Work-life balance is not the same thing as working fewer hours or splitting time fifty-fifty. The researchers are careful to define it as an individual’s overall, subjective appraisal of how well work and non-work activities fit together in relation to current priorities and opportunities for growth. Someone who works long hours but finds the arrangement satisfying and aligned with their goals can genuinely perceive balance, while someone with a lighter schedule may feel deeply out of sync. This distinguishes the construct from related theories in organizational psychology, such as work-family conflict, which focuses on incompatible demands between roles, and work-family enrichment, which describes how resources gained in one domain can benefit another. The spillover-crossover model adds a further layer, describing how experiences and emotions travel between work and home within one person, and even between partners and family members.

The scale at the heart of the new study was developed by Paula Brough and colleagues, who designed a concise four-item measure based on people’s global subjective evaluation of the balance between work and non-work activities. Unlike conflict measures, which ask whether demands in one domain interfere with functioning in another, the scale asks respondents to judge the perceived balance itself, and it was built to apply regardless of marital or parental status. In the original validation across four heterogeneous samples of workers in Australia and New Zealand, the one-factor structure and internal consistency held up, and work-life balance was associated in expected directions with work demands, job and family satisfaction, turnover intentions, and psychological strain, with several associations replicated over time. What was missing was any Swedish version, which limited researchers and practitioners who wanted a brief, well-grounded measure for large work-life health studies in Sweden.

Producing one required far more than dictionary work. The team followed the ISPOR guidelines for cross-cultural validation of instruments, a staged process designed to protect conceptual equivalence rather than literal wording. Two native Swedish speakers produced independent forward translations after being briefed on the constructs, the target population, and the purpose of the instrument, and they were explicitly instructed to prioritize culturally appropriate meaning over word-for-word fidelity. Their versions were reconciled item by item into a single draft, which was then translated back into English by two researchers who had not been involved in the forward translation. The back translations served as a diagnostic mirror, revealing ambiguities or unintended shifts in meaning, and a harmonization review compared the preliminary Swedish version, the original English scale, and both back translations across every item, instruction, and response alternative.

The most revealing stage was cognitive debriefing, in which eight Swedish-speaking participants — police officers, civilians working within the police authority, and a public order officer — completed the draft version and were asked to think aloud about their understanding of the instructions, items, key terms, and response alternatives. Their feedback caught several expressions that were technically correct but felt unnatural in Swedish. The wording corresponding to “I believe” in the final item was judged overly literal and revised to emphasize the respondent’s subjective experience of balance, while the phrase corresponding to “about right” was replaced with a more idiomatic formulation. Interestingly, participants suggested removing the temporal and summary expressions corresponding to “currently” and “overall,” but the researchers declined, judging those words to be meaningful components of the original items and essential to preserving conceptual equivalence with the source instrument.

With the adapted scale finalized, the team turned to psychometric evaluation using survey data from 215 students — 173 in police education programs at three universities and 42 in an educational program within the Swedish Prison and Probation Service. Because the respondents were students, the questionnaire opened with the clarification that “if you are a student, work means your studies.” Items are rated on a five-point scale from strongly disagree to strongly agree, with one negatively worded item reverse-coded before scoring. The mean scale score came out at 3.85 on the five-point range, with a standard deviation of 0.85, and all four items used the full response range. Internal consistency was good, with Cronbach’s alpha of 0.83 and McDonald’s omega of 0.86, comfortably above the 0.70 threshold conventionally regarded as acceptable.

Not every item performed equally, however, and the study is unusually candid about this. The scale’s single reverse-worded item showed a corrected item-rest correlation of just 0.39, compared with 0.75 to 0.79 for the three positively worded items, and removing it would have pushed alpha up to 0.91. In the confirmatory factor analysis, which treated the items as ordinal indicators and used diagonally weighted least squares estimation, the positively worded items loaded strongly at 0.88 to 0.96 while the reverse-worded item loaded at only 0.49. The model’s overall fit was mixed but generally acceptable, with an SRMR of 0.01, an RMSEA of 0.07, and CFI and TLI values of 1.0, though the scaled chi-square test reached significance. The researchers note that reverse-worded items can introduce method variance by forcing respondents to shift response direction, raising the risk of cognitive burden or misinterpretation — and the same item also performed comparatively weakly in the original validation, a pattern consistent with, though not proof of, a wording-related effect.

Crucially, the team chose not to simply delete the problem item, even though doing so would have improved the reliability statistics. Dropping it would have altered the original four-item measure, and a three-item version has never been independently validated. Instead, they recommend that Swedish users retain all four items and the original scoring to preserve comparability, while reporting item-level performance and interpreting the reverse-worded item cautiously. Future studies, they suggest, could directly compare the reverse-worded item with a semantically equivalent positively worded alternative, or apply item response theory in larger and more occupationally diverse samples to clarify whether all four items contribute distinct information across the balance continuum.

The validity evidence was otherwise encouraging. Work-life balance correlated strongly and positively with occupational balance, measured with the Swedish-born Occupational Balance Questionnaire, at r = .76 — supporting convergent validity, though the magnitude also reveals substantial overlap between the two constructs and raises questions about how distinct they really are. The scale also behaved as theory predicts in relation to mental health: higher work-life balance was associated with lower depressive symptoms on the PHQ-9 (r = −.54) and lower anxiety symptoms on the GAD-7 (r = −.45), both statistically significant and of at least moderate magnitude. These findings echo the original validation, in which higher work-life balance predicted lower psychological strain both cross-sectionally and longitudinally, and they extend the evidence to more specific indicators of psychological distress.

The authors are clear about the limits. The sample consisted of students in professional education rather than employees exposed to long-term occupational demands, which may explain why 15.8 percent of participants hit the maximum score, producing a modest ceiling effect that could limit the scale’s ability to distinguish people at the upper end of balance. The cross-sectional design cannot establish whether low balance causes distress or the reverse, and no data were collected on test-retest reliability, measurement invariance, responsiveness, or predictive validity. The translation process also involved no bilingual professionals or translation agency, leaving open the possibility of translator-related bias despite the systematic procedure. Still, the study delivers what it promised: a brief, carefully adapted Swedish measure with promising initial psychometric properties, ready to be embedded in larger surveys of health, work ability, and working conditions — and, with further validation in broader working populations, potentially a small but powerful tool for understanding one of the defining tensions of modern working life.

Subject of Research: Translation and psychometric validation of the Swedish Work-Life Balance Scale

Article Title: Translation, cross-cultural adaptation, and psychometric evaluation of the Swedish Work-Life Balance Scale

Article References: Degerstedt, F., Bellander, S., Ingrell, J., Tedeholm, P. G., Nordin, T., & Granholm Valmari, E. (2026). Translation, cross-cultural adaptation, and psychometric evaluation of the Swedish Work-Life Balance Scale. BMC Psychology, 14(1), Article 1462. https://doi.org/10.1186/s40359-026-05752-3

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05752-3

Keywords: work-life balance, psychometrics, cross-cultural adaptation, scale validation, internal consistency, confirmatory factor analysis, occupational balance, depression, anxiety, Sweden, questionnaire translation, occupational psychology

The research, led by PhD candidate Jamie Wilson at Flinders University, focuses on what the authors describe as a vulnerable transition window in an athlete’s development: the years between 17 and 24, when teenagers and young adults move from junior competition toward elite senior levels. During this period, athletes face a convergence of pressures that few other young people experience. The study found that 84.6 percent of the young athletes surveyed held outside employment while pursuing their sporting careers, and 61.5 percent were simultaneously studying. These figures illustrate the reality of the dual-career lifestyle, in which intense training schedules must be fitted around exams, shifts at work and the ordinary developmental tasks of early adulthood.

