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Systematic Review
Peer-Review Record

Mindfulness-Based Interventions and the Hypothalamic–Pituitary–Adrenal Axis: A Systematic Review

Neurol. Int. 2024, 16(6), 1552-1584; https://doi.org/10.3390/neurolint16060115
by Hernando Vargas-Uricoechea 1,2,*, Alejandro Castellanos-Pinedo 3, Karen Urrego-Noguera 1, Hernando D. Vargas-Sierra 1, María V. Pinzón-Fernández 1,4, Ernesto Barceló-Martínez 2 and Andrés F. Ramírez-Giraldo 2
Reviewer 1: Anonymous
Reviewer 2: Anonymous
Reviewer 3:
Neurol. Int. 2024, 16(6), 1552-1584; https://doi.org/10.3390/neurolint16060115
Submission received: 6 November 2024 / Revised: 14 November 2024 / Accepted: 19 November 2024 / Published: 20 November 2024

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overall Evaluation

The review addresses a timely topic with a robust systematic approach and extensive coverage of databases. The clear summaries of studies and organization of interventions are notable. Lack of quantitative synthesis and some placeholder data reduce the clarity of the results. Additionally, a more nuanced discussion of methodological limitations across studies would add value.

 

Specific evaluation

Title

It is precise and reflects the content effectively.

Abstract

Well written.

Introduction

Well written.

Methods

A few details on the selection of control groups and study types could be beneficial for reproducibility.

A clearer explanation of how bias was assessed could strengthen the methodology.

Results

No meta-analysis was conducted due to heterogeneity. While this is reasonable, the inclusion of effect sizes or summary statistics where possible could add value.

Placeholders for some data (such as specific statistical measures) should be replaced with complete information for clarity and to strengthen the section’s impact.

Discussion

The discussion could benefit from a more detailed comparison with other systematic reviews in related fields, potentially reinforcing findings or highlighting where this review differs.

References

A few foundational studies on HPA axis physiology could enhance the background.

Tables and Figures

Consider including additional graphical summaries (e.g., a forest plot or flowchart for PRISMA) to visually represent the heterogeneity of findings.

Writing Quality

The language is clear and academic. Minor edits could improve readability, and simplifying jargon may increase accessibility for a broader audience.

Author Response

Answer for Reviewer 1. Please see attached file.

 

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

1.While the systematic review provides valuable insights into the potential impact of mindfulness-based interventions (MBIs) on cortisol levels, it would benefit from a deeper analysis of the limitations related to study designs in the included articles. Specifically, elaborating on how the lack of randomization, small sample sizes, and potential confounding variables impact the reliability of the findings would strengthen the review. This added analysis would provide a clearer picture of the limitations in the current evidence base.

2.The selection criteria for included studies would benefit from further specification. For instance, detailing how “adequately specified intervention and control groups” were defined could improve the transparency of the review process and clarify the rationale behind study inclusion and exclusion.

3.It is suggested that the authors discuss the potential issue of publication bias. Including visual assessment methods, such as a funnel plot, could enhance the depth of analysis and provide a more comprehensive perspective on the results obtained.

4.The authors state that MBIs have “biological plausibility” in affecting cortisol levels; however, elaborating on the mechanisms by which mindfulness may modulate cortisol would enhance the discussion.

5.The conclusion appropriately highlights the limitations of current evidence but might benefit from recommendations for future research. Suggesting specific study designs, such as larger randomized controlled trials with rigorous blinding and control for confounders, would guide future studies in addressing the limitations identified in this review.

Comments on the Quality of English Language

I can't evaluate

Author Response

Kind regards, attached to this message you will find the file with the answers to the reviewer's suggestions and concepts.
Thank you very much,

Hernando

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript entitled, “Mindfulness-Based Interventions and the Hypothalamic–Pituitary–Adrenal Axis: A Systematic Review” discloses the advantages and limitations intricately. The detailed coverage of scientific resources has enabled to propose the major positives and negatives of MBIs. The methods of data acquisition and screening have been well represented. Moreover, the explanation of the mechanism of action of MBIs on cortisol levels is also convincing according to the information disclosed. Thus, this comprehensive review echoed the knowledge gaps and the future prospects in a brief manner, indicating its potential in acting as a valuable reference for future researchers. In my opinion, the manuscript has been authored well. But before the paper is considered for publication the authors must address the following inadequacies:

 

Abstract

1)      The titles such as materials and methods; conclusions; funding need not be highlighted in the abstract

2)      The keyword “intervention” can be considered for a replacement

 

Introduction

1)      The introduction seems very elaborate, consider reducing the references and concepts  that are repeated in the following length of the article

2)      The construction of the introduction section needs to be rearranged, as in the short paragraphs can be combined and be contained in three paragraphs in this section

 

MBIs and stress

1)      The table 1 in this section is seems exhaustive. On this note, consider reshaping the outline. In my opinion, a table like the following draft can add more clarity and strength to the manuscript

MBI Programs

Description

Aim/goal

Duration

Advantages

Reference

 

 

 

 

 

 

 

Discussion

1)      Figure 3, consider editing the spelling error (limbic system)

 

 

Author Response

Kind regards, attached to this message you will find the file with all the answers to the questions and suggestions made by the reviewer.
Thank you very much,
Hernando

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The author improved significantly their article.

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