Towards Sustainable Mental Health Using the Finnish Mood Scale

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The topic of mental health in sport is of increasing importance, and understanding the moods of this group is potentially of great practical significance. Although the article tackles an interesting topic, there are several areas for improvement. I present these below:

Theoretical underpinnings

The introduction of the article does not provide a strong enough theoretical argument to justify the need for a Finnish version of the BRUMS scale. Although the authors mention the increasing interest in mental health in sport, a detailed literature review on existing measurement tools, their advantages and limitations is missing. A ‘Theoretical background’ section should be added so that the reader can understand the context and the need for the FIMS, especially in the Finnish sports environment. Furthermore, there is a lack of citations for some important observations, which weakens the introductory argumentation.

Sample selection

The authors do not provide sufficiently detailed information on the sampling. There is a lack of clarity as to whether the sample of participants is representative of the population of Finnish athletes or physically active people. This is crucial, as the sample has an important impact on the possibility to generalise the results to the wider population. It should be clarified how the participants were selected and whether the process took into account appropriate diversification for different demographic characteristics such as age, gender or level of involvement in sport.

The process of cultural adaptation

The article does not provide detailed information on the process of cultural adaptation of the BRUMS scale to Finnish conditions. When translating and adapting a measurement tool from another language, it is crucial to discuss how it was ensured that the translation retains the substantive sense of the original items and that it meets the specific cultural needs of Finnish-speaking users. Details on how cultural differences were tested and whether they were taken into account in the analyses are also lacking.

Discussion and implications

The discussion section needs considerable improvement. The authors should better emphasise the significance of the results obtained and how they relate to previous research in the field. While overall, the article provides preliminary information about the potential of FIMS, it does not explain what implications these results have for future research or for clinical and sport practice. Instead of general conclusions, the discussion should focus on the specific implications of the results in terms of mood and the impact of physical activity on psychological well-being.

In conclusion, the reviewed article is a valuable step towards the development of a Finnish tool for assessing mood in the context of sport. However, it needs some key improvements to fully meet scientific standards and to provide a clear message to the research and practice community.

Author Response

Dear reviewer,

We would like to thank you for the provided reviews and comments to make the article better. We have tried to address all the changes requested. Please see the following detailed response to all comments:

 

Response to Reviewers

 

Reviewer 1

Comment: The topic of mental health in sport is of increasing importance, and understanding the moods of this group is potentially of great practical significance. Although the article tackles an interesting topic, there are several areas for improvement. I present these below:

Response: Thank you for the comments and suggestions which have helped us improve our paper. We have taken into account all suggestions and revised the manuscript accordingly. To facilitate further review, we have highlighted the text in the manuscript in yellow. We include Reviewers’ comments followed by our response.

Comment: Theoretical underpinnings: The introduction of the article does not provide a strong enough theoretical argument to justify the need for a Finnish version of the BRUMS scale. Although the authors mention the increasing interest in mental health in sport, a detailed literature review on existing measurement tools, their advantages and limitations is missing. A ‘Theoretical background’ section should be added so that the reader can understand the context and the need for the FIMS, especially in the Finnish sports environment. Furthermore, there is a lack of citations for some important observations, which weakens the introductory argumentation.

Response: Thank you for pointing that out. As there is not such a tool in Finnish, only a little research in the area exists. References have been added and research related to Finnish athletes’ mental health has been discussed: Only a limited number of studies have investigated the mental health of Finnish athletes, and they often employ a combination of psychometric diagnostic tools in both English and Finnish [6-8]. These studies typically utilise complex combinations of the General Health Questionnaire [9], athlete burnout questionnaires [6,8], depression and anxiety assessments [7,8], behavioural measures [6,7], and various DSM-5 [6,10] evaluations to identify instances of mental ill-health among athletes.  However, many of these tools lack a specific focus on prevention and the sports context [1,2].  (lines 45-52)

• Gouttebarge, V., Aoki, H., Ekstrand, J., Verhagen, E. A., & Kerkhoffs, G. M. (2016). Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?. Knee surgery, sports traumatology, arthroscopy, 24, 3934-3942.
• Sorkkila, M., Ryba, T. V., Aunola, K., Selänne, H., & Salmela-Aro, K. (2020). Sport burnout inventory–Dual career form for student-athletes: Assessing validity and reliability in a Finnish sample of adolescent athletes. Journal of Sport and Health Science, 9(4), 358-366.

