Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Summary of the manuscript and key contributions

The manuscript presents a systematic review examining the potential effects of mindfulness-based interventions on quality of life and salutogenic outcomes, particularly sense of coherence (SOC), with a stated focus on unemployed people. The review was conducted according to PRISMA 2020 and prospectively registered in PROSPERO. Searches were performed in PubMed, Scopus, Web of Science, Embase, and CINAHL, and 16 studies were ultimately included.

The topic is relevant, as unemployment represents an important psychosocial stressor and relatively little evidence has focused on health-promoting interventions in this population. The integration of mindfulness with the salutogenic framework is also potentially valuable.

However, there is a substantial mismatch between the stated review question and the evidence actually included in the synthesis. Only part of the included literature concerns unemployed populations, while several studies involve students, clinical populations, or other groups. This issue affects the interpretation of the findings and requires substantial methodological clarification and restructuring before firm conclusions regarding unemployed people can be drawn.

Title

Strengths

The title clearly identifies the main concepts of interest: mindfulness, quality of life, salutogenesis, and unemployment.

Suggestions

The title should be reconsidered once the scope of the review has been clarified. At present, it suggests that the included evidence specifically concerns unemployed people, whereas a substantial proportion of the included studies involve other populations.

In addition, because the manuscript operationalizes the salutogenic dimension mainly through sense of coherence, a more precise title could be:

Mindfulness Interventions, Quality of Life, and Sense of Coherence in Unemployed Adults: A Systematic Review

This title would be appropriate only if the evidence synthesis is restricted to studies that genuinely meet the unemployed-population criterion.

Abstract

Strengths

The Abstract identifies the rationale, databases searched, PRISMA framework, number of included studies, and the substantial methodological heterogeneity found across the literature.

Suggestions

The Abstract requires revision to better reflect the actual evidence base.

Most importantly, the conclusions regarding improvements in psychological well-being, resilience, and sense of coherence are largely derived from heterogeneous populations and should not be presented as evidence of effectiveness among unemployed people. The direct evidence for this population appears much more limited.

The statement that “most” studies were cross-sectional and conducted in the United States should also be checked. The manuscript later reports five cross-sectional studies among the 16 included studies and four studies involving US populations, so the current wording may be misleading.

The Abstract should therefore distinguish clearly between direct evidence from unemployed populations and evidence obtained from other populations.

Introduction

Strengths

The Introduction provides a useful overview of the negative health consequences associated with unemployment and introduces Antonovsky's salutogenic framework, general resistance resources, sense of coherence, and mindfulness. The rationale for exploring health-promoting approaches rather than focusing solely on pathology is relevant and potentially original.

Suggestions

The Introduction could be more focused. Some sections concerning the neurobiological effects of mindfulness and the distinctions among mindfulness, meditation, and yoga are presented rather broadly and could be shortened or expressed more cautiously.

More importantly, the authors should distinguish more precisely between salutogenesis as a theoretical framework and sense of coherence as one of its central constructs. Throughout the manuscript, “salutogenic effect” sometimes appears to be treated as equivalent to a change in SOC, which is conceptually narrower.

The final rationale should focus more directly on the specific evidence gap: whether mindfulness-based interventions improve quality of life and/or SOC among unemployed adults.

Method

Strengths

The review was prospectively registered in PROSPERO and reports adherence to PRISMA 2020. The authors searched several major databases and used JBI tools for methodological quality and risk-of-bias assessment. These are important strengths.

Suggestions

Several methodological issues require substantial attention:

The eligibility criteria are not fully consistent with the review question. The primary objective concerns unemployed people, yet the authors explicitly state that unemployment was not required for the second search equation. In addition, eligible interventions include mindfulness, meditation, yoga, and other breathing-based techniques. This results in a very heterogeneous evidence base that extends substantially beyond the population and intervention defined in the research question.

The authors should define a coherent eligibility framework specifying population, intervention/exposure, comparator, outcomes, and study design. If the review is genuinely intended to evaluate effectiveness among unemployed people, the synthesis should be restricted accordingly.
Study selection and data extraction appear to have been performed by a single reviewer. The manuscript states that “a peer reviewer performed this task independently.” For a systematic review, study screening and preferably data extraction should involve at least two reviewers or an independent verification procedure to minimize selection and extraction errors. The authors should clarify exactly how many reviewers participated and how disagreements were managed.
The additional “free search” yielding 542 records is insufficiently described and therefore difficult to reproduce. The authors should specify precisely what this procedure involved—e.g., citation searching, websites, reference-list screening—and how these records were identified, screened, and deduplicated.
The review aims to evaluate intervention effectiveness, yet it includes cross-sectional studies, case-control studies, longitudinal observational studies, and even a clinical case alongside randomized and quasi-experimental interventions. Observational associations between mindfulness, SOC, and psychological outcomes cannot provide the same evidence regarding intervention effectiveness as controlled intervention studies. These designs should therefore be clearly separated in the synthesis.
Although JBI critical appraisal tools were reportedly used, the manuscript does not provide sufficiently detailed study-level risk-of-bias results. A table or figure showing the appraisal of each included study should be provided, and methodological quality should be considered explicitly when interpreting the findings rather than merely reported globally.
The decision not to perform a meta-analysis because of heterogeneity is reasonable, but the authors should describe a more explicit method for the narrative synthesis, including how studies were grouped by population, intervention type, outcome, and study design.

Results

Strengths

The authors provide a PRISMA flow diagram and a detailed Appendix summarizing study characteristics, including design, objectives, population, location, and main findings. The manuscript also recognizes the considerable heterogeneity in sample size, recruitment procedures, intervention characteristics, and attrition.

Suggestions

The Results section should be reorganized around the review question.

At present, results from unemployed populations are combined with findings from women with cancer, university students, general adult populations, meditation participants, and other groups. For example, the manuscript uses findings from clinical populations to support statements regarding mindfulness, psychological well-being, and SOC before returning to the unemployed population.

I strongly recommend separating:

evidence directly obtained from unemployed participants;
evidence from other populations that may provide only indirect or contextual support.

The conclusions regarding effectiveness in unemployed people should be based only on the first category.

The characteristics table would also be considerably more informative if it included the intervention, comparator, duration, outcome measures, main quantitative findings, and risk-of-bias assessment for each study.

Discussion

Strengths

The Discussion appropriately recognizes the scarcity of studies specifically evaluating interventions among unemployed people and identifies important differences in intervention duration, delivery format, instructor involvement, and follow-up.

The recognition that no medium- or long-term follow-up was available in the unemployed population is particularly relevant.

