Sports coaches’ depression literacy, and engagement in prevention and early intervention behaviors: A moderated mediation analysis

Abstract Coaches’ mental health literacy is associated with increased engagement in prevention and early intervention behaviors. However, few studies have explored the factors that may influence these relationships. The purpose of this study was to explore whether role breadth and role efficacy mediate the relationship between coach depression literacy and prevention and early intervention, and to assess whether gender or stigma moderates any mediation effects. One thousand and forty five coaches (M = 42.71 years old; SD = 11.52; 30% female) completed an online survey exploring depression literacy, personal stigma, role breadth and efficacy and engagement in prevention and early intervention. Path analysis was conducted, followed by mediation and moderated-mediation analyzes. The overarching model for each behavior was confirmed. Role efficacy but not role breadth partially mediated the relationship between depression literacy and each behavior. Gender did not moderate any mediation relationships. Personal stigma moderated the relationship between depression literacy and prevention and early intervention. Coaches with lower levels of personal stigma, reported higher levels of depression literacy and were more confident to engage in prevention and early intervention. Increasing coaches’ knowledge and confidence may lead to increased engagement in prevention and early intervention. However, for coaches with high levels of personal stigma, approaches that go beyond the provision of knowledge may be required.  Lay summary: This study explores the relationship between coaches’ knowledge of depression and their engagement in behaviors that support young people’s mental health. It also examines how confident coaches feel to engage in these behaviors and whether the gender or stigmatizing attitudes of coaches might influence these relationships.


