within sports environments could enhance mental toughness indirectly by improving mental health outcomes(35). Our findings align with and extend these studies by demonstrating that a psychologically safe environment for mental health directly enhances mental toughness and improves psychological distress, which in turn further supports mental toughness. The significant direct and indirect effects observed in this study suggest that creating a psychologically safe and supportive environment may be important for fostering mental toughness in athletes. This integrated approach aligns with contemporary views that mental toughness includes managing mental health effectively(28). In addition, a recent research proposes a theoretically informed model of psychological safety that outlines how psychologically safe environments lead to increased help-seeking and better mental health outcomes(19). The authors argue that when individuals feel safe to show their authentic selves, perceive their environment to support mental health needs, and experience minimized psychological harms, mental health outcomes are enhanced. Our study supports and extends the model by providing empirical evidence within the cultural context of Japanese rugby players. We found that a psychologically safe environment for mental health is directly associated with mental toughness and better subjective psychological distress, which in turn further supports mental toughness. These results provide empirical support for the model(19), the framework(23), and some mental health-related position statements(8, 9, 36) from international sports organizations, reinforcing the importance of psychological safety, support for mental health needs, and reduced psychological harm in fostering resilience and mental toughness in athletes.

Relationship between Mental Toughness and Mental Health

In the realm of sports, mental toughness and mental health are often perceived as contradictory concepts. The cultural expectations within sports dictate that athletes should demonstrate mental toughness, but seeking professional treatment for psychological issues may expose them to being perceived as mentally weak(25, 37). This apprehension can deter athletes from seeking the help they need, leading to the neglect or concealment of mental health issues(24, 26). However, effective management of mental health can serve as the foundation for mental toughness. Good mental health provides the mental resources necessary to withstand pressure and confront challenges, making it crucial for athletes to address mental health issues openly and receive the necessary support to enhance both their performance and overall well-being(14, 29). The culture of sports is evolving, with more mental health professionals being embedded within organizations to focus on both the mental health and performance enhancement of athletes (9, 12). Such initiatives contribute to creating an environment where athletes can freely express mental health concerns and seek assistance without negative repercussions(19, 30).

Strengths and Limitations

This study's strengths include its culturally specific focus and robust statistical methodology, enhancing the reliability of findings related to psychological safety, mental health, and mental toughness among male Japanese rugby players. However, several limitations must be considered when interpreting the results. There is ongoing debate regarding the conceptual clarity of measuring mental toughness (38). Some researchers argue that the construct is not well-defined and poses significant challenges for accurate measurement. Recognizing these limitations and challenges, this study employed a validated and satisfactory reliability scale. However, findings should be interpreted with caution, and future research should continue to refine these measurement tools. Most of the Japanese male rugby players surveyed in this study had a university degree or higher, which may not be representative of most elite athlete populations in other countries. Additionally, due to feasibility, only Japanese male rugby players were surveyed. The study's design—a single-point, cross-sectional survey—limits causal inference, and its findings may not be generalizable to other sports or demographics due to cultural and environmental differences between East Asian and Western sports settings including high levels of university completion in the current cohort. Future research should include longitudinal studies and a broader demographic to confirm these relationships and broaden their applicability.

This study demonstrates that sports-related psychological safety for mental health is positively associated with higher mental toughness among Japanese male rugby players, both directly and indirectly through improved subjective psychological distress. These findings are significant for athletes, staff, and sports organizations, as they highlight the importance of fostering a supportive environment to enhance both mental health and performance. Researchers and clinicians can use these insights to develop targeted interventions and policies that promote mental health and resilience in athletic communities. Messages/contents based on this finding may be particularly effective for those unconcerned about "mental health" and resistant to conventional interventions. The emphasis on a psychological safety environment for mental health offers a holistic approach to athlete well-being, underscoring the need for comprehensive support systems in sports settings.

Ethics Approval and Consent to Participate

This study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki and approved by the Research Ethics Committee at the National Center of Neurology and Psychiatry, Japan (approval number: B2022-003).