At the heart of the study is a concept drawn from occupational therapy known as occupational balance, which refers to how individuals distribute their time and energy across the full range of activities that make up a life, including sport, education, paid work, leisure and rest. The researchers argue that this balance is not a peripheral concern but a powerful force shaping mental health outcomes. When a young athlete’s daily routine becomes dominated almost entirely by training and competition, the structure that once made sport enjoyable can become a source of strain. As Wilson explains, when a passion once pursued for fun begins to consume every waking hour, young athletes face heightened risks for poor mental health and wellbeing, both in the present and later in life.

The study identifies several key factors that contribute to poor mental health among young athletes on the elite pathway. The first is the sheer volume of time that sport and training demand, which can leave little room for recovery, social connection or the exploration of other interests. The second is the frequent need to relocate, often at a young age, which uproots athletes from stable relationships with family, friends and community support networks at precisely the stage of life when those connections matter most. The third is a more insidious dynamic: many athletes report feeling objectified, treated as a commodity whose value depends entirely on performance, with support systems that are contingent on results rather than on the person behind them.

A fourth factor compounds the others. The culture of elite sport often imposes what the researchers describe as superhuman expectations, an implicit demand that athletes be endlessly resilient, tireless and immune to doubt. This framing creates profound obstacles to seeking help. A young athlete who believes they must appear invulnerable is far less likely to disclose anxiety, burnout or depression to coaches, medical staff or even family members. The result is a silent accumulation of distress during a developmental window in which mental health trajectories for adulthood are being established.

The research also highlights that risk is not distributed evenly across the sporting population. Female athletes and those who compete in individual sports tend to face greater threats to their mental health, the researchers report. Individual athletes, who train and compete without the shared burden and camaraderie of a team, may carry the full weight of results and expectations alone, while the specific pressures experienced by women in high-performance environments add further layers of vulnerability. These findings suggest that support programs built around a generic image of the athlete may miss the groups who need help most.

Co-author Professor Ivanka Prichard of Flinders University frames the practical implication of the work in striking terms. Supporting young athletes beyond sport, she argues, is not a distraction from victory but the vital foundation for developing healthier, stronger and more resilient competitors. The study adds an intriguing nuance to this argument: young athletes who pursue their sport for personal enjoyment and love of the game, rather than in response to external pressure from coaches, parents or institutions, appear more likely to persist through setbacks and to be psychologically healthier. Their commitment and enthusiasm, in other words, function as protective factors, but only when the surrounding life structure allows those motivations to survive the grind of elite training.

The urgency of the findings is sharpened by the status that the International Olympic Committee has assigned to this age group. The IOC has designated young adults and teenagers in elite sport as a neglected population, a label that reflects a gap between the scale of investment in junior performance pathways and the attention paid to the wellbeing of the young people moving through them. The Flinders study argues that this gap needs to be closed with deliberate support to maintain and build long-term wellbeing and resilience, rather than leaving athletes to navigate the transition window on their own or relying on support that evaporates the moment performance dips.

From a methodological standpoint, the study contributes an occupational lens to a literature that has often approached athlete mental health through clinical or performance frameworks. Survey research of this kind allows researchers to map how young athletes actually spend their days and how those patterns relate to measures of mental health and wellbeing, rather than treating the athlete purely as a performer whose non-sporting life is incidental. The occupational therapy perspective reframes everyday activities such as studying, working a part-time job, resting or socialising as meaningful occupations that sustain identity and psychological resources. Seen this way, the dual-career demands documented in the study are not obstacles to athletic achievement but potential scaffolding for it, providing alternative sources of self-worth, social contact and future security that buffer the inevitable highs and lows of competitive sport.

The broader message of the research is one that resonates well beyond the locker room. As major sporting events turn the world’s attention toward extraordinary feats of performance, the study reminds audiences that the athletes delivering those feats are young people in the midst of forming adult identities, and that true athletic excellence and long-term wellbeing require a balanced life. The elite pathway, as Wilson describes it, is packed with soaring highs and brutal lows, and the real secret to sustainable success may lie in the life an athlete builds outside of sport. For sporting bodies, coaches and families, the implication is clear: protecting time for education, work, friendship and rest is not a concession to softness but an investment in both the person and the performance. The study, titled Balancing act: An occupational lens on the process of becoming an elite athlete, was conducted by Jamie Wilson, Ivanka Prichard, Jasmine Petersen of Flinders and Adelaide University, and Brad Stenner of Adelaide University, and was published in the Scandinavian Journal of Occupational Therapy.

Subject of Research: Occupational balance and mental health in young elite athletes during the dual-career transition window

Article Title: Sporting glory starts with life outside sport, new study finds

Article References: Sporting glory starts with life outside sport, new study finds. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: young athletes, mental health, occupational balance, dual career, elite sport, occupational therapy, wellbeing, Flinders University, International Olympic Committee, transition window, athlete burnout, sport psychology

The research team recruited 143 informal caregivers of people living after stroke in Austria, gathering data through an online survey between August 2023 and April 2025. After excluding incomplete responses, the statistical analyses rested on 138 complete cases. The participants were assessed with two validated instruments. Health-related quality of life was measured using the 12-Item Short Form Health Survey, known as the SF-12, which yields two summary scores: a Physical Component Summary, or PCS, capturing bodily health and functioning, and a Mental Component Summary, or MCS, capturing psychological well-being. Occupational balance was measured with a newer, caregiver-specific tool, the Occupational Balance in Informal Caregivers Questionnaire, or OBI-Care, which breaks the construct into three subscales: Occupational Areas, reflecting participation across life domains; Occupational Characteristics, reflecting the nature and demands of daily tasks; and Occupational Resilience, reflecting the capacity to sustain and adapt one’s activity patterns. Crucially, higher scores on the OBI-Care indicate lower balance, meaning greater restriction.

The analytical strategy was deliberately conservative. The researchers used hierarchical ordinary least squares regressions to test how each occupational balance subscale related to physical and mental quality of life, while statistically adjusting for a battery of potential confounders: caregiver age, the age and gender of the care recipient, whether caregiver and recipient lived together, whether the caregiver held additional caregiving responsibilities, the caregiver’s own rating of positive caregiving experience, and the overall level of caregiver burden. This matters because any study of caregivers must disentangle the specific effect of a disrupted daily life from the more general weight of burden, which is known to erode well-being. By holding burden constant, the team could ask whether occupational balance carries information about health that burden alone does not.

