Mixed Reality in Undergraduate Mental Health Education: A Systematic Review

Round 1

Reviewer 1 Report

This paper was to review the scientific literature of those studies involving MR and undergraduate mental health education. This article is well-organized and easy for reading in the current version. It is suggested that this article can be accepted in the journal. The reviewer suggested publishing this work with mining suggestions as below: The format in references is not correct. Please modify it based on the journal format. And, please provide supplementary Materials to me.

Thanks a lot.

Author Response

Dear reviewer.

We do really appreciate your kind report about our manuscript.

Please see the attachment, regarding supplementary Materials used.

Kind regards,

Authors.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments

The author discussed a very interesting and important topic. I highly recognize the importance of the topics studied by the author, and read them carefully, so I put forward the following suggestions that need to be modified:

1. The author of the abstract did not express the main findings of this article, and I think the author may need to modify it, focusing on the main findings of this article and its differences from other studies to highlight the significance of this article.

2. The literature in the database used by the author spans a certain period of time, and whether there is significant difference between different periods of time, especially before and after the COVID-19 epidemic. Some countries and regions have taken different measures before and after the COVID-19, and these measures may have different effects on the mental health of undergraduates. This may require the author's attention in the relevant part.

3. In the sample selected by the author, there may be more research on developed countries than on developing countries. Will this affect the applicability of the research conclusions?

Author Response

Dear reviewer.

We do really appreciate your kind report about our manuscript.

Please see below the point-by-point response to each comment suggested.

Kind regards,

Authors.

The author discussed a very interesting and important topic. I highly recognize the importance of the topics studied by the author, and read them carefully, so I put forward the following suggestions that need to be modified:

1. The author of the abstract did not express the main findings of this article, and I think the author may need to modify it, focusing on the main findings of this article and its differences from other studies to highlight the significance of this article.

- Dear reviewer. Thank you very much for pointed out this improvement. We have been modified the abstract, including main findings of this article (page 1, lines 38-42).

2. The literature in the database used by the author spans a certain period of time, and whether there is significant difference between different periods of time, especially before and after the COVID-19 epidemic. Some countries and regions have taken different measures before and after the COVID-19, and these measures may have different effects on the mental health of undergraduates. This may require the author's attention in the relevant part.

 - Once again, thanks a lot for highlighting this enhancement.  We have included this information in Discussion section (page 13, lines 474-481), as well as in limitation section (page 16, lines 648- 651, 654). As our interest was to analyze the published studied during last decade, the COVID-19 pandemic is included in this gap. However, of total records included, only one was published before the pandemic (Chuah et al., 2013).

3. In the sample selected by the author, there may be more research on developed countries than on developing countries. Will this affect the applicability of the research conclusions?

 - We really appreciate this suggestion. This information has been included in the limitation section (page 16, lines 650- 651).

Thank you so much for taking the time to revise this manuscript, and consequently, helping us for its significative improvement.

Reviewer 3 Report

Paper Strengths

-              The methodology of the review is well defined and uses standardized methods (PRISMA)

-              The authors attempt to justify the need for the review (i.e.: considerable attention to improve mental health education through application of MR, lack of a unifying review)

Paper Weaknesses

-              A lack of clarity in the writing, particularly within the Introduction section, may cause the reader to lose focus on the objectives of the paper

-              A lack of literature volume meeting the stated conclusion criteria, thereby limiting the ability to draw inference from the review

-              A lack of focus in the overarching research questions (since both mental health and its utility in education is quite broad), which manifests itself quite often during the manuscript

-              While the manuscript may fall within the broad umbrella of scope of the journal, there are undoubtedly more relevant journals where this could be published (i.e.: those with education or learning technologies as a primary focus).