Introduction
Mental health disorders are the leading cause of disease burden for young people globally (Castelpietra et al., 2022).These disorders have been found to negatively impact cognition, emotion regulation, and behavior, typically leading to distress and disability (American Psychiatric Association, 2013).Depression is a prevalent mental health disorder that is associated with increased morbidity and mortality (GBD 2019Mental Disorders Collaborators, 2022).The burden of depression for an individual can span the life course but the first onset usually occurs before the age of eighteen (Solmi et al., 2022).Depression at this life stage is associated with a range of negative consequences both in the short and long term such as failure to complete secondary school and unemployment (Clayborne et al., 2019).There is an increasing trend in the prevalence of depression in many countries (Moreno-Agostino et al., 2021).Recently, in Ireland, 30% of adults screened positive for major depression using self-report measures (Hyland et al., 2021), while 40% of adolescents self-reported levels of depression outside the normal range (Dooley et al., 2019).Indeed, the rate of depression in young people (15-24 age range) in Ireland is among the highest in Europe (Eurostat Statistics Explained, 2020).
This age range is typically a period of life when many young people are engaged in sport on a regular basis (Tremblay et al., 2016) including in Ireland where nearly 70% of adolescents are members of a sports club (Woods et al., 2018).Recent research has suggested a positive relationship between sport participation and mental health in young people (Panza et al., 2020).This association maybe due to the social interactions that a young person can have in the sport setting, the attachment they can feel to the setting, and the sense of identity they are able to draw from it (Donohue & Phrathep, 2020;Graupensperger et al., 2021).Although participation in sport may promote mental health, research indicates that athletes experience similar rates of mental health symptoms and disorders such as depression than non-athletes (Gorczynski et al., 2017).Furthermore, competitive sporting environments can create a culture whereby "toughness" is actively promoted and displays of weakness are discouraged.It is the competitive nature of sport which can breed this culture of "toughness" (Bauman, 2016).This can lead to the stigmatization of mental health symptoms and disorders, and a limiting of help-seeking behavior by athletes across sporting contexts (Bird et al., 2020;Liddle et al., 2021).Consequently, it is imperative to increase mental health awareness and promote engagement in behaviors such as help-seeking in sporting environments.Developing the mental health literacy of young people, and caregivers is a strategy which can promote mental health and facilitate engagement in help-seeking behavior (Miller et al., 2019).Therefore, mental health literacy is typically a key pillar of mental health promotion interventions for young people (Patafio et al., 2021), and has been defined as "an individual's knowledge and beliefs about mental health and how they influence one's intentions to seek support" (Jorm et al., 1997, p. 182).
Mental health literacy for depression (i.e., depression literacy) is important due to its prevalence in young people (Avenevoli et al., 2015), and its role as a significant risk factor for suicide (Hawton et al., 2013).There is evidence that depression literacy in young people can improve prevention rates, early diagnosis, and intervention (Coles et al., 2016).Alongside developing adequate depression literacy in young people, there is a need to develop depression literacy in those who engage with young people on a regular basis as young people report a preference for seeking help from informal sources of support if faced with depression (Singh et al., 2019).This highlights the importance of depression literacy for people in roles where they engage with young people on a regular basis such as sports clubs or teams.One such role is the coach, who is the key gatekeeper of the sporting environment (Bissett et al., 2020), and is an integral part of an athlete's life, creating the environment to facilitate the athlete's physical and psychosocial development (Otterbein et al., 2021;Simons & Bird, 2022).There is increasing recognition of the role of the coach in promoting mental health in young athletes through engaging in prevention (e.g., assisting young people in learning how to manage stress) and early intervention behaviors (e.g., referring a young person to an appropriate source of help; Mazzer & Rickwood, 2015;Bissett et al., 2020).However, coaches have highlighted their concerns as to their mental health literacy and perceived competence to engage with athletes on such topics (Ferguson et al., 2019).
A small number of studies have assessed the mental health literacy of coaches, highlighting varying levels of mental health literacy in this cohort (Gorczynski et al., 2020;Sullivan et al., 2019).For example, female coaches show higher levels of mental health literacy than male coaches (e.g., Gorczynski et al., 2020), a finding that mirrors research outside the sporting domain (Cotton et al., 2006).Furthermore, while, Gorczynski et al. (2020), found no association between coaches' age and their mental health literacy, coaches' mental health literacy did decrease as their sport experience increased.This could lead more experienced coaches to deemphasize or ignore the risk factors of poor mental health in their athletes (Gorczynski et al., 2020).Coaches have also been shown to have lower mental health literacy than athletes' (Gorczynski et al., 2020;Oftadeh-Moghadam & Gorczynski, 2021).Therefore, recent systematic reviews have underscored the importance of strengthening the mental health awareness of coaches across all levels of sport (Breslin et al., 2022;Sutcliffe et al., 2021).In general, mental health literacy programs have been successful along these lines, increasing coaches' knowledge of mental health symptoms and disorders, and their intentions to help athletes (Breslin et al., 2022;Sutcliffe et al., 2021).
The role of stigma is also important to consider as it is a prominent barrier to helpseeking in young athletes at all levels of sport (Gulliver et al., 2012;Vella et al., 2021).Although coaches may feel they lack the knowledge and skills to assist athletes with their mental health, some may also hold beliefs that reduce their willingness to engage with young athletes regarding mental health (Gulliver et al., 2012).Stigma is influenced by stereotypes, prejudice, and discrimination, and can be further broken down into public stigma which reflects an individual's perceptions as to others' levels of stigma, personal stigma which refers to an individual reporting their own beliefs, and self -stigma which is the stigma an individual places upon themselves (Nearchou et al., 2018;Vogel et al., 2006).Several studies have explored these forms of stigma in athletes (Bird et al., 2020(Bird et al., , 2021;;Chow et al., 2021;Tabet et al., 2021).For example, Tabet et al. (2021) found that personal stigma was associated with help-seeking attitudes whereas public stigma was not, suggesting that personal stigma is a key barrier to athlete helpseeking.Thus, focusing on reducing personally held stigmatizing attitudes as opposed to public stigma may increase the prevalence of help-seeking in athletes.To date, there has been a limited number of studies exploring coaches' stigmatizing attitudes (Tabet et al., 2021).A recent study targeting adolescent athletes and their coaches reported low levels of personal stigma in both athletes and coaches after a mental health awareness intervention.However, the researchers did not measure baseline levels of personal stigma in the sample, thus making it hard to determine if this low level was due to participation in the intervention or not (Lefebvre et al., 2022).Furthermore, Kroshus, Wagner, et al.'s (2019) study targeted collegiate level coaches' mental health literacy, and their stigma about the sport consequences of athlete help-seeking with an online intervention.Although coaches' stigma about the sport consequences of athlete help-seeking decreased following the intervention, this change was not associated with a change in coaches' intention to provide emotional support to their athletes or to refer their athletes to the team's sport medicine staff (Kroshus, Wagner, et al., 2019).Thus, there is a need for further research to explore how coaches' stigmatizing attitudes may influence their engagement in prevention and early intervention type behaviors.
Although there has been a welcome increase in research exploring the role of coaches in mental health promotion, there remains a lack of clarity as to the mechanisms that might influence coaches' mental health literacy or their engagement in prevention and early intervention behaviors (Vella et al., 2021).It is important to identify these mechanisms as they could be targeted through interventions with the aim of increasing engagement in prevention and early intervention behaviors.A recent study by Duffy et al. (2021) examined predictors of coaches' engagement in prevention and early intervention behaviors, focusing on depression literacy and perceptions of role breadth (i.e., whether a person regards an activity as part of their role) and role efficacy (i.e., an individual's confidence in his or her capabilities to carry out a particular task or behavior).The investigators in this study found both role breadth and role efficacy predicted engagement in these behaviors and these factors mediated the role of depression literacy.Although promising with respect to mediating factors, there has been limited consideration of moderating factors within the sporting environment such as gender or stigma.By focusing on these factors, it would help improve our understanding of the causal mechanisms that influence prevention and early intervention behavior, leading to a clearer understanding as to whether different cohorts of coaches (i.e., male vs female coaches or coaches with high levels of personal stigma as compared to lower levels of personal stigma) may require different or targeted intervention approaches to promote engagement in these behaviors.
In summary, there is increasing evidence for the role of the sports coach in providing initial appropriate support to young people and their mental health.However, there remain important gaps in the research literature.There is a lack of clarity as to how mental health literacy influences engagement in prevention and early intervention.Furthermore, no studies have examined how gender and stigma might moderate the causal pathway between coaches' mental health literacy and their engagement in these behaviors.Therefore, to address these gaps, the first aim of the present study was to examine the associations between depression literacy, role breadth and role efficacy, and engagement in prevention, and early intervention behaviors with young people in the sporting environment using a multi-sport sample.It was hypothesized that role breadth and role efficacy would mediate the relationship between coaches' depression literacy and prevention and early intervention (see Figure 1).A second aim of the study was to investigate whether gender moderated the relationship between coaches' depression literacy, role breadth and role efficacy and these behaviors.It was hypothesized that the effects would be stronger for female than male coaches.The final aim of the study was to examine if personal stigma moderated the relationship between depression literacy, role breadth and role efficacy and prevention and early intervention.It was hypothesized that the effects would be stronger for coaches with lower levels of personal stigma.