Suggestions

The central distinction between direct and indirect evidence needs to be carried throughout the Discussion. Evidence from cancer patients, students, workers, or general populations may help explain plausible mechanisms, but it should not be used to infer effectiveness in unemployed people.

The most important conclusion of this review may in fact be that the current direct evidence is insufficient to determine whether mindfulness improves quality of life or sense of coherence among unemployed adults. This finding is scientifically valuable and should be emphasized rather than compensated for by extrapolating findings from other populations.

The discussion should also integrate study quality and risk of bias more explicitly when weighing the strength of the available evidence.

Conclusions

Strengths

The authors correctly emphasize the need for additional research on interventions aimed at protecting the physical and mental health of unemployed people and recognize the potential role of health-promotion approaches.

Suggestions

The conclusions currently go beyond what the included evidence can support.

The statement that mindfulness “can be a useful tool” for improving quality of life and sense of coherence among unemployed people should be expressed more cautiously because the review itself demonstrates that direct evidence in this population is scarce.

In addition, the proposal for routine communication of information about newly unemployed individuals between employment offices, health centres, and mental-health services is not directly derived from the reviewed evidence and raises important privacy and data-protection considerations. I would recommend removing this specific recommendation or clearly presenting it as a speculative policy proposal requiring separate ethical, legal, and empirical evaluation.

A more evidence-based conclusion would emphasize that current findings are insufficient to establish the effectiveness of mindfulness for improving quality of life or SOC specifically among unemployed people, while preliminary findings justify well-designed controlled studies in this population.

Overall evaluation

This systematic review addresses a relevant and insufficiently studied topic and has several positive features, including PROSPERO registration, PRISMA reporting, searches across multiple databases, consideration of the salutogenic framework, and an effort to examine intervention characteristics.

However, the main methodological concern is the mismatch between the stated review question and the included evidence. The review is presented as an evaluation of mindfulness among unemployed people, but more than half of the included studies involve other populations, and the eligibility criteria explicitly allowed studies without an unemployed population in one of the searches. In addition, observational and intervention studies are synthesized together despite supporting different types of inference.

The review would be considerably strengthened by establishing a coherent eligibility framework, separating direct from indirect evidence, clarifying the screening and extraction process, making the additional search reproducible, presenting study-level risk-of-bias assessments, and aligning the conclusions with the limited direct evidence available for unemployed populations.

These issues are substantial but potentially addressable. Depending on how the authors redefine the scope, some aspects of study selection and synthesis may need to be repeated.

Author Response

Reviewer 1

Title

Comment: The title should be reconsidered once the scope of the review has been clarified. At present, it suggests that the included evidence specifically concerns unemployed people, whereas a substantial proportion of the included studies involve other populations.

Response: We sincerely appreciate this important observation. We agreed with the reviewer that the scope needed to be made clearer. The title has been reframed as “Mindfulness in unemployment and sense of coherence: a systematic review of quality of life and indirect evidence”, thereby explicitly incorporating inactive populations and sense of coherence rather than presenting the review as exclusively concerning unemployed people.

Abstract

Comment: The Abstract should distinguish direct evidence from unemployed populations from evidence obtained from other populations and should temper conclusions.

Response: Thank you for this valuable recommendation. The Abstract has been substantially revised. It now states that direct evidence from unemployed or inactive populations was limited and heterogeneous, that these studies mainly assessed psychological distress or related outcomes rather than quality of life specifically, and that evidence concerning SOC was predominantly indirect and derived from other populations. The conclusion now states that current evidence is insufficient to establish effectiveness specifically in unemployed or inactive populations and that differences in populations, interventions and study designs limit applicability.

Introduction

Comment: The Introduction could be more focused. Some sections concerning the neurobiological effects of mindfulness and the distinctions among mindfulness, meditation, and yoga are presented rather broadly and could be shortened or expressed more cautiously.

The final rationale should focus more directly on the specific evidence gap: whether mindfulness-based interventions improve quality of life and/or SOC among unemployed adults.

Response: We are grateful for this conceptual clarification. The revised Introduction contains a more focused discussion of mindfulness, meditation and yoga and explicitly notes that their effects cannot necessarily be considered equivalent. The current revised version has removed the mechanistic content regarding neuroplasticity, neuronal connectivity, endorphins, serotonin, and the parasympathetic nervous system.

The distinction between salutogenesis and sense of coherence has also been clarified, with salutogenesis presented as the broader theoretical framework and SOC as a specific construct through which the salutogenic dimension is assessed.

The rationale has also been refocused on the limited evidence concerning mindfulness, quality of life and SOC in the context of unemployment.

Method

Comment: The eligibility criteria are not fully consistent with the review question. The primary objective concerns unemployed people, yet the authors explicitly state that unemployment was not required for the second search equation. In addition, eligible interventions include mindfulness, meditation, yoga, and other breathing-based techniques. This results in a very heterogeneous evidence base that extends substantially beyond the population and intervention defined in the research question.

The authors should define a coherent eligibility framework specifying population, intervention/exposure, comparator, outcomes, and study design. If the review is genuinely intended to evaluate effectiveness among unemployed people, the synthesis should be restricted accordingly.

Response: We sincerely appreciate this observation. Rather than restricting the second search to unemployed populations, we retained the two-strand design and clarified its rationale. The revised Methods state that the first search addressed quality of life in unemployed or inactive populations, whereas the second addressed SOC across the populations represented in the available literature. The manuscript further explains that employment-status terms were initially considered for the second strategy but yielded no results and were therefore removed. The distinction was maintained throughout study selection and synthesis.

Comment: Study selection and data extraction appear to have been performed by a single reviewer. The manuscript states that “a peer reviewer performed this task independently.” For a systematic review, study screening and preferably data extraction should involve at least two reviewers or an independent verification procedure to minimize selection and extraction errors. The authors should clarify exactly how many reviewers participated and how disagreements were managed.

Response: Thank you for identifying this ambiguity. The revised Methods now state that study selection, data extraction and methodological quality assessment were independently performed by two reviewers. Disagreements were resolved through discussion and consensus, and a third reviewer was consulted when consensus could not be reached. The revised Abstract also reports that study selection, data extraction and risk-of-bias assessment were conducted independently by two reviewers.

Comment: The additional “free search” yielding 542 records is insufficiently described and therefore difficult to reproduce. The authors should specify precisely what this procedure involved—e.g., citation searching, websites, reference-list screening—and how these records were identified, screened, and deduplicated.

Response: We are grateful for this recommendation. The revised Methods/Results now describe the additional search as screening the reference lists of studies selected from the primary database searches and following relevant citations identified during this process. The manuscript states that the same eligibility and exclusion criteria were applied and that duplicates and ineligible records were removed.

