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To date, heterogeneous findings and methodologies have limited clinicians\u2019 and researchers\u2019 ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Systematic review and meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eligibility<\/jats:title><jats:p>Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89\u2009114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41\u20130.46), externalising (g=0.25\u20130.46) and overall mental health difficulties compared with controls (g=0.18\u20130.49; n=56\u2009271), with effects decreasing over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary\/conclusions<\/jats:title><jats:p>Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. 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