Study design, ethics, and procedure
The study employed a cross-sectional design and received ethical approval from a university human research ethics committee .The research team engaged with the national coaching organization in Ireland, who in conjunction with the national governing bodies of sport implement training programs for coaches and coach developers across sports in Ireland.The executive director of the national coaching organization agreed for an email to be sent on behalf of the research team to the organization's database of coaches, inviting coaches to take part in the study.This email contained a link to the online survey and a study information sheet which detailed how participants' data would be managed, how confidentiality would be maintained, and an informed consent statement.Data collection took place using JISC Online Surveys (https://www.onlinesurveys.ac.uk), with the survey taking approximately 20 minutes to complete.

Participants
Participants were sport coaches in Ireland who were currently coaching young people between the ages of 13 and 24 years old.One thousand and forty-five coaches completed the survey (30% female).Coaches ranged in age from 18 to 71 years old (M ¼ 42.71; SD ¼ 11.52), and their mean years coaching was 12.08 (SD ¼ 7.56).They were engaged in coaching activities with young people for 9.98 hours per week (SD ¼ 11.27).Participants were primarily volunteer coaches (75%), with a small number of coaches in part time (17%) or full time (8%) paid roles.There were over 20 sports represented in the study, ranging from soccer to windsurfing.For the purposes of this study, sport types were classified into team or individual sports, with 66% and 34% in each category respectively.Thirty seven percent of participants experienced mental health symptoms and disorders.

Depression literacy
To assess depression literacy in this study, the Depression Literacy Questionnaire (D-Lit; Griffiths et al., 2004) was used.It assesses participants' knowledge of the signs, symptoms, and possible treatment options for depression.There are 22 items, 11 related to the signs and symptoms of depression (e.g., "People with depression may feel guilty when they are not at fault) and 11 items related to treatment options for depression (e.g., "Cognitive behavioral therapy is as effective as antidepressants for mild to moderate depression").Participants answer "True," "False" or "Don't know" to each item.A correct answer for an item is scored 1 while an incorrect or "don't know" answer is scored 0. Scores can range from 0 to 22, with a higher score indicating greater knowledge.The D-Lit questionnaire has been used with similar populations in sports organizations (Hurley et al., 2018), and has demonstrated adequate psychometric properties (Gulliver et al., 2012;Kiropoulos et al., 2011).In the present study, internal consistency as measured by McDonald's omega value was x ¼ .72.