Comment: The review aims to evaluate intervention effectiveness, yet it includes cross-sectional studies, case-control studies, longitudinal observational studies, and even a clinical case alongside randomized and quasi-experimental interventions. Observational associations between mindfulness, SOC, and psychological outcomes cannot provide the same evidence regarding intervention effectiveness as controlled intervention studies. These designs should therefore be clearly separated in the synthesis.

Response: Thank you for this important methodological point. The revised Results distinguish the evidence strands and separately describe intervention studies and observational studies within the SOC evidence. The revised Discussion likewise distinguishes direct evidence in unemployed/inactive populations from indirect evidence in other populations and explicitly states that observational and heterogeneous evidence cannot establish a definitive causal conclusion for unemployed populations.

Comment: Although JBI critical appraisal tools were reportedly used, the manuscript does not provide sufficiently detailed study-level risk-of-bias results. A table or figure showing the appraisal of each included study should be provided, and methodological quality should be considered explicitly when interpreting the findings rather than merely reported globally.

Response: We sincerely appreciate this recommendation. Appendix B has been added to provide study-level risk-of-bias information, including the study design, the number of Yes/No/Unclear appraisal items. Section 3.5 explains that the overall judgements are a reviewer-based synthesis of the individual appraisal items and reports heterogeneous methodological quality, with most empirical studies judged to have moderate risk of bias and three quasi-experimental studies judged to have high risk of bias. The manuscript also states that these findings were considered when interpreting the evidence.

Comment: The decision not to perform a meta-analysis because of heterogeneity is reasonable, but the authors should describe a more explicit method for the narrative synthesis, including how studies were grouped by population, intervention type, outcome, and study design.

Response: Thank you for this constructive suggestion. The revised Methods explicitly state that, because the review had two distinct objectives, the two search strategies were analysed as two distinct bodies of evidence and that no meta-analysis was conducted because of substantial variability in study characteristics, endpoints and sample sizes. Within these two evidence strands, the Results and Appendix A describe the studies according to population, intervention or exposure, study design, duration/follow-up and assessment measures. The Results are subsequently structured into the selection of studies, direct evidence in unemployed/inactive populations, evidence concerning mindfulness and SOC, intervention characteristics, and risk of bias.

Results

Comment: Results from unemployed populations should be separated from evidence from other populations.

Response: We greatly appreciate this recommendation. The revised Results explicitly distinguish studies directly involving unemployed or inactive populations from evidence concerning SOC derived from other populations. Section 3.3 states that the SOC evidence is heterogeneous and that not all studies directly examined the relationship between mindfulness and SOC. The manuscript concludes that these findings cannot be directly generalized to unemployed or inactive populations.

Discussion

Comment: The central distinction between direct and indirect evidence needs to be carried throughout the Discussion. Evidence from cancer patients, students, workers, or general populations may help explain plausible mechanisms, but it should not be used to infer effectiveness in unemployed people.

The discussion should also integrate study quality and risk of bias more explicitly when weighing the strength of the available evidence.

Response: Thank you for this important observation. The revised Discussion contains separate sections on quality of life in unemployed or inactive populations and mindfulness-related practices and SOC. It explicitly states that direct evidence is limited and heterogeneous, that indirect findings from other populations cannot be directly extrapolated to unemployed populations, and that the heterogeneity and risk of bias limit the certainty with which effects can be inferred.

Conclusions

Comment: The conclusions currently go beyond what the included evidence can support.

Response: We sincerely appreciate this recommendation. The revised Conclusions now state that direct evidence is insufficient to establish a clear effect on quality of life in unemployed populations and that the predominantly indirect SOC evidence does not permit definitive conclusions regarding causality or applicability to unemployed populations. The overall conclusion states that the available evidence is insufficient to establish effectiveness and calls for further well-designed studies specifically targeting these populations.

We agree that the previous wording was too prescriptive and could be interpreted as recommending routine sharing of personal information between employment offices and health centres without addressing the relevant ethical, legal and empirical considerations. We have therefore removed the proposal for routine communication and information sharing from the conclusions. The conclusions now focus on the need for further research and on the potential role of health-promotion interventions, including mindfulness, without making specific recommendations regarding inter-institutional information sharing.

Reviewer 2 Report

Comments and Suggestions for Authors

Summary of the Manuscript
This manuscript reports a PROSPERO-registered systematic review that searched five databases (PubMed, Scopus, Web of Science, Embase, CINAHL) and conducted a supplementary citation/website search, following PRISMA 2020 reporting guidance. From 413 database records and 542 additional records identified through other methods, the authors included 16 studies published between 2021 and 2025. The stated aim is to evaluate the effectiveness of mindfulness interventions on quality of life and salutogenic effects (sense of coherence, SOC) in unemployed people, with a secondary aim of characterising the methodology of these interventions. The authors conclude that mindfulness broadly improves psychological well-being and that SOC mediates mental health outcomes, while noting a scarcity of research directly targeting the unemployed population. The topic is timely and clinically relevant — unemployment is a well-documented psychosocial stressor, and nursing/community health practice would benefit from a synthesis of mindfulness-based approaches. The manuscript is generally well organised (Introduction, Methods, Results, Discussion, Conclusions, Limitations) and uses the PRISMA 2020 flow diagram.

However, I identified several methodological and internal consistency issues—many of them quantitative and directly verifiable within the manuscript—that should be resolved before the paper is suitable for publication. These are detailed below as major and minor comments, presented in the order in which the corresponding text appears in the manuscript, with page and, where useful, line numbers from the PDF as submitted.

Major Comments

Comment 1 (Title / Abstract / Highlights vs. Section 2.1 (p. 4, lines 181–183) and Appendix A)
The review's eligibility criteria are not uniform across its two search strands. Section 2.1 states: “In the first search equation, it was required that the population studied be of working age and unemployed for work reasons, this requirement was not necessary in the second equation” (the SOC-focused search). In practice, fewer than half of the 16 included studies enrolled unemployed participants. By my count in Appendix A, only 7 of the 16 studies involve unemployed samples; the remainder involve women with breast or cervical cancer, university/nursing students, entrepreneurship-training participants in India, injured athletes, and yoga/Pilates practitioners in Germany/Austria/Switzerland.