The headline finding is stark in its consistency: the more restricted a caregiver’s occupational balance, the worse their health-related quality of life, and the association was substantially stronger for mental than for physical health. For the mental component, all three subscales of the OBI-Care were significantly linked to lower MCS scores. The strongest effect came from Occupational Areas, with a standardized beta of −0.571, followed by Occupational Characteristics at −0.376 and Occupational Resilience at −0.218, all statistically significant. In plain terms, caregivers who had lost access to a broad range of meaningful activities, who found their daily tasks draining or ill-fitting, and who could no longer sustain a resilient rhythm of activity reported markedly poorer psychological well-being.

Physical health told a more selective story. Only two of the three subscales were associated with the Physical Component Summary: restriction in Occupational Areas, with a beta of −0.258, and restriction in Occupational Characteristics, with a beta of −0.299. Occupational Resilience, by contrast, showed no significant link to physical quality of life once the other variables were accounted for. This pattern suggests that the sheer breadth of lost activities and the character of the tasks caregivers perform, such as their physical demands and time pressure, are what wear on the body, while the more internal capacity for resilience registers primarily in the mind. The fully adjusted models explained roughly 12 to 17 percent of the variance in physical quality of life but a far larger 29 to 45 percent of the variance in mental quality of life, with the model linking Occupational Areas to mental health topping out at an R-squared of 0.450, a striking figure for a cross-sectional study in this field.

The study then pushed one step further, asking whether positive caregiving experience, the sense of meaning, purpose, and reward that many caregivers report despite the strain, changes these associations. The researchers used a standard moderation framework, PROCESS Model 1, to test whether the interaction between positive experience and each balance subscale predicted quality of life. The results were among the most intriguing in the paper, and notably domain-specific. For the Occupational Characteristics subscale, positive caregiving experience strengthened the negative association with physical health, with an interaction coefficient of −0.64, but weakened the association with mental health, with a coefficient of 0.57, which became statistically non-significant at higher levels of the moderator.

That double-edged result invites careful interpretation, and the authors are candid about its tentativeness. One reading is that caregivers who feel positively about their role may throw themselves into demanding tasks with an overcommitment that exacts a physical toll, even as the sense of meaning buffers the psychological cost, rendering the link between task-related restriction and mental health negligible among the most positively appraising caregivers. The authors themselves flagged this possibility in advance, noting that positive appraisals may buffer psychological strain or, conversely, coincide with overcommitment that exacerbates physical strain. Notably, no moderation was found for the Occupational Areas subscale, and the interaction between Occupational Resilience and positive experience for mental health fell just short of significance at p equals 0.083. The authors also reported that the significant interaction for mental health was not robust to the exclusion of caregiver burden from the model, a caveat that underscores how exploratory these interaction findings remain.

What elevates this study beyond a statistical exercise is the theoretical framing. Occupational balance has long been a central concept in occupational therapy and occupational science, resting on the premise that humans need a varied, satisfying portfolio of daily activities to stay healthy, much as they need a balanced diet. Yet most research has examined it in general populations or clinical samples of patients, not in the people standing behind them. By developing and deploying a caregiver-specific instrument, the team captured dimensions that generic balance scales miss, such as the way caregiving tasks colonize the day and crowd out everything else. The finding that lost breadth of activity, the Occupational Areas dimension, is the strongest correlate of mental health aligns with a large body of work linking social participation, leisure, and self-care to psychological resilience, and it gives that literature a concrete, measurable target for intervention.

The clinical implications follow directly. If restricted occupational balance is tied to poorer quality of life, then occupation-based interventions, programs that deliberately expand caregivers’ participation in valued activities and optimize the demands of the tasks they must perform, become a plausible lever for protecting caregiver health. The authors are explicit that their cross-sectional design forbids causal claims: it is equally possible that poorer health restricts activity, or that unmeasured third factors drive both. But the subscale-specific pattern they observed generates testable hypotheses for longitudinal and interventional research, and it argues for assessing occupational balance in a differentiated way rather than as a single lumped score, since different dimensions track different health outcomes.

For the millions of families navigating life after stroke, the study’s message is quietly radical. The health of the caregiver is not a side issue to be addressed once the patient has recovered; it is woven into the texture of the caregiver’s ordinary day, into whether there is still time for a walk, a friend, a hobby, a job. The Austrian data, collected with ethics approval from the Ethics Committee of Lower Austria and funded through the Collaborative Research on Occupational Balance project under the RTI-Strategy 2027 initiative, suggest that measuring and restoring that daily balance may be as important to caregivers’ well-being as any respite service or financial support. As populations age and stroke survival improves, the ranks of informal caregivers will only grow, and the science of keeping them whole is finally catching up with the scale of the task they carry.

Subject of Research: Occupational balance and health-related quality of life in informal caregivers of stroke survivors

Article Title: Associations between occupational balance and health-related quality of life in informal caregivers of persons after stroke: a cross-sectional study

Article References: Köttl, H., Lentner, S., Fallahpour, M., Haberl, E., Baciu, L., Guidetti, S., Schön, M., Lischka, C., & Dür, M. (2026). Associations between occupational balance and health-related quality of life in informal caregivers of persons after stroke: a cross-sectional study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08410-w

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08410-w

Keywords: stroke, informal caregivers, occupational balance, health-related quality of life, caregiver burden, SF-12, occupational therapy, mental health, cross-sectional study, caregiving experience, BMC Geriatrics, Associations

The research, led by Tomoe Ebisu of Kobe University Graduate School of Health Sciences together with colleagues at Osaka Kawasaki Rehabilitation University and Lund University in Sweden, was published on 2 July 2025 as an open-access article. Its central question was deceptively simple: does the Japanese adaptation of this Swedish interview-based tool produce stable, meaningful measurements when used with Japanese people living with mental illness? To answer it, the team followed the Consensus-Based Standards for the Selection of Health Measurement Instruments, or COSMIN, a widely respected framework for evaluating how well health measurement instruments perform.

The SDO-OB itself is an interview conducted by occupational therapists and organized into three sections covering four domains of daily life: work and studies, leisure, household and maintenance, and self-care. The first section measures activity level by asking whether the respondent engages in thirteen specific activities, with the number of affirmative answers summed into a score. The second section asks the respondent to rate satisfaction with those same thirteen activities on a seven-point scale ranging from worst to best, regardless of whether the activities were actually performed in the previous two months. The third section probes perceived occupational balance with one question per domain plus a general question—’Overall, how much do you feel you are doing various daily activities?’—rated on a five-point scale from far too little to far too much.

That final section is what distinguishes the SDO-OB from its predecessor, the SDO, which included only the activity level and satisfaction components. The balance questions generate a profile classifying respondents as under-occupied, in-balance, or over-occupied in each domain, reflecting the time-allocation perspective of occupational balance. Earlier versions of the instrument had already proven psychometrically sound in Sweden among people with mental illness, and Spanish versions had been validated for people with mental disorders and stroke survivors. But no Japanese version existed, leaving Japanese clinicians without an efficient tool that links perceived balance to concrete daily activities.

To fill that gap, the researchers recruited fifty-three participants from four healthcare facilities in a Japanese prefecture that provide vocational training, community activity support centre services, and assisted group homes. Eligible participants were between eighteen and sixty-five years old, not hospitalized at the time of data collection, had a psychiatric diagnosis under Chapter 5 of the tenth revision of the International Statistical Classification of Diseases, could recall their daily lives over the previous two months, and were native Japanese speakers. Roughly sixty percent were men, about half lived with family, and around half carried schizophrenia-related diagnoses. The sample size of fifty or more was chosen because COSMIN guidance considers it adequate for test-retest reliability studies and hypothesis testing for construct validity.