Depression stigma
This study used the Depression Stigma Scale (DSS; Griffiths et al., 2004) which is one of the most widely used measures of stigma (Boerema et al., 2016).The DSS includes a Personal Stigma subscale that was used in this study.It contains nine items (e.g., "Depression is not a real medical illness"; "I would not employ someone if I knew they had been depressed").Participants are asked to indicate how strongly they personally agreed or disagreed with each statement on a 5-point Likert scale (1 -"Strongly Agree", 5 -"Strongly Disagree").The DSS has demonstrated internal consistency and convergent validity (Boerema et al., 2016) and has been used previously in a sporting context (Gulliver et al., 2012).In the current study, McDonald's omega value was x ¼ .72.

Prevention and early intervention
A measure developed by Mazzer and Rickwood (2013) was used to examine participants' engagement in prevention and early intervention behaviors.This measure includes five items for each of the aforementioned behaviors.Responses are scored utilizing a 5-point Likert scale (1 -"Never", 5 -"Very Often").Prevention items included "I encourage a young person to talk to their parents about their personal problems" and early intervention was measured with items such as "I personally contact the family of a young person whose mental health I am concerned about."These scales have demonstrated acceptable internal consistency, and discriminant validity in previous studies with sports coaches and teachers (Duffy et al., 2021;Mazzer & Rickwood, 2013, 2015).
In the present study, McDonald's omega value for prevention was x ¼ .79 and for early intervention was a ¼ .82.

Role perceptions
Role breadth and role efficacy were measured using items from a study by McAllister et al. (2007).To assess role breadth, participants were asked to respond to a single item (i.e., "this behavior is an expected part of my role") for prevention, and early intervention behavior.Similarly, for role efficacy, participants were asked to answer "I am completely confident in my capacity to engage in this behavior" for the same behaviors.
Role breadth and role efficacy subscales were then created for prevention, and early intervention, leading to six subscales.Each of these four scales showed adequate internal reliability, with omega values ranging from x ¼ .78 to x ¼ .82.

Data analysis
Data were analyzed using IBM SPSS V26 and was checked for missing data.Seven participants were excluded due to large amounts of missing data throughout their responses to the questionnaire (>60%), leaving the total sample size at 1045.Within this sample, there were 25 instances from 11 participants, where the participant was missing responses to more than 2 items in a particular scale.Therefore, these 11 participants were excluded from any analysis that required that scale.All other instances of a missing item were imputed with the mean of that participant's remaining items from that scale.There were 254 instances across 141 participants, which equated to 0.003% of the data.The normality of the data was confirmed (skewness range: À0.51 to 0.79, kurtosis range: À0.62 to 0.54), and descriptive statistics (i.e., means, standard deviations) of the study variables were calculated.Path analysis was then conducted for prevention, and early intervention behaviors using AMOS 24 software.To assess the fit of these models, a range of indices were used.They were chi-square, the Tucker Lewis index (TLI), the comparative fit index (CFI), the root mean square error of approximation (RMSEA), and the standardized root mean residual (SRMR).As chi square can be sensitive to sample size, these other indices were chosen to complement it (Marsh et al., 2005).Acceptable model fit includes a CFI and TFI of greater than .95,a RMSEA of less than .06and a SRMR of less than .08(Hu & Bentler, 1999;Schreiber et al., 2006).Mediation and moderated mediation analyses were tested with bias-corrected (BC) bootstrap analyses (Shrout & Bolger, 2002) using the PROCESS macro for SPSS (Preacher & Hayes, 2008).A 95% confidence interval not containing zero indicated a statistically significant effect (Preacher & Hayes, 2008).For mediation, model 4 of the PROCESS macro was used.The mediated effect represented depression literacy via the proposed mediators (role breadth and role efficacy) for the prevention, and early intervention dependent variables, with age as a covariate.Moderated mediation was then conducted using Model 59 of the PROCESS macro, with separate analysis for gender and personal stigma as moderators with age entered as a covariate.These moderated mediation analyses were only conducted where significant mediation pathways were previously identified.