For instance, studies have shown that males typically report more positive moods than females [19,20]. This finding aligns with extensive cross-sectional research conducted in Europe, which shows that females report approximately twice the level of depressive symptoms compared to males [21]. Furthermore, physically active people typically report more positive moods than inactive people [11,14,20]. (lines 84-89)

Comment: Sample selection. The authors do not provide sufficiently detailed information on the sampling. There is a lack of clarity as to whether the sample of participants is representative of the population of Finnish athletes or physically active people. This is crucial, as the sample has an important impact on the possibility to generalise the results to the wider population. It should be clarified how the participants were selected and whether the process took into account appropriate diversification for different demographic characteristics such as age, gender or level of involvement in sport.

Response: Thank you for highlighting the importance of generalisability. We tried to clarify this section by providing additional information:

Participants were recruited using a snowball sampling method via social media. Higher education institutions, sporting clubs, and companies were contacted throughout Finland to share the research information online. With the aim of recruiting a similar number of athletes, regular exercisers, and physically inactive participants, specific groups were targeted at different times. Initially, many regularly exercising students completed the survey. Subsequently, professional sporting clubs and sedentary industry workers were contacted with the aim of equalising the participant numbers in each group. Individuals aged 16 and older were eligible to complete the questionnaire. (lines 207-214)

Comment: The process of cultural adaptation. The article does not provide detailed information on the process of cultural adaptation of the BRUMS scale to Finnish conditions. When translating and adapting a measurement tool from another language, it is crucial to discuss how it was ensured that the translation retains the substantive sense of the original items and that it meets the specific cultural needs of Finnish-speaking users. Details on how cultural differences were tested and whether they were considered in the analyses are also lacking.

Response: Thank you for raising a concern about cultural adaptation. We followed the back-translation process for cross-cultural research. We think it was not clearly explained, but we tried to clarify that. We also included a better explanation of expert panel review, what we used to ensure cultural adaptation.

Firstly, a group of six dual linguists (i.e. university lecturers/teachers in sport and exercise psychology who were fluent in Finnish and English) translated the BRUMS items and instructions into Finnish. Then a different group of eight dual linguists (i.e. sport psychology master’s students who were fluent in Finnish and English) translated the Finnish version of the BRUMS back into English [28]. A comparison between the original and back-translation showed that only three items (i.e. downhearted, mixed up and muddled) differed from the original item list. The translation process, highlighting the problematic items, was presented at a Finnish Association of Sport Psychology seminar attended by 52 delegates to resolve translation differences [35]. The same expert panel evaluated the substantive sense of the items and accurate translation of the instructions to ensure cultural adaptation [34,35]. The final list of 24 FIMS items was confirmed when this expert group reached a consensus on the translated word list and agreed that translated units accurately described the initial intent of the scale [34,35]. The translation process was supervised by the first author, who is fluent in both English and Finnish. All authors have experience of previous translation papers and therefore cultural adaptation was a prime consideration throughout the process [20,21,33,34]. (lines 182-197)

Comment:  Discussion and implications. The discussion section needs considerable improvement. The authors should better emphasise the significance of the results obtained and how they relate to previous research in the field. While overall, the article provides preliminary information about the potential of FIMS, it does not explain what implications these results have for future research or for clinical and sport practice. Instead of general conclusions, the discussion should focus on the specific implications of the results in terms of mood and the impact of physical activity on psychological well-being.