Each participant was interviewed twice, two weeks apart, between July 2023 and January 2024, with the same interviewer conducting both sessions. At the first time point, participants also completed the Trail Making Test Part B, a measure of neurocognition requiring them to alternately connect numbers and Japanese characters in sequence, and the Japanese version of the MOS 8-Item Short-Form Health Survey, which yields physical and mental component summary scores for health-related quality of life. Global functioning was rated with the Japanese version of the modified Global Assessment of Functioning scale, determined jointly by the interviewer and facility staff. Crucially, neither functioning scores nor cognitive test times changed significantly between the two interviews, confirming that participants’ conditions were stable enough for reliability to be meaningfully assessed.

The reliability results were striking. Weighted kappa coefficients, which measure agreement between repeated ratings while correcting for chance, reached 0.75 for total activity level—a value classified as substantial—0.85 for total activity satisfaction, classified as almost perfect, and 0.54 for general occupational balance, classified as moderate. This was the first study to examine the test-retest reliability of the complete SDO-OB instrument in people with mental illness, and the findings align with earlier Swedish studies of the SDO and a Spanish study of the SDO-OB in stroke survivors. Notably, the general balance question performed better here than in the Spanish stroke study, though the authors suggest that perceptions of general balance may be influenced by more confounding factors than the more concrete activity scores.

Construct validity was tested through seven pre-formulated hypotheses derived from previous research. The activity level and satisfaction scores showed no significant correlation with global functioning, neurocognition, or mental-related quality of life, supporting the predicted discriminant validity—the idea that a measure of daily activity engagement should not simply mirror measures of cognition or clinical functioning. Physical-related quality of life, however, correlated significantly with activity satisfaction, supporting convergent validity and echoing earlier findings. One hypothesis was only partly supported: activity satisfaction did not correlate with mental-related quality of life, contrary to expectations, which the authors attribute to the fact that quality of life is not a uniform concept.

The general balance question revealed its own pattern. Participants were classified as under-occupied, in-balance, or over-occupied, with twenty-one, twenty-three, and nine individuals in those groups respectively. The in-balance group scored significantly higher on mental-related quality of life than the under-occupied group, with mean T-values of 46.9 versus 42.0, a statistically significant difference. No differences emerged in global functioning, cognitive performance, or physical quality of life across the groups. The authors suggest that Japan’s mental health system—marked by many psychiatric care beds, long-term inpatients, and community support that relies heavily on families—may shape how occupational balance relates to functioning, and that daily-activity concepts like balance are likely more tied to real-world functioning than to neurocognition, whose link to outcomes is known to be indirect.

The study’s limitations are acknowledged: participants were all users of healthcare facilities, the sample was modest given the diversity of psychiatric diagnoses, and comparisons with Swedish cohorts were constrained by differing healthcare systems and sociodemographic profiles. Still, the verdict is clear. The SDO-OB-J showed relatively good test-retest reliability and construct validity, and the authors conclude it can serve as a first step in clinical practice for evaluating occupational balance among people with mental illness in Japan. Future work will test additional psychometric properties nationwide with larger, more diverse samples, and the Japanese manual and interview form are available on request from the first author. For a country working to shift psychiatric care from long hospital stays toward community life, a validated tool that captures not just how much people do, but how balanced and satisfying their daily occupations feel, could prove an quietly powerful instrument in the rehabilitation toolkit.

Subject of Research: Psychometric validation of a Japanese occupational balance assessment tool for people with mental illness

Article Title: Test–retest reliability and construct validity of a Japanese version of the Satisfaction with Daily Occupations and Occupational Balance for people with mental illness

Article References: Ebisu, T., Masuzawa, T., Yotsumoto, K., Hashimoto, T., Argentzell, E., & Eklund, M. (2025). Test–retest reliability and construct validity of a Japanese version of the Satisfaction with Daily Occupations and Occupational Balance for people with mental illness. Scandinavian Journal of Occupational Therapy, 32(1), Article 2526427. https://doi.org/10.1080/11038128.2025.2526427

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2526427

Keywords: occupational balance, mental illness, psychometrics, test-retest reliability, construct validity, occupational therapy, quality of life, Japan, assessment tool, daily activities, rehabilitation, kappa coefficient

Occupational balance is a deceptively simple concept with deep roots in occupational therapy, the health profession concerned with helping people engage in the everyday activities, or occupations, that give life structure and meaning. Swedish researchers Petra Wagman and Carita Håkansson, both co-authors of the new study, defined it in earlier work as an individual’s perception of having the right amount of occupations and the right variation between them. Crucially, the definition is subjective: there is no universal formula dictating how time should be divided among self-care, work, leisure, and sleep. What matters is whether each person feels their mix of activities is sufficient and varied enough. Occupational imbalance arises when someone feels they are doing too little, too much, or lacking variety, and research consistently links this perception to well-being, quality of life, and mental health.

People with depression face particular obstacles in achieving this balance. Symptoms such as low mood, lack of interest and energy, and difficulties with decision-making, concentration, and memory reduce the capacity to perform personal care, household tasks, and social or productive activities. Many individuals scale back the roles they take on, withdrawing from chores, employment, and family responsibilities. Over time, depression can shift daily patterns toward sleeping and resting at the expense of active pursuits, further narrowing the variety of occupations. Prior research suggests that people with depression achieve occupational balance when they feel they have varied things to do, the right amount to do, satisfaction with how their time is spent, and a good mix of energizing and draining activities. Measuring where a patient stands on this spectrum is therefore essential for designing effective, individualized interventions, which is precisely why a validated assessment tool matters.

The instrument at the heart of the new study is the OBQ11, an eleven-item self-report questionnaire developed in Sweden and refined through Rasch analysis, a modern psychometric technique. Respondents rate each statement, such as having just enough to do during a regular week or balancing obligatory and voluntary occupations, on a four-point Likert scale from completely disagree to completely agree, yielding total scores from 0 to 33, with higher scores indicating better occupational balance. The questionnaire takes less than fifteen minutes to complete, making it practical for clinical use. It has already been translated into Spanish, Norwegian, Turkish, Arabic, Persian, and Danish, but until now no version existed for Chinese-speaking populations, and no tool had been found suitable for people in Taiwan.

Translating a psychological questionnaire is far more demanding than swapping words between languages, and the Taiwanese team followed a rigorous, standardized procedure. Two bilingual occupational therapists produced a forward translation into traditional Chinese, while a bilingual translator supported by a professional English editor handled the back translation. The first author then reconciled the two versions and corresponded directly with the OBQ11 developers to confirm accuracy. Some items proved stubborn: two required back translation twice, and one needed four rounds before the meaning aligned with the original. This iterative process, repeated across multiple reviews, ensured that each translated item preserved the intent of the Swedish source rather than merely its surface wording.