Results
Means and standard deviations are shown in Table 1.Participants scored 13.3 (SD ¼ 3.4) on the depression literacy scale and reported low levels of personal stigma.They were more likely to be engaged in prevention rather than early intervention behaviors with athletes.Participants' role breadth and efficacy for both behaviors followed a similar pattern.Specifically, they perceived engaging in prevention behaviors as more likely to be part of the coaching role than early interventions behaviors, They also reported having greater confidence to engage in prevention rather than early intervention behaviors.Path analysis was carried out for both prevention and early intervention.
Multiple mediation analysis using 5000 bootstrapping samples was conducted to estimate the indirect effects of depression literacy on prevention and early intervention via the mediating effects of both role breadth and role efficacy.For both models tested, the direct path from depression literacy to the behavior was significant (see Figures 2 and  3).For each one, depression literacy was positively related to role efficacy but not to role breadth.This combination of findings demonstrates that the positive relationship between participants' depression literacy and their engagement in prevention or early intervention is partially mediated by their role efficacy but not their role breadth.The relationships between the mediators (role breadth and role efficacy) and both prevention and early intervention were significant (see Table 2).Moderated mediation analysis was then conducted with gender and stigma as moderators.Paths via role breadth were excluded from this analysis as they did not mediate the relationship between depression literacy and either behavior.Gender did not moderate any of the paths for prevention, or early intervention.For prevention, there was an interaction between personal stigma and depression literacy (B ¼ À.63, SE ¼ .32,t ¼ À1.96, p ¼ .05)for role efficacy.However, for the paths between role efficacy and prevention, and depression literacy and prevention, there were no interactions.Tests of simple slopes were conducted for the prediction of role efficacy from depression literacy for prevention.Figure 4 indicates that for those with low levels of personal stigma, there was a positive effect between depression literacy and role efficacy for prevention (B ¼  .91,t ¼ 4.10, 95% CI [0.50 1.37)].For moderate levels of stigma, a similar but weaker effect was seen (B ¼ .62,t ¼ 3.96, 95% CI [0.32 0.93]) while for high levels of stigma, the effect was not significant (B ¼ .34,t ¼ 1.64, 95% CI [-0.07 0.75]).For early intervention, similarly, the path between depression literacy and role efficacy was moderated by personal stigma (B ¼ .08,SE ¼ .34,t ¼ À2.21, p ¼ .03)but other paths were not (i.e., role efficacy to early intervention; depression literacy to early intervention).Tests of simple slopes were conducted for the prediction of role efficacy from depression literacy for early intervention.Figure 5 indicates that for those with low levels of personal stigma, higher depression literacy was positively associated with higher levels of role efficacy for early intervention (B ¼ 1.08, t ¼ 4.56, 95% CI [.62 1.54).For moderate levels of stigma, a similar but weaker effect was seen (B ¼ .74,t ¼ 4.39, 95% CI [0.41 1.07]) while for high levels of stigma, the effect was not significant (B ¼ .39,t ¼ 1.80, 95% CI [-0.03 0.83]).