Recommendations for Improvement

-              Streamline the content presented within the Introduction (i.e.: reduce/condense general background content about the technology, streamline content relevant to the actual study objectives (i.e.: application of MR in mental health education)

-              Give the lack of literature ultimately meeting the inclusion criteria, justify why conference manuscripts were automatically discarded

-              Consider submission to a more relevant journal

Specific Editing Recommendations by Section

Abstract

1)            On line 26 in the abstract, the acronym RCT is presented without definition

2)            As the authors imply heavily in the abstract that the primary contribution of this manuscript is related to the sparseness of relevant literature, it may be good to add quantitative descriptors of the review result (i.e.: i) total # of papers filtered via the stated keyword screen, ii) total # reviewed, etc.) to help support this claim/scope the readers’ expectations (this information is presented within the manuscript itself)

Introduction

1)            It may be worth considering adding some specific content regarding how MR has been used in medical student training, why it has been successful, and what changes are forthcoming (i.e.: adding a bit of more substantial/specific content to P1). I realize that some of this content is covered later (i.e.: Advantages of MR use subsection), but has written the usefulness of this first paragraph is limited.

2)            While I appreciate the effort that the authors have taken to provide background context regarding MR technologies, the text length seems a bit excessive here (particularly given the focus of the paper).  Perhaps consider truncating this sum, or at minimum adding some figures to improve readability.

3)            The wording of the two sentences beginning on line 75 is a bit confusing. Namely, although the title/abstract exclusively refers to applications of MR in mental healthcare education, this phrasing sounds like it is describing clinical applications (especially in the context of the final two lines of the prior paragraph).

4)            Lines 159-160 read atypically as a stand-alone, one sentence paragraph

5)            Regarding the basic research questions, the authors may wish to consider rewording “develop” in question 2 to “deploy” or “utilize,” since the prior seems to imply (in my opinion) changes to the underlying hardware (or firmware) architecture, and not necessarily the utilization of off-the-shelf devices for the stated application

Materials and Methods

1)            The first exclusion criteria seems redundant (i.e.: isn’t it just stating the logical complement of the inclusion criteria on line 180? In general, there seems to be a lot of redundancy between the content presented in the inclusion and exclusion criteria section (i.e.: the journal article criteria mentioned twice, etc.)

2)            Within the Search Methodology section, the authors mention that the search was ran “since inception until Nov 2022.,” but earlier mention hat only the last ten years were used. Can this please be clarified?

3)            Program is unnecessarily capitalized on line 214

4)            The text in line 271 is confusing to me, as the authors mention that 6 papers met inclusion criteria, but then only account for 2 between the two publication years explicitly mentioned (2013 and 2022)

5)            Line 183 mentions that inclusion of quantitative results was an inclusion criteria, yet line 276 mentions that papers with only qualitative results were included. This should be clarified.

6)            In Table 3, “Trainning” is misspelled

Conclusions

1)            In line 584, “address” should read “addressed”

2)            The readability of the sentence in lines 587-588 could be improved

Author Response

Dear reviewer.

We do really appreciate your kind report about our manuscript.

Please see below the point-by-point response to each comment suggested.

Kind regards,

Authors.

Paper Strengths

-              The methodology of the review is well defined and uses standardized methods (PRISMA)

-              The authors attempt to justify the need for the review (i.e.: considerable attention to improve mental health education through application of MR, lack of a unifying review)

• Thank you very much for your kind feedback.

Paper Weaknesses

-              A lack of clarity in the writing, particularly within the Introduction section, may cause the reader to lose focus on the objectives of the paper

-              A lack of literature volume meeting the stated conclusion criteria, thereby limiting the ability to draw inference from the review

-              A lack of focus in the overarching research questions (since both mental health and its utility in education is quite broad), which manifests itself quite often during the manuscript

-              While the manuscript may fall within the broad umbrella of scope of the journal, there are undoubtedly more relevant journals where this could be published (i.e.: those with education or learning technologies as a primary focus).

• Thanks a lot for all the suggestions provided. We will submit the paper for English editing service, and, hopefully, it will clarify the written message. As the Introduction should not be pretty much extended in a Systematic review, we decided not include more references regarding mental health and its utility in education, more than the one focused on Metaverse-related technology. We would prefer to publish this challenging paper in Electronics, not only for its valuable international recognition, but also for the professionalism, kindness and continuous support from the managing Editorial Office.

Recommendations for Improvement

-              Streamline the content presented within the Introduction (i.e.: reduce/condense general background content about the technology, streamline content relevant to the actual study objectives (i.e.: application of MR in mental health education)

• Thank you very much for pointed out this improvement. We have struck out the second paragraph of Introduction section (page 2, lines 56-64).