Cultural nuance surfaced most vividly in the expert review phase. Ten occupational therapy experts from across Taiwan, with an average of thirteen years of clinical experience, initially rated the translated items below the accepted thresholds for content validity, flagging ambiguous wording, difficult phrasing, and a missing instruction about the recall period. In response, the team refined item 1, clarifying that just enough things means an appropriate amount of activity, neither too little nor too much, and adjusted item 3 to indicate that it concerns doing some of the things a person genuinely wants. Item 9, which addresses balancing obligatory and voluntary occupations, required extensive discussion because the distinction itself is culturally loaded. The researchers noted that in Sweden people commonly separate activities they want to do, such as leisure, from activities they must do, such as work and caregiving, whereas in Taiwan obligations may align with personal desires and thus bring satisfaction. Parenthetical explanations of responsibility and voluntary were added, and after revision the expert-level content validity indices reached acceptable values, with item-level scores between 0.8 and 1.0 and a scale-level average of 0.93.

The validation then moved to the people who would actually use the questionnaire. Ten participants with depressive disorder completed cognitive debriefing interviews, confirming that they understood the items, and a larger sample of 161 adults with depressive disorder, recruited from two psychiatric outpatient clinics in central Taiwan, completed the finalized OBQ11-C. Participants averaged 39.2 years of age, were predominantly female, and had developed psychiatric disorders at an average age of 31.2 years. Of these, 131 returned a second completed questionnaire by mail within seven to fourteen days, allowing the team to assess stability over time. The results were striking: the intraclass correlation coefficient, a measure of test-retest reliability, reached 0.94, indicating excellent agreement between the two administrations, while Cronbach’s alpha, a gauge of internal consistency, stood at 0.90, and corrected item-total correlations ranged from 0.49 to 0.77, all comfortably above accepted standards.

Beyond classical test theory, the researchers applied Rasch analysis, a mathematical framework that converts person ability and item difficulty into a common unit called the logit and tests whether a questionnaire measures a single underlying construct. The analysis supported the four-point rating scale, confirmed that all items fit the model, and demonstrated unidimensionality, meaning the eleven items all tap the same construct of occupational balance. Item separation was 3.95 with item reliability of 0.94, and person separation was 2.87 with person reliability of 0.89, indicating the scale distinguishes both item difficulty levels and individual differences effectively. Principal component analysis of residuals explained 53.6 percent of the variance, and no floor or ceiling effects emerged, meaning the scale works across the full range of occupational balance levels.

Perhaps the most intriguing findings came from comparing item difficulty rankings across the Chinese, Swedish, Norwegian, and Danish versions. Some patterns held everywhere: item 3, concerning time for doing things one wants, consistently ranked among the easiest, while item 10, balancing energy-giving and energy-taking activities, and item 7, satisfaction with how time is spent, ranked among the hardest. But other items shifted dramatically between versions, by more than three ranking positions. In the Chinese version, the hardest item concerned balancing physical, social, mental, and restful occupations, plausibly reflecting the daily struggles of people with depression in managing chores, social interaction, and self-care. In the original Swedish version, balancing work, home, family, leisure, rest, and sleep posed the greatest difficulty, while Norwegian students found obligatory versus voluntary balance hardest, and Danish workers struggled with having sufficient time for obligatory tasks. These differences underscore that occupational balance is a personal, culturally situated perception shaped by age, health status, and life context.

The study has limitations the authors acknowledge: participants were adults aged 20 to 66 recruited from outpatient clinics in central Taiwan with relatively homogeneous characteristics, and properties such as criterion validity, differential item functioning, and minimal clinically important difference remain to be examined. Even so, the OBQ11-C now stands as the first validated tool of its kind for Chinese-speaking individuals with depression in Taiwan, giving clinicians a foundation for building individualized, occupation-based assessment and intervention programs. For a condition that affects one in twenty adults worldwide and reshapes the texture of everyday life, the ability to measure something as intimate as whether one’s days feel balanced, varied, and sufficient is a quiet but meaningful advance, one that may help therapists meet patients where they actually live.

Subject of Research: Validation of the Chinese version of the Occupational Balance Questionnaire 11 for assessing occupational balance in people with depression

Article Title: Psychometric properties of the Occupational Balance Questionnaire 11-Chinese version

Article References: Chen, Y.-L., Su, P.-C., Ko, W.-T., Hsieh, M.-H., Ju, P.-C., Chan, Y.-T., Wagman, P., & Håkansson, C. (2025). Psychometric properties of the Occupational Balance Questionnaire 11-Chinese version. Scandinavian Journal of Occupational Therapy, 32(1), Article 2559893. https://doi.org/10.1080/11038128.2025.2559893

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2559893

Keywords: occupational balance, Occupational Balance Questionnaire, depression, psychometrics, Rasch analysis, reliability, validity, occupational therapy, Taiwan, questionnaire translation, mental health, content validity

The Activity Calculator was developed by two occupational therapists from the Netherlands, Greke Hulstein–van Gennep and Karin ten Hove–Moerdijk, who recognized from their clinical experience that therapists needed a standardized, structured method to help patients with chronic fatigue participate in daily occupations in line with fatigue management recommendations. The method has since spread remarkably widely: certification courses have been organized for occupational therapists in the Netherlands since 2008 and in Norway since 2015, and more than 25 percent of all occupational therapists in the Netherlands and 8 percent of those in Norway have completed the training. Manuals are available in Dutch, Norwegian and English. That level of uptake, the researchers note, suggests the method fills a genuine clinical need. Yet until now, the tool has been criticized for lacking a solid theoretical foundation—a serious gap, since program theory describing how an intervention is expected to work, and under what conditions, is considered necessary before an intervention can be meaningfully evaluated.

The new paper, published open access in the Scandinavian Journal of Occupational Therapy by Irma Pinxsterhuis and Fanny Alexandra Jakobsen of Oslo Metropolitan University and Kirsti Nordstokkå of Sørlandet Hospital, addresses that gap by elaborating three core concepts from occupational therapy and occupational science: occupational adaptation, patterns of daily occupation, and occupational balance. The authors systematically discuss how each concept maps onto the phases of the Activity Calculator intervention, from evaluation and goal-setting through the intervention itself to re-evaluation. Their conclusion is that the three concepts appear to serve as a suitable theoretical foundation, providing a conceptual framework that may explain how the method helps people organize and adjust their everyday occupations to promote health, participation and well-being.

The Activity Calculator itself is a person-centred, time-contingent method. Patients begin by categorizing their usual activities as light, medium, strenuous or relaxing, then complete time registration lists for three to five representative days. Points are assigned to each activity according to its category and the time spent on it, and the total yields an activity level—the number of points the patient can manage in one day, whether it is a good day or a bad day. Patients then plan their activities against this budget using an app, activity cards, a pre-set day or week schedule, a diary, or an individually designed tool. This makes the approach time-contingent, in contrast to symptom-contingent approaches that assume patients have an accurate view of their capabilities and respond reliably to warning signs. Over time, activity levels can be increased gradually to avoid relapses or worsening of fatigue, and the calculator can eventually be retired once patients have internalized the planning habit.