Response: Thank you for the comment. Overall, there is not much scientific research conducted within the area of mental ill-health among the athletes in Finland. This is at least partially explained by the absence of a suitable measure, which is the gap we were attempting to fill by developing the FIMS. Thus, the FIMS opens new areas of research. We tried to emphasise the significance of the results more clearly and provide some specific implications:

The development of the FIMS creates research opportunities in Finnish-speaking contexts, as no such tool currently exists [2, 5-8]. Given the International Olympic Committee's program emphasizing standardised procedures for identifying mental health issues, it is crucial to develop an effective tool for this purpose [2]. The thorough translation process and evidence of the psychometric integrity of the FIMS [17,28] provides an opportunity for exploration of mood and performance connections [19] and early prevention of mental ill-health towards sustainable psychosocial stability [3]. (lines 352-358)

The BRUMS, and now the FIMS, offer a tool to investigate the relationship further and longitudinally. (lines 370-371)

Thus, specific exercise protocols can be suggested for promoting sustainable psychosocial functioning [14,19]. (lines 375-376)

Moreover, longitudinal intervention research using FIMS generated mood profiles can edify a mental training program shifting the profile from dysfunctional (e.g. inverse Everest) to more functional (the iceberg) [11,19]. This shift could ideally lead to improved performance from a mental perspective, especially combined with the psychobiosocial states research [11,31]. (lines 379-382)

Future research could also focus on measurement invariance across gender and physical activity groups, to test whether the measurement model remains the same across such groups. Alternatively, future research could explore the reasons why females tend to report more mood-related depressive symptoms [21], as well as investigate why physical activity is an effective treatment for mental health issues [19,24,25]. (lines 394-399)

Comment: In conclusion, the reviewed article is a valuable step towards the development of a Finnish tool for assessing mood in the context of sport. However, it needs some key improvements to fully meet scientific standards and to provide a clear message to the research and practice community.

Response: Thank you for all the comments. We agree that it should be important to get a such tool in Finnish to explore the role of mood in mental health and sport contexts.

 

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for the opportunity to review the manuscript "Towards sustainable mental health using the Finnish Mood Scale"

I found the aim of this study  the adaptationa and validation of BRUMS - very interesting. The increasing focus that Sport Psychology is placing on psychophysical well-being requires the construction or adaptation, as in your case, of instruments that are valid and reliable. This study is in continuity with this current exigency and also highlights the importance of clear and replicable methodological processes in the construction/validation of instruments.

Please find below some annotations::

Section 1: The introduction is well thorough. I would advise the authors to split the objective and assumptions of the study into a separate paragraph and better specify the assumptions on the factor structure of the model. This would also make the analysis steps conducted clearer. 

Section 2 Material and Methods

- The paragraph 2.4 could be inserted into section 2.1 since it might be more consistent to mention the sampling process when discussing the participants recruited for the study. The paragraph could be named ‘Procedure and Participants’ for example. 

- Further analyses on the accuracy of the extracted factors (such as Hancock's Latent and Observed index and Factor Determinacy Index) could be added in section 2.4. 

The exploration of convergent and discriminant validity could be enriched by considering Fornell and Larcker's criteria before correlational analyses (Fornell and Larcker 1981. Composite Reliability, the AVE index for each factor and the analysis of standardised Factor Loadings could enrich this section.

These analyses could enrich the subsequent ‘results’ section

- Figure 1: The figure is not very clear. The model that emerged in SPSS AMOS could be recreated more clearly on another programme. 

I noticed that some factor loadings are greater than 1.0, standardised factor loadings should be reported. The significance of the latter should also be reported. 

- Paragraph 3.3: Generally, if the distribution of the variables is non-normal, as in your case, non-parametric correlational analyses (e.g. Spearman's rho) are preferred.

Section 4: The discussion congruently resumes the statistical analyses conducted and their results. 

The practical implications for the use of the tool could be further elaborated upon and a separate section created from the ‘discussion’ concerning limitations and future trajectories (which you have, however, elaborated on in section 4). In future trajectories, it might be interesting to explore the tool invariance on gender. 

