PONE-D-23-11659The Intricacies of psychological response to mindfulness training among Saudi medical studentsPLOS ONE

Dear Dr. Alzahrani,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Fadwa Alhalaiqa

Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Authors.

Using of mindfulness to reduce psychological problems among students is very important issues. and this paper is considered the foundation base intervention. However:

1- The title should reflects the aim of the study

2- The abstract must be written in academic way with no more than 250 words that reflect what you have done in your study.

3- The introduction: re-organize it to be in good flow, so the reader could understand what is the gaps in the literatures, importance of your study, why you use your selected instruments.

4- Method: sample size calculation?? based on what intervention group number is different from the control one. randomization process?

- the intervention must be discussed in details. how you have done the recruitment procedure ?? more details about the instruments are needed, validity and reliability? these instruments already translated into Arabic, why you used English version?

Results: is there any differences in demographics characteristics between two groups? since this will may change the statistical tests that you used.

5- Discussion: Usually started by summary of your main study's findings. your point view and rationalization of your findings must be included in the discussion.

6- Limitation: what about the sample size? the dropout rate?

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to review this manuscript on a relevant theme. The main limitation is the loss to follow-up of 14 students (10 in the MBSR group and 3 in the waiting list group) on time 1 and 43 students (23 in the MBSR group and 20 in the waiting list group) on time 2.

I hope some questions and comments below contribute to the paper.

#1 - The Abstract should be rewritten in a structured mode (including the following separate sections).

#2 - Abstract - Methods - The authors should indicate the study's design with a commonly used term in the Title or Abstract.

#3 - Abstract - Methods - The study period and sampling and randomization methods should be provided.

#4 - Abstract - Results - It is unclear how many students were evaluated in T1 and T2.

#5 - Abstract - Results - The key results should be present in a numerical form that estimates associations and appropriate measures of variability and uncertainty (e.g., mean difference with 95% confidence intervals, correlation coefficients, and p-values, as appropriate).

#6 - Introduction - The authors should avoid giving the p-values of the previous studies (e.g., the p-values for the results of studies cited as references).

#7 - Methods - The setting should be described in more detail. Besides, the Saudi Arabian medical education system should be explained.

#8 - How was the sample size defined?

#9 - Methods - Lines 148 and 149 - It should be clear that it used stratified random allocation and not simple random allocation.

#10 - Methods -The Perceived Stress Scale (PSS), Mindful Attention Awareness Scale (MAAS), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) should be more detailed.

#11 - Methods - The methods should explicitly state all outcomes.

#12 - Methods - What was the normality test used in the study? The authors also should specify the variables that had a parametric distribution.

#13 - Methods - Data Analysis - Lines 198 to 200 - Did the number of attendance at MBSR have a normal distribution? If not, Pearson's correlation coefficient is not an appropriate test to assess this variable.

#14 - Methods - Should repeated measures ANOVA within- and between-subjects design be used to compare MBSR and waiting list groups on T0, T1, and T2?

#15 - Results - The authors should evaluate the balance assignment between the groups regarding the baseline characteristics. In addition, they also should assess whether the loss to follow-up influenced the balance of these variables.

#16 - Results - Legends explaining the acronyms should be included in the tables.

#17 - Discussion - The authors do not need to repeat the data and p-values already given in the Results section.

#18 - Discussion - The low number of students who meet all MBSR sections is noteworthy. To what do the authors attribute this finding? Could the students who noticed the most significant benefit from the initial sessions be the ones who were motivated to do the most sessions?

Reviewer #2: Dear Author,

The manuscript entitled "The Intricacies of psychological response to mindfulness training among Saudi medical students" presents a topic that may interest readers of the journal. Although I consider an interesting topic, I would like to make some comments about the present manuscript below:

introduction:

1. Clarify the context: It would be helpful to provide some context or background information on the alarming findings mentioned at the beginning of the introduction. What specific findings or issues are being addressed? This would help readers understand the significance of the research and why a need-driven response is necessary.

2. Provide more information about mindfulness: While the introduction mentions mindfulness as a solution, it would be beneficial to provide a concise definition or explanation of what mindfulness is. This would enhance the readers' understanding, especially if they are not familiar with the concept.

3. The introduction briefly mentions that the study aims to examine the impact of the Mindfulness-Based Stress Reduction (MBSR) program on medical students, but it would be helpful to explicitly state the research objective. Clearly articulating the purpose of the study would provide a strong foundation and help readers understand the focus of the research.

4. Overall, the introduction provides some relevant information about mindfulness and its potential benefits. However, by addressing the points mentioned above, the authors can improve the clarity and focus of the introduction, making it more engaging for readers.

Methods:

1. Clarify the recruitment process: While the inclusion criteria are mentioned, it would be helpful to provide more details about how the participants were recruited. How were the medical students approached and informed about the study? Providing information on the recruitment process would enhance the transparency of the study and help readers understand how the participants were selected.

2. Provide more information on the waitlist group: The methods mention that there were two study groups, the MBSR group and the waitlist group. However, there is limited information about the waitlist group and their involvement in the study. It would be beneficial to explain the purpose and rationale for including a waitlist group, as well as how they were involved in the study beyond receiving the program at the end.

3. Elaborate on the content of the MBSR program: While the introduction briefly mentions the topics and exercises covered in the MBSR program, it would be valuable to provide more details about each component. This would give readers a clearer understanding of the specific techniques and strategies used in the program.

4. By expanding upon these aspects in the methods section, the authors can provide a more comprehensive explanation of the study design and procedures, enhancing the reader's understanding.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Ebrahim Norouzi

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The Effectiveness of mindfulness training in improving medical students' stress, depression, and anxiety

PONE-D-23-11659R1

Dear Dr. Ahmed Alzahrani,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Fadwa Alhalaiqa

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have made appropriate adjustments to the original submission.

All my comments have been answered, and I have no further recommendations.

Reviewer #2: The authors have addressed all of my concerns. I would like to accept this manuscript as it is in the present version. I really like this manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Fábio Ferreira Amorim

Reviewer #2: Yes: Ebrahim Norouzi

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