Discussion
This study aimed to examine the association between sport coaches' depression literacy, role breadth and efficacy, and their engagement in prevention, and early intervention behaviors with young people, and how gender and personal stigma might moderate these relationships.There was partial support for the study hypotheses.Specifically, the overarching model examining the association between depression literacy, role breadth, role efficacy and engagement in prevention and early intervention behaviors was confirmed.However, only role efficacy partially mediated the relationship between depression literacy and either of the behaviors.Only personal stigma moderated the relationship between depression literacy and prevention and early intervention via the pathway between depression literacy and role efficacy.
Research examining the organized sport context suggests improving the mental health literacy of coaches may lead to an increase in prevention and early intervention behaviors and has been the target of interventions to promote mental health in recent years (Sutcliffe et al., 2021).In the present study, there was a direct association between coaches' depression literacy and engagement in prevention and early intervention, thus highlighting the relevance of targeting the mental health literacy of coaches to enhance their engagement in prevention, and early intervention behaviors.However, there is considerable evidence to suggest that knowledge alone is unlikely to be sufficient to promote sustained engagement in behavior (Kelly & Barker, 2016).In the present study, role efficacy not only partially mediated the relationship between depression literacy and helping behaviors but also had strong direct associations with prevention, and early intervention behaviors.This finding reinforces the important role that a coach's beliefs about their capabilities can have in influencing their engagement in prevention and early intervention behaviors.Similar findings have been found in high school coaches who were more likely to try to help an athlete if they were confident in their ability to do so (Kroshus, Chrisman, et al., 2019), and also in a cohort of student athletic therapists whose mental health literacy predicted their referral efficacy (Sullivan & Tennant, 2021).Consequently, in designing interventions to promote prevention and early intervention behaviors, it is important to consider factors beyond the provision of information to promote knowledge.Indeed, the results of this study suggest skill development may also be necessary to strengthen confidence to engage in such behaviors.For example, utilizing evidence-based behavior change techniques linked to enhancing selfefficacy, such as demonstrating the behavior, and problem solving potential barriers to engaging in the behavior (Connell et al., 2019).In a similar fashion to Duffy et al. (2021), role breadth was associated with prevention and early intervention but did not mediate the relationship between depression literacy and either behavior.Therefore, increasing a coach's depression literacy may be unlikely to further strengthen their beliefs that these behaviors are part of their role.Instead, other factors might be important in influencing role breadth such as, social norms or the environmental context.Although coaches have a crucial role to play in athlete mental health promotion, their behavior is situated within and is influenced by the wider organizational context.Thus, there is a need to consider an approach to mental health promotion in sports organizations whereby it is integrated into the structures and policies of the organization and is clearly articulated and reinforced to coaches (Gorczynski et al., 2021).This might occur through the creation of a mental health declaration that details a common goal of supporting athletes by normalizing mental health promotion within the organization, with the aim of reducing stigma and increasing help-seeking behavior (Purcell et al., 2022).
Previous research has highlighted the role of stigma in the sporting environment, including how coaches' attitudes can influence athletes' engagement in help-seeking (Kroshus, 2017).The present study's findings highlight how personal stigma does interact with depression literacy to affect coaches' prevention and early intervention behaviors via role efficacy.Specifically, coaches with lower levels of personal stigma, reported higher levels of depression literacy and were more confident to engage in prevention and early intervention behaviors.However, for coaches with high levels of personal stigma there was no interaction with depression literacy.This finding suggests that increasing a coach's knowledge of the signs, symptoms and treatment options may be insufficient to influence their engagement in prevention and early intervention behaviors for those who hold stronger stigmatizing beliefs.Thus, increasing mental health literacy may be appropriate in targeting coaches with low levels of personal stigma but alternative or complimentary interventions may be needed to target coaches with more stigmatizing attitudes, e.g., perspective-taking to enhance empathy (Galinsky & Ku, 2004) and contact-based interventions (Amsalem & Martin, 2022).A recent study targeting increased help-seeking and reduction of stigma in a student athlete population used perspective-taking, contact-based approaches, and counter stereotyping alongside an education session over four 1-hour sessions.Encouragingly, the authors found that this multi-component intervention increased mental health literacy and help-seeking intention and reduced some forms of stigma (i.e., self-stigma but not personal or perceived stigma; Chow et al., 2021).However, there is a lack of clarity as to whether each of these approaches had a similar level of effect or whether one might be more beneficial than others.Future studies should assess these approaches individually as well as in a combined fashion.
Research suggests that female coaches and athletes have higher levels of mental health literacy than male coaches (Gorczynski et al., 2020;Oftadeh-Moghadam & Gorczynski, 2021;Sullivan et al., 2019).Thus, we hypothesized that gender would moderate the relationship between depression literacy, role breadth and role efficacy and prevention and early intervention behavior.However, gender did not moderate this relationship, a finding which contrasts with much of the existing sport related literature.This inconsistency may be due to the focus of the present study on depression literacy as compared to the wider concept of mental health literacy (as measured by the mental health literacy scale, O 'Connor & Casey, 2015).Furthermore, the D-Lit (Griffiths et al., 2004) focuses only on knowledge while the MHLS assesses knowledge, attitude, and intention to seek help.Although the lack of gender differences in the present study differs from existing sport literature, it does mirror the findings from a study involving secondary school teachers (N ı Chorcora & Swords, 2021).It may be that gender differences in roles such as a teacher or sports coach are less accentuated, with males in these roles more aware of their pastoral responsibilities (Hansen & Mulholland, 2005).