The first theoretical pillar, occupational adaptation, is historically and philosophically rooted in occupational therapy but has been defined ambiguously in the literature. First described by Schkade and Schultz in 1992 as a normative process most pronounced in periods of transition, the concept has been reconceptualized by later researchers into clinically applicable language. In contemporary usage, occupational adaptation describes both a transactional process between the person, their occupations and the occupational environment, and an outcome of occupational participation. When a person encounters an occupational challenge—an obstacle or demand encountered while performing an occupation—it is the desire for occupational engagement that drives the adaptive response, linked to internal processes such as perception of choice, conscious awareness, self-reflection, problem-solving, acceptance and emotional regulation. Adaptation is a lifelong, cumulative, non-linear process, and people can learn from earlier experiences to support future adaptation.

Two measures of adaptation as an outcome are particularly relevant to the Activity Calculator. Relative mastery refers to a person’s subjective experience of competence in an occupation, assessed through effective participation, efficiency in using available personal and environmental resources such as time, energy and social supports, and satisfaction with occupational performance. Adaptive capacity, meanwhile, describes whether an individual has sufficient tools in their toolbox to respond to occupational challenges—including the ability to creatively develop new strategies when old ones fail. Some studies have shown positive associations between occupational adaptation and experiences of health and well-being, which matters because the two aims of the Activity Calculator explicitly target adaptation: helping patients find a balance between what they want to do and what they are able to do, and helping them obtain congruence between occupational participation and their values and personal meaning.

The second pillar, patterns of daily occupation, is often described as doing in time. Researchers have explored these patterns by categorizing occupations using taxonomies such as work, play, rest and sleep, or, in a scheme from Erlandsson and Eklund, distinguishing main occupations that dominate time and awareness, hidden occupations performed routinely, and unexpected occupations that interrupt the others. Other work has examined the complexity of 24-hour cycles, including duration, frequency, parallel occupations performed simultaneously, and the social coordination of occupations with other people. Diaries are a standard tool for documenting and reflecting on these patterns, and the Activity Calculator’s time registration lists function in exactly this way. Review of the lists reveals the prevalence of different occupation types, temporal aspects such as duration and frequency, perceived time pressure, orchestration of activities with others, and changes over time. Patients may also be asked to label registered activities as main, hidden or unexpected occupations, and perceptions can be complemented by significant others—for instance when patients are minors or have cognitive impairments.

The third pillar, occupational balance, is commonly defined as an individual’s perception of having the right amount of occupations and the right variation between them. A review by Eklund and colleagues identified three indicators: perception of the right variation and harmony between occupations, having the ability and resources for occupational engagement, and engagement in line with personal meaning and values. Jonsson and Persson proposed a tentative model in which balance is perceived through a relational mix of Exacting occupations that exceed actual skills, Flowing occupations with a reasonable match between skills and challenges, and Calming low-challenge experiences such as relaxation. A scoping review by Wagman and Håkansson added that occupational balance must be considered interpersonally, since it affects and is affected by partners, family members, employers and colleagues. The research base is striking: occupational balance is positively related to health, well-being, quality of life, life satisfaction and work ability, while imbalance has been linked to fatigue, stress and depression—one study finding that people with fatigue limited its consequences by applying adaptive strategies.

The authors’ discussion walks through how these concepts anchor each phase of the intervention. In the evaluation and goal-setting phase, occupational adaptation as a transactional process helps therapists identify occupational roles, role demands, occupational challenges and previously used responses, while assessments of relative mastery and adaptive capacity provide a picture of perceived adaptation. The Transtheoretical Model of Change, embedded in the Activity Calculator manuals, ensures the method is introduced only when patients have the intention and willingness to change, since decision-making about behaviour change depends on weighing the pros and cons of current behaviour. In the intervention phase, categorizing activities provides insight into the complexity of each patient’s daily patterns; registration reveals discrepancies between current occupational responses and perceived energy for mental or physical activity; and planning against the calculated activity level gives patients a framework for optimizing the relationship between time, energy and occupation. Patterns of daily occupation form the more objective, partly observable aspect of the framework, while occupational balance adds the subjective, emotional and personal dimension—and because the two constructs are interrelated, changes in one affect the other. Therapists support the process with education in energy conservation, spreading activities over the day and week, prioritizing and delegating, balancing engagement with rest, and modifying environments or adding assistive devices to make activities less strenuous.

At the end of the intervention, therapists assess the temptations and personal challenges patients face in maintaining adaptive occupational responses. Some patients continue to use the calculator indefinitely to maintain or improve their adaptation; others learn to engage without calculating points, responding to warning signs instead—taking a break, or switching to an activity that uses different muscles. At times of high risk, such as personal crises, social pressure, holidays or moving house, the calculator can be reintroduced, since these triggers may reactivate dysadaptive responses. Regular re-evaluation of patterns, balance, relative mastery and adaptive capacity detects when the activity level needs adjusting or new occupational responses need developing. The authors acknowledge that further research is needed to explore the relationship between using the Activity Calculator and improvements in health and well-being—but with this theoretical foundation in place, those studies can finally be designed on solid conceptual ground.

Subject of Research: A theoretical foundation for the Activity Calculator, an occupational therapy method for managing chronic fatigue through activity planning

Article Title: Theoretical foundation of the Activity Calculator – a method for fatigue management

Article References: Pinxsterhuis, I., Nordstokkå, K., & Jakobsen, F. A. (2025). Theoretical foundation of the Activity Calculator – a method for fatigue management. Scandinavian Journal of Occupational Therapy, 32(1), Article 2608471. https://doi.org/10.1080/11038128.2025.2608471

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2608471

Keywords: chronic fatigue, Activity Calculator, occupational therapy, occupational adaptation, occupational balance, patterns of daily occupation, energy conservation, pacing, long Covid, occupational science, fatigue management, rehabilitation

The scientific significance of the study lies in its deductive design. Rather than letting themes emerge freely from interview data, the researchers deliberately mapped participants’ narratives onto the CHIME framework, a widely accepted conceptual model of personal recovery developed through systematic review. CHIME stands for Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment, and it has become something of a gold standard for characterising what recovery from mental health problems actually involves. By testing whether the experiences of Balancing Everyday Life participants fit this established framework, the investigators could determine both whether the intervention promotes recovery in the sense that the field recognises and whether it offers anything the framework itself has overlooked.

The data came from a re-analysis of in-depth qualitative interviews originally collected during and after a randomised controlled trial of the intervention. From nineteen original interviewees, the researchers purposefully selected eleven information-rich cases: nine women and two men aged between thirty and sixty-three, with an average age of forty-six. Their diagnoses spanned bipolar disorder, psychosis, emotionally unstable personality disorder, ADHD, PTSD, eating disorders, panic disorder, depression, stress-related problems and previous substance abuse. Crucially, all had been interviewed at the completion of the intervention, allowing the researchers to capture recovery reflections at a consistent point in time. Semi-structured interviews lasting between thirty minutes and two and a half hours were transcribed verbatim and then analysed using the three phases of deductive content analysis: preparation, organising and reporting.