Yet the title, running head, highlights, and abstract all frame the review as specifically about “unemployed people”. A reader relying on the title or abstract alone would reasonably expect the evidence base to be predominantly about unemployment, which it is not. I recommend that the authors either (a) restructure the eligibility criteria so both search strands require the unemployed population, narrowing the review accordingly, or (b) retain the two-strand design but rename or reframe the paper (title, highlights, abstract, and conclusions) to make clear that it synthesises two distinct bodies of evidence — mindfulness and quality of life specifically in unemployed people, and sense of coherence more broadly across populations — and report findings separately for each so the two evidence bases are not blended into single narrative claims.

Comment 2 (Section 2.2 Study Selection and Data Extraction (p. 4, line 190) and Abstract)
The manuscript states, “A peer reviewer performed this task independently,” indicating that database screening, study selection, data extraction, and the JBI risk-of-bias appraisal were all carried out by a single reviewer. Current systematic-review methodology (Cochrane Handbook; PRISMA 2020 items 8–9) recommends that screening and data extraction be performed independently by at least two reviewers, with disagreements resolved by discussion or a third reviewer, because single-reviewer screening carries a materially higher risk of selection and extraction error.

This substantive limitation is not currently disclosed anywhere in the manuscript, including in Section 5.1 (Limitations). At a minimum, the authors should add it as an explicit, named limitation. Ideally, a second reviewer should independently re-screen a sample of the excluded and included records and report an agreement statistic (e.g., Cohen's kappa) before resubmission.

Comment 3 (Methods 2.2 (p. 5, lines 195–197) vs. Results/Appendix A and the PRISMA 2020 checklist (Supplementary File))
The Methods state that “methodological quality and risk of bias were appraised using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design,” and a single sentence summarises the aggregate findings (concern about lack of blinding of outcome assessors). However, no per-study risk-of-bias results, scores, or summary table or figure appear anywhere in the manuscript or in Appendix A — Appendix A's columns are limited to Title, Author, Study Type, Aims, Location, Population, and Results.

Notably, the authors' completed PRISMA 2020 checklist (submitted as supplementary material) lists the location of item 18 (“Risk of bias in studies”) as “page 29,” which does not exist in this 17-page manuscript. Several other checklist entries have the same problem (e.g., item 23a/b/c “Discussion” limitations are located at “15–18” and “19–20”; “Support” at “21”). This strongly suggests that the PRISMA checklist submitted with this manuscript was not updated to match the manuscript's actual pagination and content. Together with the missing risk-of-bias results, this indicates that the risk-of-bias assessment was not, in fact, fully reported. Please add the missing per-study risk-of-bias results (a summary table is standard) and resubmit a PRISMA 2020 checklist with page references verified against the submitted manuscript.

Comment 4 (Figure 1 / PRISMA 2020 flow diagram (p. 5) and Section 3.1 (p. 5, lines 212–215))
The numbers in Figure 1 do not align with the text or the stated total of 16 included studies. For the “identification via other methods” arm: 114 reports were “assessed for eligibility,” of which 72 were excluded for “inadequate inclusion criteria” and 38 for “not measuring the intervention effect.” That is 110 excluded, leaving 4 (114 − 72 − 38 = 4), not the “three more articles” reported in the text. Using 4 here would also make the overall total 17 (13 from the database search + 4), not the 16 reported throughout the manuscript.
Separately, the “other methods” arm of Figure 1 omits a screening/exclusion step: it goes directly from “Records identified from other methods (n = 542)” to “Reports sought for retrieval (n = 125)” with no box explaining what happened to the other 417 records (the parallel database arm, by contrast, shows an explicit “Records screened” → “Records excluded” step). PRISMA 2020 requires each stage of exclusion to be accounted for. Please recheck and correct the counts in Figure 1 (and Section 3.1) so that they reconcile arithmetically end to end.

Comment 5 (Discussion, p. 8, lines 343–358, vs. Appendix A)Several Discussion sentences characterising “the articles targeting the unemployed population” cite references 47 and 49 (e.g., “standard 8-week programmes (28,36,47,49)”; “pre- and post-intervention assessments (33,35,49)”; “expert instructor... (33,49)”), yet Appendix A lists only the 16 included studies, corresponding to reference numbers 28–43. References 47 and 49 fall outside that range and do not appear in Appendix A. Reference 49 (Foale et al.) is described in the reference list as “a realist review” — i.e., a synthesis of other studies rather than a primary study — which makes its use as an individual data point on intervention duration, timing of assessment, or instructor qualifications conceptually inconsistent with the rest of the paragraph.

Please verify these citations. Either Appendix A is missing two studies that should be included among the 16, or references 47 and 49 were cited in error and should be replaced with the correct in-scope reference numbers.

Comment 6 (Results, p. 7, line 297)
“Only three of the articles targeting the unemployed population provide pre- and post-intervention analyses (33,35), but none of them includes medium- or long-term follow-up.” However, only two reference numbers are cited for a claim of three articles. Please add the missing citation or correct “three” to “two.”

Comment 7 (Discussion / Conclusions — certainty of evidence)
No formal certainty-of-evidence assessment (e.g., GRADE, or even a structured qualitative equivalent) is reported, and the authors' own PRISMA-for-Abstracts checklist (supplementary file, item 6/9) marks the relevant items as not addressed. Given the very wide heterogeneity documented in the manuscript itself (original sample sizes ranging from 40 to 115,936; dropout rates from 5% to 84.45%; designs ranging from case reports to RCTs), the Conclusions currently read more confidently (“the results suggest mindfulness improves psychological well-being and resilience”) than the heterogeneity of the underlying evidence base would support. I recommend adding an explicit, appropriately hedged certainty statement and tempering the language in the Abstract and Conclusions accordingly.

Comment 8 (Conclusions, p. 9, lines 382–392)
The manuscript proposes routine data-sharing between job-search/employment offices and health/mental-health centres, so that health centres would automatically “be informed about the details of a new unemployed person” and nurses could proactively conduct an anamnesis. This is a substantive health-policy recommendation involving personal data on a vulnerable population's employment status, yet the manuscript does not address the consent, data-protection, or legal basis this would require (e.g., under the EU General Data Protection Regulation, which would apply given the authors' Spanish affiliations). The review's evidence base, moreover, concerns the effectiveness of mindfulness interventions, not the feasibility, acceptability, or ethics of inter-agency data sharing, so this recommendation is not directly supported by the review's own findings. I recommend either removing this proposal, substantially qualifying it, or explicitly flagging it as a policy idea that would require separate ethical, legal, and feasibility evaluation.