Practical implications
Sports coaches can have a significant role in supporting young people's mental health from promoting help-seeking behaviors to signposting and supporting a young person to access services.Education-based mental health literacy intervention can increase role efficacy and helping behaviors (Breslin et al., 2022).However, interventions that predominantly target knowledge of mental health symptoms and disorders may be insufficient for decreasing stigma (Chow et al. 2021).Although mental health literacy interventions that predominantly target knowledge may be effective for those with lower levels of personal stigma, it is likely these types of interventions will be insufficient for those with higher levels of stigma.Thus, other interventions such as contact-based approaches where an individual engages directly or indirectly with a person experiencing mental health symptoms and disorders may also be required.However, these approaches if undertaken in person may not be feasible to scale.Consequently, the use of technology might be a cost-effective way to reach a large number of coaches and facilitate the inclusion of mental health promotion initiatives within wider coach education programmes.Indeed, there is evidence for the use of video-based contact interactions to reduce student athletes' stigma (Kern et al., 2017) and a recent study using an online module for sport coaches also showed promise in increasing mental health literacy and reducing stigma (Kroshus, Wagner, et al., 2019).In conjunction with the possible use of technology, using baseline measures at the start of such mental health promotion programs to tailor and individualize content within interventions might be useful (Noar et al., 2007).For example, for coaches with lower levels of stigma, the online program might direct the coaches to intervention content that focuses on increasing knowledge, whereas for coaches with higher levels of stigma, additional contact-based components might be included that allow their personal experiences to be corrected.

Limitations and future directions
There were limitations to the present study.All participants were coaches aligned with sporting bodies in Ireland potentially limiting the generalizability of the findings to other countries.The study examined coaches' engagement in prevention and early intervention behaviors using a measure developed by Mazzer and Rickwood (2013).This measure also assesses promotion behavior (e.g., encouraging young people to build positive attitudes toward people with mental health symptoms and disorders).However, the data from this subscale was excluded from the analysis as it was found to lack internal consistency.An explicit measure of personal stigma was used in this study.Such measures of stigma can be influenced by factors such as social desirability bias or demand characteristics (Monteith & Pettit, 2011).Therefore, future studies might look to include implicit measures of stigma to be able to detect possible underlying bias that coaches hold toward people with mental health symptoms and disorders.To the authors' knowledge, only two studies in a sporting context, targeting student athletes rather than coaches, have included an implicit measure of stigma (Chow et al., 2021;;Donohue et al., 2004).The present study was cross-sectional in nature and only examined the relationships between constructs rather than causation.Thus, there is a growing need for theory-driven intervention studies that target the factors that influence coaches' engagement in behaviors such as prevention and early intervention, and track outcomes longitudinally (Breslin et al., 2022).Finally, this study focused on coaches as the key gatekeeper in the sporting environment.However, strategic approaches that target multiple levels of influence (e.g., athletes, coaches, parents, institutions) may be more effective than focusing initiatives at one level of the sporting environment (Breslin et al., 2022).Such an approach may be facilitated by guiding frameworks such as the mental health promotion framework for sport recently developed by Purcell et al. (2022).

Conclusion
Sports coaches can have a considerable impact on young people's lives and can engage in behaviors to support young people's mental health.Mental health literacy can help to build coaches' awareness and facilitate their engagement in these types of behaviors.This study examined coaches' depression literacy and how role efficacy and stigma may influence coaches' engagement in prevention and early intervention behavior with their athletes.The study findings highlighted that coaches' depression literacy was associated with prevention and early intervention and these associations were partially mediated by role efficacy and moderated by personal stigma.Increasing coaches' depression literacy and targeting stigmatizing attitudes may facilitate coaches' engagement in prevention and early intervention behaviors with their athletes.

Figure 4 .
Figure 4. Moderating effect of personal stigma on the relationship between depression literacy and role efficacy for prevention.

Figure 5 .
Figure 5. Moderating effect of personal stigma on the relationship between depression literacy and role efficacy for early intervention.

Table 1 .
Means and standard deviations for the study variables.

Table 2 .
Indirect effects of depression literacy via role efficacy and role breadth for prevention and early intervention.Standardized beta coefficients are presented with biased-corrected 95% confidence intervals.Ã p < .05.