Consent for Publication

The participants were informed about the survey process, including the purpose of the study, data collection procedures, and the consequences of participating or not participating via the cover page of the questionnaire. Each participant gave their informed consent to the use of their responses for research purposes.

Availability of Data and Materials

Data cannot be shared publicly because there exist ethical restrictions. Publishing data sets is not covered by the informed consent given by the study participants, which was approved by the Research Ethics Committee of the National Center of Neurology and Psychiatry. The data are not owned by a third party. Non-author contact information for the body imposing the restrictions upon the data, to which data access requests can be sent, is the Research Ethics Committee of the National Center of Neurology and Psychiatry ([email protected]).

Competing Interests

The authors declare that they have no competing interests.

Funding

YO, as the principal researcher, declares that this study received funding from the TOYOTA Foundation (D22-PI-0002), KAKENHI Fostering Joint International Research (21KK0226). The authors declare no conflicts of interest in this paper.

Author Contributions

Y.O., K.Y., R.A., S.K., S.R., and R.P. contributed to the conception and design of the study. Y.O. conducted the statistical analysis, and K.Y., R.A., S.K., S.R., and R.P. contributed to the interpretation of the results and the discussion. Y.O. and S.K. contributed to data management.

Y.O., K.Y., R.A., S.K., S.R., and R.P. contributed to writing the draft manuscript. All authors contributed to the data assessment and approved the final version of the manuscript.

Acknowledgments

We are grateful to the secretariat staff members of JRPA and the players at each club for their support and cooperation with the study.