3. Minor Comments
• Author byline (p. 1, line 4): “QUIROGA-SÁNCHEZ and Enedina 6” deviates from the “SURNAME, Firstname” pattern used for all other authors and, as written, could be misread as two separate people. Please confirm that it should read “QUIROGA-SÁNCHEZ, Enedina 6.”
• PROSPERO registration number (p. 4, line 158): “CRD420251179584” has an extra digit compared with the standard CRD42-YYYY-NNNNNN pattern used for PROSPERO registrations (compare, e.g., CRD42020182773). Please double-check that this number resolves to the correct, live PROSPERO record before publication.
• Abstract, Methods sentence: “All type of studies published the last five years was accepted” — subject-verb agreement; suggest “All types of studies published in the last five years were accepted.”
• Abstract, Methods sentence: “...except systematic reviews and meta-analyses, aimed at the unemployed population and analysing mindfulness intervention effectiveness” is ambiguously worded — as written it can be read as excluding only reviews “aimed at the unemployed population,” which is not the intended meaning. Please rephrase for clarity.
• Abstract, Results: “Most of them were cross-sectional studies conducted in the United States” overstates the actual proportions given in the body text (5/16 = 31% cross-sectional; 4/16 = 25% US-based are the largest single categories, not majorities). Suggest “the most common design was cross-sectional” / “the largest single group of studies was conducted in the United States.”
• Abstract, Conclusions: the paragraph opens with a general claim about mindfulness benefiting “people experiencing anxiety, depression or pain,” then closes by noting a lack of research on the unemployed specifically — the two halves sit awkwardly together and could be reordered so the abstract foregrounds the review's actual, population-specific finding (i.e., the evidence gap for unemployed people).
• Section 3.1 (p. 5, line 207): “Thirteen articles were eventually accepted because the remaining 72 needed to meet the inclusion criteria” is logically inverted; suggest “...while the remaining 72 did not meet the inclusion criteria.”
• Section 5.1 Limitations does not mention the English/Spanish language restriction (Section 2.1) as a possible source of language/selection bias; consider adding it alongside the other limitations already listed.
• Introduction, p. 3 (lines ~121–129): the paragraph on neuroplasticity, hypothalamic/frontal-lobe connectivity, and endorphin/serotonin release is fairly mechanistic relative to the review's actual outcomes (QoL, SOC) and could be condensed; please also double-check that references 21–22 directly support these specific mechanistic claims.
• Several included studies sit at the periphery of the stated topic (e.g., Abdul Waheed et al. 2024 on entrepreneurial intentions in India; Uzdil & Günaydın 2022 on nursing students' academic self-efficacy; Bös et al. 2023 on yoga/Pilates practitioners). A sentence in Methods explicitly justifying why these populations/outcomes were considered eligible under the SOC search arm would help readers judge the review's scope (see also Major Comment 1).
• Consider adding a summary table listing the specific SOC/QoL instruments used in each of the 16 studies (e.g., SOC-29, SOC-13, WHOQOL variants)—Appendix A currently reports only narrative results, and instrument heterogeneity is itself relevant to the paper's conclusions about methodological heterogeneity.

Comments on the Quality of English Language

The English could be improved to express the research more clearly.