The results were striking in their breadth. Every one of the five CHIME categories was represented in the participants’ accounts, and most of the framework’s subcategories appeared as well. Two categories dominated the narratives, however: Connectedness and Empowerment. Participants repeatedly described how the safe, accepting climate of the group allowed them to open up to others, share experiences, exchange tips and support each other’s goals. One participant described recognising fellow group members as comrades in a shared fight, even when their specific goals differed. Another explained that the group was the first place she felt able to talk with people who had also been through hardship, expanding a social network she had not previously had and breaking a cycle of isolation that many mental health service users know intimately.

The importance of trusting relationships extended beyond the peer group to the healthcare staff who led the sessions. Participants emphasised that group leaders who listened without rushing, who radiated calmness and who responded to missed sessions with empathy rather than critique strengthened their confidence in the care system and in themselves. Support from family, friends and even new acquaintances made through the intervention also featured prominently, with one participant describing how a friend introduced through a fellow group member helped her get to a gym activity and became a source of mutual inspiration. These findings align with a substantial body of occupational therapy research showing that group-based activity interventions carry therapeutic value precisely because belonging and shared occupation reinforce one another.

The Empowerment category proved equally central. Participants spoke about personal responsibility in their own care, including having a voice in decisions about medication, and about regaining control over daily life through concrete strategies. One participant set a goal of reducing his sleeping pills and valued the freedom to experiment with his doctor rather than simply following a prescription. Others described learning to set limits, to tell an employment agency when they could not cope with too many changes, to break housework into manageable half-hour segments, and to let go of activities that drained them, such as one participant who abandoned a photography hobby when the fear of failure outweighed the joy. Balancing rest and activity, setting realistic goals matched to one’s abilities, and pacing oneself step by step emerged as practical recovery tools that participants carried into their everyday lives.

Beyond confirming the CHIME categories, the study made a discovery with potentially broader implications: two recovery experiences that the framework does not cover appeared consistently in the data. The first was occupational balance, the sense that daily activities are satisfyingly mixed, aligned with personal values and matched to one’s abilities. Because Balancing Everyday Life is explicitly built around learning about and self-analysing occupational balance, its prominence among participants’ recovery experiences may reflect what is distinctive about occupational therapy as a discipline. The second was self-esteem and self-confidence, which participants reported had grown through the course and which the researchers suggest could be added to CHIME’s Identity category. These additions hint that recovery frameworks developed in psychology and psychiatry may benefit from incorporating occupational science concepts that capture how people structure and experience their daily doing.

The study’s findings also illuminate the temporal nature of recovery. Categories such as Hope and optimism, Identity and Meaning and purpose appeared in the narratives but less prominently, and not all of their subcategories were identified. The researchers propose a plausible explanation: participants were interviewed shortly after completing the intervention, at a relatively early stage of what is often a long, multi-phase recovery journey. People earlier in that journey may experience belonging and connection most vividly, while hope, a redefined identity and a rebuilt sense of meaning may consolidate later. This interpretation is supported by the intervention’s randomised trial data, which showed that quality-of-life improvements among Balancing Everyday Life participants emerged only at a six-month follow-up rather than immediately after completion. The authors therefore call for follow-up studies that track recovery after occupational therapy interventions over longer horizons.

Methodologically, the researchers took deliberate steps to ensure trustworthiness. Two occupational therapy students coded transcripts independently and reached consensus under supervision, while one author independently re-analysed an entire interview, with discrepancies resolved through iterative discussion at the subcategory level. The selection of participants across different regions, group leaders, genders, ages and service contexts strengthened dependability, and illustrative participant quotes bolstered credibility. The authors acknowledge that the interview data was originally collected for earlier inductive studies and that the interview guide did not probe recovery specifically, but they argue that this openness was actually a strength, since questions framed around CHIME would have led participants toward the framework’s own concepts rather than testing whether those concepts genuinely fit their experience.

The clinical implications are concrete. The study concludes that Balancing Everyday Life supports recovery in the way the field has conceptualised it, providing evidence that practitioners can use when encouraging service users to enrol. Perhaps more importantly, it demonstrates that an occupational therapy intervention, grounded in everyday activity rather than symptom management, can foster the connectedness, hope, identity, meaning and empowerment that define personal recovery. For a population that research consistently shows to be under-occupied, isolated at home and struggling with imbalanced daily routines, the message is quietly radical: recovery can be built through the ordinary architecture of daily life, one goal, one homework assignment and one shared group session at a time. As mental health systems worldwide search for recovery-oriented services, this Swedish study suggests that the humble tools of occupational therapy, goal setting, self-reflection, activity strategies and peer belonging, deserve a central place in that conversation.

The broader context of the study’s intervention is worth noting. Balancing Everyday Life was evaluated in a randomised controlled trial across community-based and specialist psychiatry units in southern and western Sweden, where it demonstrated significant gains in occupational engagement, activity level and occupational balance compared with standardised treatment. The intervention itself unfolds over sixteen weeks through fourteen themed group sessions covering topics such as meaning and motivation, daily habits and social activities. Between sessions, participants pursue individually chosen homework activities, a structure rooted in self-reflection, goal setting and the testing of activity strategies in real-world settings.

The concept of personal recovery that anchors the analysis has its own history. Established during the 1990s as an alternative to purely biomedical notions of clinical recovery, it emphasises that individuals can experience health and well-being despite persisting symptoms, regaining control over their lives and participating more actively in meaningful activity. The CHIME framework was developed to bring clarity to this process and is now used in both research and clinical practice internationally.

The study also situates itself within a documented problem: mental health service users tend to live low-active lives, spending much of their time on sleep, meals, self-care and quiet pursuits, with isolation at home common and under-occupation far more frequent than overload. Occupational balance, defined as a subjectively satisfying mix of work, leisure, housework and rest aligned with personal values, has been shown to link with well-being and recovery, making it a natural target for therapeutic attention. The study was approved by the ethical review board in Lund and conducted in accordance with the Declaration of Helsinki.

Subject of Research: Recovery experiences of mental health service users participating in the Balancing Everyday Life occupational therapy intervention, analysed with the CHIME recovery framework

Article Title: Recovery experiences among mental health service users going through the Balancing Everyday Life™ intervention – A deductive qualitative study

Article References: Eklund, M., & Argentzell, E. (2025). Recovery experiences among mental health service users going through the Balancing Everyday Life ™ intervention – A deductive qualitative study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451267. https://doi.org/10.1080/11038128.2025.2451267

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451267

Keywords: occupational therapy, mental health recovery, Balancing Everyday Life, CHIME framework, personal recovery, occupational balance, empowerment, connectedness, qualitative research, group intervention, mental illness, Lund University

The study arrives at a moment of mounting concern in international sport. In 2023, the International Olympic Committee formally identified youth elite athletes as a ‘neglected population’ and issued a call for further research into their wellbeing. Despite the enormous investment that sporting systems pour into identifying and developing young talent, relatively little is known about how the process of becoming an elite athlete shapes the day-to-day occupational lives of adolescents and young adults. Previous work has leaned heavily on psychological frameworks, focusing on traits such as motivation, resilience and burnout, while paying less attention to how training regimes, relocation, institutional demands and social pressures restructure a young athlete’s entire pattern of living.