Jones G, Hanton S, Connaughton D. A Framework of Mental Toughness in the World’s Best Performers. Sport Psychol. 2007;21(2):243–64.
Jones G, Hanton S, Connaughton D. What Is This Thing Called Mental Toughness? An Investigation of Elite Sport Performers. J Appl Sport Psychol. 2002;14(3):205–18.
Cowden RG, Mental Toughness E, Intelligence, Effectiveness C. An Analysis of Construct Interrelatedness Among High-Performing Adolescent Male Athletes. Percept Mot Skills. 2016;123(3):737–53.
Gucciardi DF, Gordon S, Dimmock JA. Towards an Understanding of Mental Toughness in Australian Football. J Appl Sport Psychol. 2008;20(3):261–81.
Crust L, Azadi K. Mental toughness and athletes’ use of psychological strategies. EJSS. 2010;10(1):43–51.
Gucciardi DF, Hanton S, Gordon S, Mallett CJ, Temby P. The concept of mental toughness: tests of dimensionality, nomological network, and traitness. J Pers. 2015;83(1):26–44.
Bell JJ, Hardy L, Beattie S. Enhancing mental toughness and performance under pressure in elite young cricketers: A 2-year longitudinal intervention. Sport Exerc Perform Psychol. 2013;2(4):281–97.
Schinke RJ, Stambulova NB, Si G, Moore Z. International society of sport psychology position stand: Athletes’ mental health, performance, and development. Int J Sport Exerc Psychol. 2018;16(6):622–39.
Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53(11):667–99.
Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(11):700–6.
Purcell R, Rice S, Butterworth M, Clements M. Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System. Sports Med. 2020;50(9):1683–94.
Purcell R, Gwyther K, Rice SM. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Med Open. 2019;5(1):46.
Rice SM, Gwyther K, Santesteban-Echarri O, Baron D, Gorczynski P, Gouttebarge V, et al. Determinants of anxiety in elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(11):722–30.
Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Med. 2016;46(9):1333–53.
Ojio Y, Matsunaga A, Hatakeyama K, Kawamura S, Horiguchi M, Yoshitani G et al. Anxiety and Depression Symptoms and Suicidal Ideation in Japan Rugby Top League Players. Int J Environ Res Public Health [Internet]. 2021;18(3). http://dx.doi.org/10.3390/ijerph18031205
Ojio Y, Matsunaga A, Kawamura S, Horiguchi M, Yoshitani G, Hatakeyama K, et al. Anxiety and Depressive Symptoms in the New Life With COVID-19: A Comparative Cross-Sectional Study in Japan Rugby Top League Players. Int J Public Health. 2021;66:1604380.
Ojio Y, Matsunaga A, Kawamura S, Horiguchi M, Yoshitani G, Hatakeyama K, et al. Validating a Japanese Version of the Athlete Psychological Strain Questionnaire. Sports Med Open. 2021;7(1):90.
Rice S, Walton CC, Pilkington V, Gwyther K, Olive LS, Lloyd M, et al. Psychological safety in elite sport settings: a psychometric study of the Sport Psychological Safety Inventory. BMJ Open Sport Exerc Med. 2022;8(2):e001251.
Walton CC, Purcell R, Pilkington V, Hall K, Kenttä G, Vella S et al. Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model. Sports Med [Internet]. 2023; http://dx.doi.org/10.1007/s40279-023-01912-2
Edmondson A. Psychological Safety and Learning Behavior in Work Teams. Adm Sci Q. 1999;44(2):350–83.
Breslin G, Shannon S, Haughey T, Donnelly P, Leavey G. A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials. Syst Rev. 2017;6(1):177.
Breslin G, Shannon S, Cummings M, Leavey G. An updated systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches, officials and parents. Syst Rev. 2022;11(1):99.
Purcell R, Pilkington V, Carberry S, Reid D, Gwyther K, Hall K, et al. An Evidence-Informed Framework to Promote Mental Wellbeing in Elite Sport. Front Psychol. 2022;13:780359.
Castaldelli-Maia JM, Gallinaro JG, de ME, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B, et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. Br J Sports Med. 2019;53(11):707–21.
Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry. 2012;12:157.
Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27.
Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59(7):614–25.
Coulter TJ, Mallett CJ, Gucciardi DF. Understanding mental toughness in Australian soccer: perceptions of players, parents, and coaches. J Sports Sci. 2010;28(7):699–716.
Henriksen K, Schinke R, Moesch K, McCann S, Parham WD, Larsen CH, et al. Consensus statement on improving the mental health of high performance athletes. Int J Sport Exerc Psychol. 2020;18(5):553–60.
Moesch K, Kenttä G, Kleinert J, Quignon-Fleuret C, Cecil S, Bertollo M. FEPSAC position statement: Mental health disorders in elite athletes and models of service provision. Psychol Sport Exerc. 2018;38:61–71.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.
Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184–9.
Ito H, Yamada K, Funahashi H, Uebayashi I, Mano Y, Hirosawa M. Development of Mental Toughness Scale for Elite Swimmers. J Japan Soc Sports Ind. 2017;27(3):3203–21.
Donohue B, Galante M, Maietta J, Lee B, Paul N, Perry JE, et al. Empirical development of a screening method to assist mental health referrals in collegiate athletes. J Clin Sport Psychol. 2019;13(4):561–79.
Weinberg R, Freysinger V, Mellano K, Brookhouse E. Building Mental Toughness: Perceptions of Sport Psychologists. Sport Psychol. 2016;30(3):231–41.
Breslin G, Smith A, Donohue B, Donnelly P, Shannon S, Haughey TJ, et al. International consensus statement on the psychosocial and policy-related approaches to mental health awareness programmes in sport. BMJ Open Sport Exerc Med. 2019;5(1):e000585.
Bauman NJ. The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport? Br J Sports Med. 2016;50(3):135–6.
Gucciardi DF. Mental toughness: progress and prospects. Curr Opin Psychol. 2017;16:17–23.

