Sein Choi,1, Md Nazmul Huda,1– 3, James Rufus John,1– 3 Valsamma Eapen1– 3 1Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia; 2Infant, Child and Adolescent Mental Health Service, South-Western Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, 2170, Australia; 3Child Psychiatry Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, AustraliaThese authors contributed equally to this workCorrespondence: Valsamma Eapen, Infant, Child and Adolescent Mental Health Service, South-Western Sydney Local Health District, Level 1, Mental Health Centre, Liverpool Hospital, Elizabeth Street, Locked Bag 7103, Liverpool, Sydney, NSW, 2170, Australia, Tel +61 02 96164364, Email v.eapen@unsw.edu.auBackground: The management of persistent symptoms for long COVID (eg, fatigue, concentration difficulties, sleep difficulties, loss of appetite and taste, depression, and anxiety) has not been widely studied among adolescents and young adults (AYA). This systematic review and meta-analysis aimed to synthesise and review evidence on the effectiveness of non-pharmacological interventions for AYA aged 13– 25 years, presenting with long COVID symptoms.Methods: A systematic literature search was conducted in four electronic databases (PubMed, EMBASE, PsycInfo, and ProQuest) in addition to manual searches for studies from January 2020 to May 2025 (PROSPERO: CRD42024516016). The studies were screened for eligibility, and methodological quality was assessed using the Joanne Briggs Institute Critical Appraisal tool by two independent reviewers. Findings were summarised using a narrative synthesis approach, and where possible, a meta-analysis was conducted using a random effects model with standardised mean differences (SMD) and a 95% confidence interval (CI).Results: Of the 325 screened articles, seven studies were included, which discussed six interventions. Three studies reported on the effectiveness of three multidisciplinary rehabilitation programs (eg, neuropsychological rehabilitation program, multidisciplinary post-COVID rehabilitation program, micro-choice-based concentrated group rehabilitation), three on alternative medicine practices (eg, forest bathing, traditional Thai Medicine), and one on mechanical therapy (eg, enhanced external counterpulsation). Findings suggested that interventions, although varied in duration and follow-up, were effective in improving mental health (SMD: 0.64, 95%, p< 0.0497). There were also non-statistical improvements in fatigue (SMD: 1.74, 95%, p = 0.1307), quality of life (SMD: − 1.34, 95%, p = 0.2787), and cognitive function (SMD: 1.05, p = 0.2989).Conclusion: This review’s findings suggest that non-pharmacological interventions may effectively treat neuropsychiatric symptoms of long COVID in AYA, ensuring better outcomes. Nevertheless, further research must be conducted with longer-term follow-up and robust methodology to explore sustained benefits, which may better inform treatment decisions.Trial Registration: This systematic review is registered in Prospero (CRD42024516016).Keywords: post-acute COVID-19 syndrome, children, adolescents, non-pharmacological interventions
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