Methodologically, the research combined quantitative and qualitative evidence in a convergent mixed-methods design. A cross-sectional questionnaire captured data from 39 athletes, measuring dimensions of mental health alongside constructs such as enthusiastic commitment and grit. In parallel, the team conducted semi-structured individual interviews with eight athletes, gathering both the current experiences of young athletes on the talent pathway and retrospective accounts from more experienced athletes who had already lived through the transition. By analysing the two data streams side by side, the researchers could test statistical patterns in the sample while also building a richer narrative picture of what occupational balance, or the lack of it, actually looks like in the lives of developing athletes.

The quantitative results pointed to stark differences in mental health outcomes across the sample. Gender and sport type were both associated with psychological wellbeing: female athletes and athletes competing in individual sports reported poorer mental health than their male peers and those in team environments. This pattern is significant because it suggests that the structural and social conditions of different sporting contexts, rather than elite status alone, may shape psychological risk. Team sports may offer built-in social connection and shared identity, whereas individual sports can place the full weight of performance, travel and self-directed training on a single young person, with fewer companions to share the load.

One of the most technically interesting quantitative findings concerned the relationship between commitment quality and mental health. The researchers distinguished enthusiastic commitment, a form of engagement characterised by genuine enjoyment and willing dedication, from more constrained forms of commitment driven by obligation or entrapment. Enthusiastic commitment was positively correlated with grit, the persevering passion for long-term goals that psychologists have linked to achievement, and negatively correlated with depression. In other words, young athletes who pursued their sport out of love rather than pressure tended to be both more persistent and psychologically healthier. This distinction carries practical weight, because talent systems that rely on coercive or highly controlling selection pressures may inadvertently convert healthy dedication into a risk factor for depression.

The qualitative analysis, meanwhile, identified six key factors that influence occupational balance during the process of becoming an elite athlete. The first was the sheer scale of elite sport as a time commitment: training, competition, travel and recovery consumed the hours that peers spent on study, part-time work, hobbies and socialising. The second was relocation for recognition, as promising athletes moved away from home, often in adolescence, to access better coaching, facilities or selection opportunities, severing the familiar occupational routines and support networks of their home environments. These are not merely logistical inconveniences; from an occupational science perspective, they are disruptions to the pattern of meaningful activity that scaffolds identity and wellbeing during development.

The remaining factors exposed the uncomfortable commercial and institutional realities of youth sport. Athletes described being treated as a commodity, valued for their results and potential rather than as whole people, which shaped how they understood their own worth and their willingness to admit difficulty. Meaningful relationships emerged as a powerful protective force supporting life balance, with family, friends, coaches and partners helping athletes preserve a sense of self beyond performance. Access to formal support varied widely and mattered enormously, as did what the researchers termed superhuman barriers to help-seeking: an ingrained cultural expectation that elite athletes should be physically and mentally invincible, making it difficult to acknowledge fatigue, anxiety or distress without fearing that a place on the team, a scholarship or a contract might be jeopardised.

Taken together, the findings reframe athlete wellbeing as an occupational balance problem rather than purely an individual psychological one. Occupational balance, a core concept in occupational science and occupational therapy, refers to a healthful distribution of meaningful activities across a person’s life, including work, rest, play and social participation. When elite sport monopolises a young person’s occupational repertoire, displacing sleep, education, friendships and leisure, the conditions for depression and other mental health difficulties are quietly established. The study’s authors argue that this perspective exposes opportunities for imbalance that a purely psychological or performance-based framing can miss, and it opens a door for occupational therapy to contribute to sport as an emerging practice area, supporting athletes not just in their sporting roles but in their lives as students, family members and friends.

The implications reach well beyond the clinic. Sporting bodies, academies and national institutes invest heavily in the physical development of young athletes, yet this study suggests that investment must be matched by systems that protect whole-life balance, monitor the mental health of female athletes and competitors in individual sports, cultivate enthusiastic rather than coerced commitment, and dismantle the superhuman norms that silence help-seeking. For a population the International Olympic Committee has labelled neglected, the message of this research is clear: the making of an elite athlete is an occupation in the fullest sense, and if we want young people to reach the podium and flourish afterwards, we must support the entire balancing act, not just the performance that happens on the field of play.

Occupational science, the discipline underpinning this study, emerged in the late twentieth century when researchers began arguing that human health cannot be fully understood by examining symptoms in isolation from the everyday activities that structure people’s lives. Within this tradition, occupation refers not only to paid employment but to the full range of purposeful activities that fill a person’s days, from sleeping and eating to studying, socialising and training. Applying this framework to sport represents a relatively recent extension of the field, and the current study is notable for treating athletic development itself as an occupational transition, comparable in scope to the transitions into parenthood, retirement or chronic illness that occupational scientists have long studied.

The emphasis on transition is particularly relevant given what is known about adolescence and early adulthood as developmental windows. During these years, young people typically consolidate their identities through experimentation with multiple roles, build peer networks outside the family, and establish habits of self-care and study that persist into adult life. When a demanding elite pathway absorbs a disproportionate share of a young person’s time and identity resources during precisely this window, the developmental work of building a diversified occupational repertoire may be deferred or derailed. The retrospective accounts gathered from experienced athletes in the study are valuable in this respect, because they offer a view of how early occupational imbalance echoes across a sporting career rather than only how it feels in the moment.

The statistical associations reported in the questionnaire data also invite careful interpretation. Because the design was cross-sectional, the findings describe patterns present at a single point in time rather than causal pathways. It is possible, for example, that the poorer mental health reported by female athletes and those in individual sports reflects unmeasured differences in coaching environments, media exposure, injury burden or resource allocation, and longitudinal follow-up would be needed to disentangle these possibilities. The sample of 39 questionnaire respondents and eight interviewees, while rich in depth, is modest in size, which means the quantitative estimates should be read as indicative rather than definitive.

Even with these caveats, the convergence between the two data streams strengthens the overall picture. The statistical correlation between enthusiastic commitment and lower depression mirrors the qualitative accounts of athletes who described thriving when their sporting lives remained connected to genuine enjoyment and supportive relationships, and struggling when obligation and external evaluation dominated. This kind of mixed-methods agreement is often taken as evidence that a phenomenon is robust across different ways of knowing.

The authors also frame their work as a contribution to the growing conversation about mental health in elite sport, an area that has gained visibility as prominent athletes have spoken publicly about psychological distress. By grounding that conversation in occupational balance, the study offers sporting organisations a practical vocabulary for auditing their programmes, asking not only whether young athletes are performing, but whether their daily lives retain the breadth of activity, connection and rest that sustained wellbeing requires, both during their careers and after they eventually leave the podium behind.

Subject of Research: Occupational balance and mental health among youth athletes transitioning to elite sport

Article Title: Balancing Act: An Occupational Lens on the Process of Becoming an Elite Athlete

Article References: Wilson, J., Prichard, I., Petersen, J., & Stenner, B. (2026). Balancing Act: An Occupational Lens on the Process of Becoming an Elite Athlete. Scandinavian Journal of Occupational Therapy. https://doi.org/10.1007/s44474-026-00006-2

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DOI: 10.1007/s44474-026-00006-2

Keywords: elite athletes, youth sport, occupational balance, mental health, occupational therapy, athlete wellbeing, grit, enthusiastic commitment, help-seeking, International Olympic Committee, mixed methods, occupational science