Table 1. Demographic characteristics of the study participants

Age (in years; mean±SD)	27.97±3.98
Rugby experience (in years; mean±SD)	16.97±5.00
Highest level of educational attainment % (n)
High school	3.18 (7)
Four-year college or university	96.8 (213)
Marital status % (n)
Married	46.82(103)
Never married	52.27 (115)
Divorced or widowed	0.91 (2)
Child living in household % (n)	34.55 (76)
Residential Status % (n)
Living alone	22.27 (49)
Living with family and/or partner	50.00 (110)
Dormitory	27.73 (61)
Experience of national team % (n)	12.73 (28)

Table 2: Association of psychological safety for mental health on mental toughness mediated by psychological distress

Variables	Regression Coefficient (β)	SE	t-Value	p-Value	95% Confidence Interval
SPSI → K10	-0.367	0.069	-5.32	<0.001	[-0.503, -0.231]
K10 → MT	-0.286	0.086	-3.32	< 0.001	[-0.456, -0.116]
SPSI → MT	0.539	0.093	5.77	<0.001	[0.355, 0.723]
Sobel Test	z = 2.818 (p < 0.01) p = 0.0048
SPSI: Sport Psychological Safety Inventory; K10: 10-item Kessler Distress Scale; MT: 15-item mental toughness scale Sobel Test Calculation: To test the mediation effect, the Sobel Test was used. The indirect effect of SPSI on MT through K10 was calculated using the following formula: Where a is the path coefficient from SPSI to K10 (𝛽=−0.367), is the standard error of a (SE=0.069), b is the path coefficient from K10 to MT (𝛽=−0.286), and is the standard error of b (𝑆𝐸=0.086). The calculated z-value was 2.818 (p < 0.01), indicating a significant mediation effect.

Table 3: Sensitivity Analysis

Variables	Regression Coefficient (β)	SE	t-Value	p-Value	95% Confidence Interval
SPSI → K10	-0.370	0.071	-5.24	<0.001	[-0.509, -0.231]
Age	-0.004	0.157	-0.02	0.981	[-0.312, 0.305]
Rugby experience	-0.079	0.101	-0.79	0.433	[-0.278, 0.120]
Educational attainment	-0.965	1.186	-0.81	0.416	[-3.303,1.372]
Marital status	-0.165	1.166	-0.14	0.888	[-2.463, 2.133]
Child living in household	0.303	1.145	0.26	0.792	[-1.954, 2.560]
Residential Status	-0.614	0.609	-1.01	0.315	[-1.814, 0.587]
Experience of national team	-0.133	1.244	-0.11	0.915	[-2.586, 2.319]
K10 → Mental Toughness	-0.308	0.086	-3.60	< 0.001	[-0.477, -0.140]
Age	-0.355	0.194	-1.83	0.069	[-0.738, 0.028]
Rugby experience	-0.135	0.125	-1.08	0.282	[-0.382, 0.112]
Educational attainment	1.194	1.475	0.81	0.419	[-1.714, 4.102]
Marital status	-0.933	1.448	-0.64	0.520	[-3.788, 1.922]
Child living in household	-0.871	1.422	-0.61	0.541	[-3.675, 1.932]
Residential Status	-1.034	0.758	-1.36	0.174	[-2.528, 0.461]
Experience of national team	1.277	1.545	0.83	0.410	[-1770, 4.323]
SPSI → Mental Toughness	0.610	0.090	6.77	<0.001	[0.433, 0.788]
Age	-0.354	0.200	-1.77	0.078	[-0.748, 0.040]
Rugby experience	-0.111	0.129	-0.86	0.390	[-0.365, 0.143]
Educational attainment	1.491	1.514	0.98	0.326	[-1.494, 4.476]
Marital status	-0.882	1.489	-0.59	0.554	[-3.817, 2.053]
Child living in household	-0.965	1.462	-0.66	0.510	[-3.841, 1.917]
Residential Status	-0.844	0.778	-1.09	0.279	[-2.377, 0.688]
Experience of national team	1.318	1.589	0.83	0.408	[-1.8140, 4.449]
Sobel Test	z = 2.97 (p < 0.01) p = 0.003

No competing interests reported.

supportingfilesSTROBEchecklist.docx

Understanding the relationship between sport-related psychological safety and mental toughness in male elite athletes

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

Background

Methods

Results

Discussion

Integration of Mental Toughness, Mental Health, and Psychological Safety for Mental Health

Relationship between Mental Toughness and Mental Health

Strengths and Limitations

Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1