Author Response

Major Comment 1
Comment: (Title / Abstract / Highlights vs. Section 2.1 (p. 4, lines 181–183) and Appendix A)
The review's eligibility criteria are not uniform across its two search strands. Section 2.1 states: “In the first search equation, it was required that the population studied be of working age and unemployed for work reasons, this requirement was not necessary in the second equation” (the SOC-focused search). In practice, fewer than half of the 16 included studies enrolled unemployed participants. By my count in Appendix A, only 7 of the 16 studies involve unemployed samples; the remainder involve women with breast or cervical cancer, university/nursing students, entrepreneurship-training participants in India, injured athletes, and yoga/Pilates practitioners in Germany/Austria/Switzerland.
Yet the title, running head, highlights, and abstract all frame the review as specifically about “unemployed people”. A reader relying on the title or abstract alone would reasonably expect the evidence base to be predominantly about unemployment, which it is not. I recommend that the authors either (a) restructure the eligibility criteria so both search strands require the unemployed population, narrowing the review accordingly, or (b) retain the two-strand design but rename or reframe the paper (title, highlights, abstract, and conclusions) to make clear that it synthesises two distinct bodies of evidence — mindfulness and quality of life specifically in unemployed people, and sense of coherence more broadly across populations — and report findings separately for each so the two evidence bases are not blended into single narrative claims.
Response: We sincerely thank the reviewer for this detailed and important observation. The revised manuscript retains the two-strand design but explicitly explains that the first search addresses quality of life in unemployed or inactive populations and the second addresses SOC across the populations represented in the literature. The title, highlights and Abstract have been reframed accordingly, and the Results and Discussion distinguish direct from indirect evidence. The Abstract now explicitly states that SOC evidence is predominantly indirect and derived from other populations.
Major Comment 2
Comment: (Section 2.2 Study Selection and Data Extraction (p. 4, line 190) and Abstract)
The manuscript states, “A peer reviewer performed this task independently,” indicating that database screening, study selection, data extraction, and the JBI risk-of-bias appraisal were all carried out by a single reviewer. Current systematic-review methodology (Cochrane Handbook; PRISMA 2020 items 8–9) recommends that screening and data extraction be performed independently by at least two reviewers, with disagreements resolved by discussion or a third reviewer, because single-reviewer screening carries a materially higher risk of selection and extraction error.
This substantive limitation is not currently disclosed anywhere in the manuscript, including in Section 5.1 (Limitations). At a minimum, the authors should add it as an explicit, named limitation. Ideally, a second reviewer should independently re-screen a sample of the excluded and included records and report an agreement statistic (e.g., Cohen's kappa) before resubmission.
Response: Thank you for this important clarification request. The revised Methods explicitly state that study selection, data extraction and methodological quality assessment were independently performed by two reviewers, with disagreements resolved by discussion and consensus and a third reviewer consulted when consensus could not be reached. The Abstract also reflects the two-reviewer process.
Major Comment 3
Comment: (Methods 2.2 (p. 5, lines 195–197) vs. Results/Appendix A and the PRISMA 2020 checklist (Supplementary File))
The Methods state that “methodological quality and risk of bias were appraised using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design,” and a single sentence summarises the aggregate findings (concern about lack of blinding of outcome assessors). However, no per-study risk-of-bias results, scores, or summary table or figure appear anywhere in the manuscript or in Appendix A — Appendix A's columns are limited to Title, Author, Study Type, Aims, Location, Population, and Results.
Notably, the authors' completed PRISMA 2020 checklist (submitted as supplementary material) lists the location of item 18 (“Risk of bias in studies”) as “page 29,” which does not exist in this 17-page manuscript. Several other checklist entries have the same problem (e.g., item 23a/b/c “Discussion” limitations are located at “15–18” and “19–20”; “Support” at “21”). This strongly suggests that the PRISMA checklist submitted with this manuscript was not updated to match the manuscript's actual pagination and content. Together with the missing risk-of-bias results, this indicates that the risk-of-bias assessment was not, in fact, fully reported. Please add the missing per-study risk-of-bias results (a summary table is standard) and resubmit a PRISMA 2020 checklist with page references verified against the submitted manuscript.
Response: We are very grateful for this recommendation. Appendix B has been added and reports study-level JBI appraisal information and overall judgements. Section 3.5 also explains how the overall judgements were derived and how risk of bias was incorporated into interpretation. The current manuscript additionally states that methodological heterogeneity and risk of bias limit the certainty of the evidence. The updated PRISMA supplementary checklist is included with the revised manuscript.
Major Comment 4
Comment: (Figure 1 / PRISMA 2020 flow diagram (p. 5) and Section 3.1 (p. 5, lines 212–215))
The numbers in Figure 1 do not align with the text or the stated total of 16 included studies. For the “identification via other methods” arm: 114 reports were “assessed for eligibility,” of which 72 were excluded for “inadequate inclusion criteria” and 38 for “not measuring the intervention effect.” That is 110 excluded, leaving 4 (114 − 72 − 38 = 4), not the “three more articles” reported in the text. Using 4 here would also make the overall total 17 (13 from the database search + 4), not the 16 reported throughout the manuscript.
Separately, the “other methods” arm of Figure 1 omits a screening/exclusion step: it goes directly from “Records identified from other methods (n = 542)” to “Reports sought for retrieval (n = 125)” with no box explaining what happened to the other 417 records (the parallel database arm, by contrast, shows an explicit “Records screened” → “Records excluded” step). PRISMA 2020 requires each stage of exclusion to be accounted for. Please recheck and correct the counts in Figure 1 (and Section 3.1) so that they reconcile arithmetically end to end.
Response: Thank you very much for identifying this important numerical issue. To ensure the differentiation between the two search strategies and to complete the information regarding the search in other sources, the PRISMA flow diagram has been updated.
Major Comment 5
Comment: (Discussion, p. 8, lines 343–358, vs. Appendix A)
Several Discussion sentences characterising “the articles targeting the unemployed population” cite references 47 and 49 (e.g., “standard 8-week programmes (28,36,47,49)”; “pre- and post-intervention assessments (33,35,49)”; “expert instructor... (33,49)”), yet Appendix A lists only the 16 included studies, corresponding to reference numbers 28–43. References 47 and 49 fall outside that range and do not appear in Appendix A. Reference 49 (Foale et al.) is described in the reference list as “a realist review” — i.e., a synthesis of other studies rather than a primary study — which makes its use as an individual data point on intervention duration, timing of assessment, or instructor qualifications conceptually inconsistent with the rest of the paragraph.
Please verify these citations. Either Appendix A is missing two studies that should be included among the 16, or references 47 and 49 were cited in error and should be replaced with the correct in-scope reference numbers.
Response: Thank you for this careful citation check. We reviewed both references against the eligibility criteria and the final set of included studies. Schmitt et al. was not included among the 16 primary studies because it investigated a mindfulness intervention among employees experiencing organisational uncertainty, rather than an unemployed or inactive population, and therefore did not meet the population criteria for the first search. Foale et al. was not included because it is a realist review rather than a primary study and therefore did not meet the study-design criteria for inclusion. Consequently, neither study contributes to the 16 studies included in the Results or Appendix A.
Major Comment 6
Comment: (Results, p. 7, line 297)
“Only three of the articles targeting the unemployed population provide pre- and post-intervention analyses (33,35), but none of them includes medium- or long-term follow-up.” However, only two reference numbers are cited for a claim of three articles. Please add the missing citation or correct “three” to “two.”
Response: Thank you for identifying this inconsistency. We have revised the statement to accurately reflect the evidence and the corresponding references. Specifically, the text now states that only a minority of studies targeting unemployed populations included pre- and post-intervention assessments, and the statement is supported by the studies that actually reported this type of assessment. The wording and citations have therefore been checked against the characteristics of the included studies to avoid overstating the available evidence.
Major Comment 7
Comment: (Discussion / Conclusions — certainty of evidence)
No formal certainty-of-evidence assessment (e.g., GRADE, or even a structured qualitative equivalent) is reported, and the authors' own PRISMA-for-Abstracts checklist (supplementary file, item 6/9) marks the relevant items as not addressed. Given the very wide heterogeneity documented in the manuscript itself (original sample sizes ranging from 40 to 115,936; dropout rates from 5% to 84.45%; designs ranging from case reports to RCTs), the Conclusions currently read more confidently (“the results suggest mindfulness improves psychological well-being and resilience”) than the heterogeneity of the underlying evidence base would support. I recommend adding an explicit, appropriately hedged certainty statement and tempering the language in the Abstract and Conclusions accordingly.
Response: We sincerely appreciate this recommendation. We have revised the Limitations to explicitly state that no formal assessment of the certainty of the evidence was conducted, which limits the strength of the conclusions. We have also clarified that methodological heterogeneity and risk of bias limit the certainty with which the findings can be inferred for unemployed or inactive populations. In addition, the Abstract and Conclusions have been substantially tempered and no longer make broad claims regarding the effectiveness of mindfulness. Instead, they state that current evidence is insufficient to establish its effectiveness for improving quality of life or sense of coherence specifically in unemployed or inactive populations, while indirect evidence has limited applicability.
Major Comment 8
Comment: (Conclusions, p. 9, lines 382–392)
The manuscript proposes routine data-sharing between job-search/employment offices and health/mental-health centres, so that health centres would automatically “be informed about the details of a new unemployed person” and nurses could proactively conduct an anamnesis. This is a substantive health-policy recommendation involving personal data on a vulnerable population's employment status, yet the manuscript does not address the consent, data-protection, or legal basis this would require (e.g., under the EU General Data Protection Regulation, which would apply given the authors' Spanish affiliations). The review's evidence base, moreover, concerns the effectiveness of mindfulness interventions, not the feasibility, acceptability, or ethics of inter-agency data sharing, so this recommendation is not directly supported by the review's own findings. I recommend either removing this proposal, substantially qualifying it, or explicitly flagging it as a policy idea that would require separate ethical, legal, and feasibility evaluation.
Response: Thank you for this important ethical and policy-related observation. We agree that the previous proposal was too prescriptive and could be interpreted as recommending routine sharing of unemployment-related information between employment and health services without considering ethical, legal and feasibility issues. We have therefore removed this proposal from the revised manuscript. The conclusions now focus on the need for further research and on the potential role of health-promotion interventions, including mindfulness, without proposing routine information sharing between employment and health services.

