The mental health of high-level athletes has received increased research attention over the past decade. Rates of mental illness in athletes are comparable to, or slightly higher than, the rates reported for same-aged general population samples. The experience of a major life or sport stressor (e.g. injury, relocation, relationship break-up) has been recognised as a risk factor for mental health issues such as depression and anxiety in athletes. The pressures of dealing with stressors such as career threatening injury, performance expectations and involuntary career termination may particularly increase high-level athletes` risk of mental health issues. Despite this, Adjustment Disorder (AjD), a mental health diagnosis directly concerned with maladjustment to one or multiple stressors, is virtually absent from the athlete mental health literature. Therefore, this thesis presents the first investigation into AjD in high-level athletes. Study one aimed to validate the amendment of an AjD monitoring instrument for the high-level athlete population. This study consisted of three stages. In Stage one, a critical screening of the literature facilitated the creation of an athlete-relevant stressors list and sport-related AjD screening questions. These were combined with the existing validated Adjustment Disorder New Module 20 (ADNM-20), to form the preliminary Adjustment Disorder New Module-Athlete (ADNMA). In Stage 2, seven experienced sport psychologists reviewed the preliminary ADNMA to establish content validity. Their feedback was incorporated to establish the final version of the ADNMA. Stage three investigated the convergent construct validity of the ADNMA. One hundred and forty-seven high-level athletes (various sports, State to Olympic level, male: n=69; Age: 21.4+3.9 years) completed the ADNMA, Athlete Burnout Questionnaire (ABQ), Depression Anxiety Stress Scales (DASS-21), Survey of Recent Life Experiences (SRLE), and the Perceived Stress Scale (PSS-10). Pearson`s r correlation coefficients between the ADNM-20, DASS-21, PSS-10 and SRLE ranged from r=.48 to r=.64 (p<.01), indicating good convergent validity. Multiple regression on the ABQ confirmed the added value of the ADNMA-sport subscale over the original ADNM-20 (change in R2 .032 to .129, p<.05). These are small, yet significant, changes in the variance explained, while the additional questions provide unique insight into the sport-related representations of AjD. The final ADNMA showed good construct validity, with the capability to assess both general and sport-specific AjD representations. Study two employed the ADNMA to investigate the presence of AjD, and potential interactions with demographic and psychological variables, in a high-level athlete sample. This cross-sectional survey study, in which 147 high-level athletes (Olympic to state level) participated, also explored which life and/or sport events caused athletes the most stress. The survey consisted of an assessment of demographic and sport-related variables, the ADNMA, the Mindful Attention Awareness Scale (MAAS), the Athletic Identity Measurement Scale (AIMS), and the Brief COPE. The results indicated that 49% of the participants could be classified as at risk of AjD. Injured athletes reported significantly higher levels of sport-specific AjD representations than non-injured athletes (p<0.01). Male athletes experienced less general and sport-specific AjD symptoms than their female counterparts (p< 0.05). The coping strategies: self-distraction, behavioural disengagement, and self-blame were related to higher levels of both general and sport-specific AjD symptoms. Contrarily, higher levels of dispositional mindfulness were related to lower levels of both general and sport-specific AjD symptoms. Injury, university and finances were most commonly named as the stressors that were the greatest burden on athletes. The ADNMA was then used in a practical application which monitored athletes on a fortnightly basis for nine months. High-level athletes who had relocated, spent considerable time touring overseas, or had a serious injury were invited to participate. Fifteen high-level athletes participated in the monitoring trial throughout the year 2020. This provided the unanticipated opportunity to analyse their wellbeing in response to the COVID-19 pandemic and virus transmission restrictions (e.g. lockdowns). The largest number of athletes simultaneously at risk of AjD coincided with the implementation of the first lockdown, indicating that the mental wellbeing of high-level athletes was negatively impacted during the COVID-19 pandemic. Study three aimed to investigate the coping mechanisms utilised by high-level athletes in response to life and sport stressors, and explore the factors that facilitated or hindered adjustment. Nine athletes, five females and four males (age: 23.8 ± 4.5 years), participated in semi-structured, one-on-one interviews. The study was grounded in an interpretive description framework, while using inductive thematic analysis as a qualitative analytic method. Five main themes were developed to represent the participants experiences of coping with stressors: these were (a) "I am" (multifaceted individual), (b) "I want" (driving forces), (c) "I have" (environment), (d) "I think" (cognitive and emotional coping strategies), and (e) "I do" (behavioural and practical coping strategies). Factors that facilitated or hindered adjustment were identified, however it should be noted that these factors can in themselves be stressors (e.g. support from a partner versus relationship issues with a partner). This duality guided the final organisation of the themes in which "I am" was placed central to the participants` stressor experience and coping strategies. These findings highlight the importance of basing support for athletes who are coping with stressors on their individuality and unique situation. In conclusion, this thesis has produced a valid AjD monitoring instrument for high-level athlete populations, the ADNMA. Based on the cross-sectional study and the practical monitoring trial, there are strong indications that AjD exists within this population. However, further studies are needed to facilitate the unequivocal diagnosis of AjD in high-level athletes. Dispositional mindfulness, and the use of certain coping strategies were found to be related to AjD in athletes. Future studies are needed to further clarify the links between AjD, mindfulness and coping strategies, such studies may provide valuable information for the development of treatments and/or intervention strategies for AjD. Additionally, this thesis highlights the complex interplay of factors that support and hinder adjustment to stressors. These findings ultimately position the individual at the centre of the stressor adjustment process. From a clinical perspective, the findings of this thesis indicate that AjD should be considered as a diagnosis when athletes present with mental health difficulties following the experience of a stressor. The professional support provided to an athlete in those circumstances should be based on their unique situation, and include the assessment of the use of (potentially maladaptive) coping strategies.
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