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Mental stress and illness are common health problems in competitive sports that can reduce performance and have effects beyond the end of a career as sport-specific and unspecific disorders. The promotion of mental health and safe handling of mental problems and illnesses require appropriate education and train-ing. However, child, adolescent and adult psychiatrists with specific expertise in competitive sports (sports psychiatrists) are not yet an integral part of the structure of medical care provision in competitive sports. This position paper gives an overview about existing care structures in competitive sports for the promotion of mental health, and investigated them with proposals for the further development of sports psychiatric care in competitive sports. Sports physicians, sports psychiatrists, as well as interdisci-plinary and interprofessional collaboration, are at the center of mental health efforts in competitive sports. Further aspects that will be discussed are the education and training of athletes and the environment in competitive sports, as well as the promotion of coaches’ health. Key Words: Elite sports, Prevention, Mental health problems and disorders, Sports psychiatry, Sports Medicine

Abstract. Objectives: Sports injuries usually have severe consequences for the concerned athletes as well as for trainers and teams. The question is if accidents can be predicted in specific cases. Can early-warning signals be detected in psychological time series? Methods: An App-based method of process-monitoring was applied for data collection of psychological parameters. Daily self-assessments using a Sports Process Questionnaire were realized by a professional soccer player during the after-care period of a psychiatric treatment. Methods for the prediction of critical events were applied (Dynamic Complexity, Recurrence Plots, dynamic inter-item correlations). Injuries may demarcate pattern transitions in the mental functioning of athletes, which could be identified by the Pattern Transition Detection Algorithm (PTDA). Results: Early-warning signals of the accident could be identified in the time series. Dynamic Complexity revealed a critical instability, Recurrence Plots a transient period, and the dynamic inter-item correlations a period of increased system coherence just before the accident. The PTDA revealed a phase transition at the occurring injury. Conclusions: Even if the analysis is based on a single case, the results are promising. Psychological self-reports allow a short-term prediction of bio-mechanical injuries and by this, can help to prevent them. Nonlinear measures can be applied to time series data collected by digital process monitoring.

Pre-Participation Examination (PPE) is recommended in many countries prior to or during the practice of competitive sports. The dedicated exploration of psychological complaints and illnesses in the sense of a psychiatric basic assessment within the PPE is not yet the rule. The implementation of a Psychiatric Basic Assessment (PBA) in the PPE is proposed and presented in terms of content. Abnormal findings in the PBA, crises, emergencies as well as conspicuous changes in behaviour should lead to further sports psychiatric evaluation (SPE) by child, adolescent and adult psychiatrists and psychotherapists qualified for this purpose. The goal is to use diagnostic and procedural standards to identify risks to mental health, stress, and already manifest illnesses in a timely manner and to provide qualified, specialized medical or psychiatric treatment. The diagnostic standards are intended to promote research and the benefits are to be verified by studies. Key Words: Psychiatric Basic Assessment (PBA), Sports Psychiatric Evaluation (SPE), Mental Health, Mental Disorders, Pre-Participation Examination (PPE)

Background: The impact of the COVID-19 pandemic on the mental health of patients suffering from addictive disorders is of major concern. This study aimed to explore the presence and potential increase in post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety since the beginning of the pandemic for patients in opioid substitution therapy (OST).Methods: This cross-sectional survey study evaluated a clinical sample of patients in OST (N = 123). Symptoms of post-traumatic stress disorder (PTSD) due to the COVID-19 pandemic were assessed by an adapted version of the impact of event scale (IES-R), resulting in two subgroups of low and high risk for PTSD. The depression, anxiety, and stress scale (DASS-21) was applied to collect data on the respective symptoms, and changes since the onset of the pandemic were reported on separate scales. Sociodemographic and COVID-19 related factors, as well as data on craving, consumption patterns, concomitant use, and the drug market were further assessed.Results: A binary logistic regression analysis confirmed the impact of self-perceived higher burden by psychological and economic factors on the elevated risk for PTSD due to the pandemic. The high-risk PTSD group also showed higher levels of depression, anxiety and stress, as well as a more pronounced deterioration in these symptoms since the pandemic. While reported levels of craving did not differ between the two groups, the high-risk PTSD group indicated a significantly higher increase in craving since the crisis, when compared to the low-risk group.Discussion: Our findings demonstrate elevated levels of clinical symptoms among patients in OST, with more than a quarter of patients found at risk for PTSD due to the COVID-19 pandemic. Furthermore, about 30–50% of our patients reported concerning levels of depression, anxiety, or stress. Special attention should be drawn to these findings, and potential deterioration of the situation should be addressed by health care facilities. Particularly, psychological, and financial burden due to the crisis were identified as factors increasing the risk for PTSD. These factors can easily be evaluated during routine anamneses, and might be a valuable source of information, when special attention is needed.