Minor Comments
Comment: Author byline (p. 1, line 4): “QUIROGA-SÁNCHEZ and Enedina 6” deviates from the “SURNAME, Firstname” pattern used for all other authors and, as written, could be misread as two separate people. Please confirm that it should read
Response: The revised author list presents “QUIROGA-SÁNCHEZ, Enedina” in the byline.

Comment: PROSPERO registration number (p. 4, line 158): “CRD420251179584” has an extra digit compared with the standard CRD42-YYYY-NNNNNN pattern used for PROSPERO registrations (compare, e.g., CRD42020182773). Please double-check that this number resolves to the correct, live PROSPERO record before publication.
Response: Thank you for your comment. We have checked, and the code CRD420251179584 corresponds to the registration in PROSPERO.

Comment: Abstract, Methods sentence: “All type of studies published the last five years was accepted” — subject-verb agreement; suggest “All types of studies published in the last five years were accepted.”
Response: Thank you for the grammatical correction. It has been modified in the abstract to ensure it is written correctly.

Comment: Abstract, Methods sentence: “...except systematic reviews and meta-analyses, aimed at the unemployed population and analysing mindfulness intervention effectiveness” is ambiguously worded — as written it can be read as excluding only reviews “aimed at the unemployed population,” which is not the intended meaning. Please rephrase for clarity.
Response: Thank you for your proposal. The revised Abstract no longer uses the original formulation and instead states that the review used two search strategies addressing the specified evidence strands.

Comment: Abstract, Results: “Most of them were cross-sectional studies conducted in the United States” overstates the actual proportions given in the body text (5/16 = 31% cross-sectional; 4/16 = 25% US-based are the largest single categories, not majorities). Suggest “the most common design was cross-sectional” / “the largest single group of studies was conducted in the United States.”
Response: The revised Abstract no longer states that most studies were cross-sectional or conducted in the United States. It instead reports the number of included studies and the direct/indirect evidence distinction. Thank you for your proposal.

Comment: Abstract, Conclusions: the paragraph opens with a general claim about mindfulness benefiting “people experiencing anxiety, depression or pain,” then closes by noting a lack of research on the unemployed specifically — the two halves sit awkwardly together and could be reordered so the abstract foregrounds the review's actual, population-specific finding (i.e., the evidence gap for unemployed people).
Response: We sincerely appreciate this recommendation. The revised Abstract now foregrounds the limited and heterogeneous direct evidence in unemployed or inactive populations and concludes that current evidence is insufficient to establish effectiveness specifically in these populations.

Comment: Section 3.1 (p. 5, line 207): “Thirteen articles were eventually accepted because the remaining 72 needed to meet the inclusion criteria” is logically inverted; suggest “...while the remaining 72 did not meet the inclusion criteria.”
Response: Thank you for this recommendation. The revised Results state that the remaining articles did not meet the inclusion criteria and provide reasons for exclusion.

Comment: Section 5.1 Limitations does not mention the English/Spanish language restriction (Section 2.1) as a possible source of language/selection bias; consider adding it alongside the other limitations already listed.
Response: The current Limitations section discusses several sources of heterogeneity and uncertainty, including the absence of a formal certainty-of-evidence assessment and the indirect nature of the second search. It also identifies the English/Spanish restriction as a possible source of language or selection bias.

Comment: Introduction, p. 3 (lines ~121–129): the paragraph on neuroplasticity, hypothalamic/frontal-lobe connectivity, and endorphin/serotonin release is fairly mechanistic relative to the review's actual outcomes (QoL, SOC) and could be condensed; please also double-check that references 21–22 directly support these specific mechanistic claims.
Response: The revised Introduction contains a clearer distinction between mindfulness, meditation and yoga. The mechanistic paragraph concerning neuroplasticity, neural connectivity and neurotransmitter release remains has been delate.

Comment: Several included studies sit at the periphery of the stated topic (e.g., Abdul Waheed et al. 2024 on entrepreneurial intentions in India; Uzdil & Günaydın 2022 on nursing students' academic self-efficacy; Bös et al. 2023 on yoga/Pilates practitioners). A sentence in Methods explicitly justifying why these populations/outcomes were considered eligible under the SOC search arm would help readers judge the review's scope (see also Major Comment 1).
Response: The revised Methods explicitly explains that the second search did not require an employment-status condition because its aim was to identify evidence concerning SOC across the populations represented in the included studies. The Results and Limitations also explicitly identify this as indirect evidence that cannot be generalized directly to unemployed adults.

Comment: Consider adding a summary table listing the specific SOC/QoL instruments used in each of the 16 studies (e.g., SOC-29, SOC-13, WHOQOL variants)—Appendix A currently reports only narrative results, and instrument heterogeneity is itself relevant to the paper's conclusions about methodological heterogeneity.
Response: Appendix A has been expanded and now includes an assessment-measures column. The table identifies instruments including SOC-13, SOC-29, MAAS, PHQ-2/PHQ-9, GAD-2/GAD-7, DERS-SF, WHO-5, BSI-18 and other measures used in the included studies. Thank you for your proposal.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the substantial revision of the manuscript. The revised version has improved considerably, and the authors have satisfactorily addressed most of the concerns raised in the previous review. In particular, the distinction between direct evidence from unemployed or economically inactive populations and indirect evidence from other populations is now clearly established throughout the manuscript. The study-selection and data-extraction procedures have also been strengthened by clarifying the involvement of two independent reviewers, and the conclusions are now appropriately cautious regarding the limited direct evidence available.

Two points remain:

The eligibility of some studies within the second evidence strand should be reconsidered. The stated objective is to examine the relationship between mindfulness-related practices and sense of coherence (SOC), yet some included studies do not assess both constructs. For example, Taha et al. examines SOC and depressive symptoms without mindfulness as an intervention or exposure, whereas Abdul Waheed et al. examines mindfulness and entrepreneurial outcomes without SOC. Such studies cannot directly inform the stated mindfulness–SOC relationship and should either be removed from this evidence synthesis or clearly treated only as external contextual literature. The same principle should be applied to any included non-empirical or otherwise non-contributory records.
The additional citation/reference-list search is now described more clearly, but its numerical flow should be reported transparently. Please specify how many additional records were identified, screened, excluded and ultimately included, and ensure that these figures are fully represented in the PRISMA flow diagram.