 

Overall, the research is very interesting and well structured. I wish the authors all the best for their paper. 

Author Response

Dear reviewer,

We would like to thank you for the provided reviews and comments to make the article better. We have tried to address all the changes requested. Please see the following detailed response to all comments:Reviewer 2

 

Comment: Dear authors, Thank you for the opportunity to review the manuscript "Towards sustainable mental health using the Finnish Mood Scale"

Response: Dear reviewer, Thank you for your detailed and helpful comments regarding the article.

Comment: I found the aim of this study the adaptations and validation of BRUMS - very interesting. The increasing focus that Sport Psychology is placing on psychophysical well-being requires the construction or adaptation, as in your case, of instruments that are valid and reliable. This study is in continuity with this current exigency and also highlights the importance of clear and replicable methodological processes in the construction/validation of instruments.

Response: Thank you for the comments, especially with data analyses. We tried to clarify the methodological process and add some analyses based on you recommendations.

Comment: Section 1: The introduction is well thorough. I would advise the authors to split the objective and assumptions of the study into a separate paragraph and better specify the assumptions on the factor structure of the model. This would also make the analysis steps conducted clearer. 

Response: Thank you. Suggested changes conducted.

Comment: Section 2 Material and Methods - The paragraph 2.4 could be inserted into section 2.1 since it might be more consistent to mention the sampling process when discussing the participants recruited for the study. The paragraph could be named ‘Procedure and Participants’ for example. 

Response: Thank you for the suggestion. Even though that change would make sense, this paper follows the protocol of previous translation papers. Sampling elaborated in the paragraph 2.4. to make it more coherent with paragraph 2.1.

• Terry, P.C.; Parsons-Smith, R.L.; Skurvydas, A.; Lisinskienė, A.; Majauskienė, D.; Valančienė, D.; Cooper, S.; Lochbaum, M. Physical activity and healthy habits influence mood profile clusters in a Lithuanian population. Sustainability 2022, 14, 10006, doi :https://doi.org/10.3390/su141610006.
• Quartiroli, A.; Terry, P.C.; Fogarty, G.J. Development and initial validation of the Italian Mood Scale (ITAMS) for use in sport and exercise contexts. Psychol. 2017, 8, 275427, doi:10.3389/fpsyg.2017.01483.

Comment: The exploration of convergent and discriminant validity could be enriched by considering Fornell and Larcker's criteria before correlational analyses (Fornell and Larcker 1981. Composite Reliability, the AVE index for each factor and the analysis of standardised Factor Loadings could enrich this section.

Response: Thank you for this insightful information. Instead of using the Fornell and Larcker’s (1981) criteria, we have decided to use the latterly proposed Heterotrait-Monotrait Ratio (Henseler et al. 2015) with CR and AVE for discriminant validity and added the section 3.3:

3.3. Construct Reliability and Validity

The Composite Reliability (CR), Average Variance Extracted (AVE), and Heterotrait-Monotrait (HTMT) Ratio for the FIMS are presented in Table 4. Construct reliability is deemed adequate, as all CR values exceed the minimum benchmark of 0.7 [40,41]. However, the AVE for the Confusion subscale raises slight concerns about convergent validity, as it falls just below the acceptable threshold of 0.50 [40,47]. Nevertheless, this is mitigated by the fact that the CR for the Confusion subscale exceeds the psychometrically sound value [40,41]. The HTMT ratio of correlations was utilised to assess the discriminant validity of the FIMS [47]. Since all HTMT values are below the threshold of 0.90, the FIMS is considered to demonstrate discriminant validity [47]. As construct validity is typically evaluated through convergent and discriminant validity, the FIMS appear to meet the criteria for both construct reliability and validity [40,41,45,47]. Furthermore, the final standardised factor loadings presented in Figure 1, were all significant at the p < 0.05 level.