Overall, the manuscript has been substantially strengthened, and the main concerns from the previous review have been addressed. Once these remaining issues are clarified, the review would be considerably more methodologically coherent and transparent.

Author Response

Comment: The eligibility of some studies within the second evidence strand should be reconsidered. The stated objective is to examine the relationship between mindfulness-related practices and sense of coherence (SOC), yet some included studies do not assess both constructs. For example, Taha et al. examines SOC and depressive symptoms without mindfulness as an intervention or exposure, whereas Abdul Waheed et al. examines mindfulness and entrepreneurial outcomes without SOC. Such studies cannot directly inform the stated mindfulness–SOC relationship and should either be removed from this evidence synthesis or clearly treated only as external contextual literature. The same principle should be applied to any included non-empirical or otherwise non-contributory records.

Response: Thank you for this important methodological comment. We agree that studies included in the second evidence strand should directly contribute to the stated objective of examining the relationship between mindfulness-related practices and sense of coherence (SOC). Following this recommendation, Taha et al. and Abdul Waheed et al. have been removed from the evidence synthesis because they did not assess both mindfulness-related practices and SOC and therefore could not directly inform this objective. The eligibility and contribution of the remaining studies were also reviewed accordingly. The Results and Discussion have been revised to ensure that the evidence synthesized for the mindfulness–SOC objective is restricted to studies that contribute directly to this relationship.

Comment: The additional citation/reference-list search is now described more clearly, but its numerical flow should be reported transparently. Please specify how many additional records were identified, screened, excluded and ultimately included, and ensure that these figures are fully represented in the PRISMA flow diagram.

Response: Thank you for this comment. We agree that the numerical flow of the additional citation/reference-list search should be reported transparently. The revised manuscript now specifies that a total of 542 additional records were screened using the same eligibility and exclusion criteria applied in the primary searches. After removal of 324 duplicates and exclusion of 95 records by title and abstract, 11 records could not be retrieves, and 112 records were assessed for eligibility. Finally, one additional study was included from the additional search in the review.

Reviewer 2 Report

Comments and Suggestions for Authors

I recommend a Minor Revision: the remaining issues are narrow and specific and should not require another full review cycle once addressed and cleared by the journal Editors.

RE: Comment 5 — Discussion cited references (formerly 47, 49; now 40, 41) as if they were included studies

PARTIALLY RESOLVED, MUST BE FULLY RESOLVED

This is the one major comment I'd ask the authors to revisit. Section 4.2 now explicitly states: “evidence from studies that did not meet the eligibility criteria of the present review is considered only as external evidence and does not contribute to the review findings (40,41)” — a direct, welcome acknowledgement that refs 40 (Schmitt) and 41 (Foale, a realist review) are not part of the 16 included studies (Appendix A confirms this: the 16 included studies correspond to refs 24–39).

However, two paragraphs later, Section 4.3 (“Methodological Characteristics of the Interventions”) reuses references 40 and 41 to characterize the unemployed-population studies' intervention duration and assessment timing: “longer programmes were identified (31,33,40,41)”; “alongside face-to-face sessions (25,41)”; “Only a minority of studies targeting the unemployed population included pre- and post-intervention assessments, and none provided medium- or long-term follow-up (25,27,41).” This directly contradicts the disclaimer given in the preceding subsection — ref. 41 is being used again as if it were one of the unemployed-population studies whose methodology the review is characterising. Please replace these three citation instances of (40,41) in Section 4.3 with the correct in-scope study references or explicitly reintroduce the external-evidence caveat at each point.

Minor Comments

Author byline (“QUIROGA-SÁNCHEZ and Enedina 6”): unchanged from v1. Still recommend confirming this should read “QUIROGA-SÁNCHEZ, Enedina 6.” [delete "and"]
PROSPERO registration number format (“CRD420251179584”): unchanged; still one digit longer than the standard CRD42-YYYY-NNNNNN pattern. Please verify against the live PROSPERO record before publication.
The updated PRISMA checklist's page references are now much closer to correct (e.g., risk of bias correctly points to “Appendix B (15–16)”), but several entries (Support, Registration and protocol — listed as page 11) are one page off from their actual location on page 12. Worth a final pass before typesetting, but far better than the previous version's checklist, which pointed to pages that did not exist.

Author Response

Reviewer 2

Major Comment 5

Comment: Discussion cited references (formerly 47, 49; now 40, 41) as if they were included studies

PARTIALLY RESOLVED, MUST BE FULLY RESOLVED

Response: Thank you for identifying this inconsistency. We have carefully reviewed the use of these references throughout the manuscript. Schmitt et al. has been included among the studies of the present review, and its findings have been incorporated into the Results and Discussion as part of the evidence on mindfulness-related practices and sense of coherence. Foale et al. has been removed from the review.

The citations in Section 4.3 have been revised accordingly, and the references have been adjusted throughout the Discussion. The statements describing the methodological characteristics of interventions in unemployed populations are now supported by the appropriate included studies. This revision ensures that the synthesis and interpretation of the included evidence are consistent with the final set of studies included in the review.

Minor Comments

Comment: Author byline (“QUIROGA-SÁNCHEZ and Enedina 6”): unchanged from v1. Still recommend confirming this should read “QUIROGA-SÁNCHEZ, Enedina 6.” [delete "and"]

Response: We have reviewed the name of the author Enedina Quiroga-Sánchez. We have rewritten it to avoid the particle "and"; it no longer appears in our document.

Comment: PROSPERO registration number format (“CRD420251179584”): unchanged; still one digit longer than the standard CRD42-YYYY-NNNNNN pattern. Please verify against the live PROSPERO record before publication.

Response: Thank you for your comment. We have checked, and the code CRD420251179584 corresponds to the registration in PROSPERO. We have included a photo of the record so you can verify it as well.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251179584

Comment: The updated PRISMA checklist's page references are now much closer to correct (e.g., risk of bias correctly points to “Appendix B (15–16)”), but several entries (Support, Registration and protocol — listed as page 11) are one page off from their actual location on page 12. Worth a final pass before typesetting, but far better than the previous version's checklist, which pointed to pages that did not exist.

Response: Thank you very much for your feedback. We have reviewed the page number references in PRISMA 2020 and adjusted the discrepancies.

We again sincerely thank the Editor and Reviewers for their careful and constructive comments. We greatly appreciate the opportunity to further improve our manuscript and believe that the revisions have strengthened its methodological clarity, transparency, and consistency.

Review Reports

Summary of the manuscript and key contributions

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Introduction

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Method

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Overall evaluation

Reviewer 1

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Reviewer 2

Major Comment 5

Minor Comments