Table 4. Composite Reliability (CR), Average Variance Extracted (AVE), and Heterotrait-Monotrait (HTMT) Ratios of the FIMS subscales (n = 445).

	CR	AVE	HTMT
			Tension	Depression	Anger	Vigour	Fatigue
Tension	0.823	0.540
Depression	0.897	0.685	0.884
Anger	0.825	0.542	0.811	0.861
Vigour	0.862	0.616	-0.226	-0.430	-0.181
Fatigue	0.859	0.610	0.682	0.689	0.552	-0.402
Confusion	0.771	0.461	0.857	0.799	0.755	-0.203	0.555

 

The Composite Reliability (CR), Average Variance Extracted (AVE), and Heterotrait-Monotrait (HTMT) Ratio were used to evaluate the construct reliability and validity of the FIMS [40,46.47]. (lines 235-237)

See: Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43, 115-135.

Comment: Figure 1: The figure is not very clear. The model that emerged in SPSS AMOS could be recreated more clearly on another programme. I noticed that some factor loadings are greater than 1.0, standardised factor loadings should be reported. The significance of the latter should also be reported. 

Response: Thank you for pointing out the incorrect values in Figure 1. Figure 1 has been recreated with standardised factor loadings. This figure is consistent with previous translation studies [16,18,25-30] and we did not think that recreating the figure with different software would add value. The significance of standardised factor loadings is now also provided.

Comment: Paragraph 3.3: Generally, if the distribution of the variables is non-normal, as in your case, non-parametric correlational analyses (e.g. Spearman's rho) are preferred.

Response: Thank you for pointing that out. Spearman’s rho was computed. Table 4 was recreated with Spearman’s rho and related sections (2.5.; 3.3. and discussion) were rewritten accordingly.

Comment: Section 4: The discussion congruently resumes the statistical analyses conducted and their results. The practical implications for the use of the tool could be further elaborated upon and a separate section created from the ‘discussion’ concerning limitations and future trajectories (which you have, however, elaborated on in section 4). In future trajectories, it might be interesting to explore the tool invariance on gender. 

Response: We tried to emphasise the significance of the results more clearly and provide some specific implications:

The development of the FIMS creates research opportunities in Finnish-speaking contexts, as no such tool currently exists [2, 5-8]. Given the International Olympic Committee's program emphasizing standardised procedures for identifying mental health issues, it is crucial to develop an effective tool for this purpose [2]. The thorough translation process and evidence of the psychometric integrity of the FIMS [17,28] provides an opportunity for exploration of mood and performance connections [19] and early prevention of mental ill-health towards sustainable psychosocial stability [3]. (lines 352-358)

The BRUMS, and now the FIMS, offer a tool to investigate the relationship further and longitudinally. (lines 370-371)

Thus, specific exercise protocols can be suggested for promoting sustainable psychosocial functioning [14,19]. (lines 375-376)

Moreover, longitudinal intervention research using FIMS generated mood profiles can edify a mental training program shifting the profile from dysfunctional (e.g. inverse Everest) to more functional (the iceberg) [11,19]. This shift could ideally lead to improved performance from a mental perspective, especially combined with the psychobiosocial states research [11,31]. (lines 379-382)

Future research could also focus on measurement invariance across gender and physical activity groups, to test whether the measurement model remains the same across such groups. Alternatively, future research could explore the reasons why females tend to report more mood-related depressive symptoms [21], as well as investigate why physical activity is an effective treatment for mental health issues [19,24,25]. (lines 394-399)

Comment: Overall, the research is very interesting and well structured. I wish the authors all the best for their paper. 

Response: Thank you very much for your comments. We especially appreciated your statistical expertise. Your comments will inform future translation protocols.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, 

thank you for making the requested suggestions that have made your work - already well structured - even stronger on the statistical part. The goal of a reviewer is to provide authors with advice and suggestions so that they can make their work even more brilliant. I believe that the changes you have made and the addition of a broader description of the practical implications have served this purpose.

I wish you and your work the best.

Kind regards