-              Give the lack of literature ultimately meeting the inclusion criteria, justify why conference manuscripts were automatically discarded

• Thanks for letting us know this improvement. The information required has been included in Materials and Methods section (page 5, lines 203-205).

-              Consider submission to a more relevant journal

• Thanks for your recommendation. We will keep in mind, for further manuscripts submissions.

Specific Editing Recommendations by Section

Abstract

1)            On line 26 in the abstract, the acronym RCT is presented without definition

2)            As the authors imply heavily in the abstract that the primary contribution of this manuscript is related to the sparseness of relevant literature, it may be good to add quantitative descriptors of the review result (i.e.: i) total # of papers filtered via the stated keyword screen, ii) total # reviewed, etc.) to help support this claim/scope the readers’ expectations (this information is presented within the manuscript itself)

- Thanks for pointing out these enhancements. We have modified the abstract (page 1).

Introduction

1)            It may be worth considering adding some specific content regarding how MR has been used in medical student training, why it has been successful, and what changes are forthcoming (i.e.: adding a bit of more substantial/specific content to P1). I realize that some of this content is covered later (i.e.: Advantages of MR use subsection), but has written the usefulness of this first paragraph is limited.

• Thanks a lot for providing us this consideration. However, as the paper topic is not “medical student training” but mental health training, we have already covered advantages and disadvantages regarding both of them, but generally.

2)            While I appreciate the effort that the authors have taken to provide background context regarding MR technologies, the text length seems a bit excessive here (particularly given the focus of the paper).  Perhaps consider truncating this sum, or at minimum adding some figures to improve readability.

• Thank you very much for pointed out this improvement. We have deleted the second paragraph of Introduction section (page 2, lines 56-64).

3)            The wording of the two sentences beginning on line 75 is a bit confusing. Namely, although the title/abstract exclusively refers to applications of MR in mental healthcare education, this phrasing sounds like it is describing clinical applications (especially in the context of the final two lines of the prior paragraph).

• Thanks a lot for letting us know about this. We have deleted the paragraph (page 2, lines 79-81).

4)            Lines 159-160 read atypically as a stand-alone, one sentence paragraph

• Thank you. We have included them in the previous paragraph (page 4, lines 162-164)

5)            Regarding the basic research questions, the authors may wish to consider rewording “develop” in question 2 to “deploy” or “utilize,” since the prior seems to imply (in my opinion) changes to the underlying hardware (or firmware) architecture, and not necessarily the utilization of off-the-shelf devices for the stated application

• Thanks a lot for providing us this consideration. The verb ' develop' has been replaced by 'deploy' (page 4, line 172).

Materials and Methods

1)            The first exclusion criteria seems redundant (i.e.: isn’t it just stating the logical complement of the inclusion criteria on line 180? In general, there seems to be a lot of redundancy between the content presented in the inclusion and exclusion criteria section (i.e.: the journal article criteria mentioned twice, etc.)

• Thanks for letting us know. However, we consider relevant to clarify that only journal papers were included (in inclusion criteria), and lastly, what kind of non-journal papers were not included, as conference proceedings (in exclusion criteria). Even we have been asked to specify why conferences paper were not included. As a systematic review methodology followed, we do prefer to offer extensive information to readers in those crucial aspects.

2)            Within the Search Methodology section, the authors mention that the search was ran “since inception until Nov 2022.,” but earlier mention hat only the last ten years were used. Can this please be clarified?

• Thanks for letting us know. The meaning from “inception” try to explain that as authors started to review the existing literature (in November 2022), that was the final date of inclusion. This kind of phrase is commonly used in high recognized JCR journal. Please see the following examples:

Assefa, D.G.; Zeleke, E.D.; Bekele, D.; Ejigu, D.A.; Molla, W.; Woldesenbet, T.T.; Aynalem, A.; Abebe, M.; Mebratu, A.; Manyazewal, T. Isoniazid Preventive Therapy for Prevention of Tuberculosis among People Living with HIV in Ethiopia: A Systematic Review of Implementation and Impacts. Int. J. Environ. Res. Public Health 2023, 20, 621. https://doi.org/10.3390/ijerph20010621).

Chee, Y. J., Fan, B. E., Young, B. E., Dalan, R., & Lye, D. C. (2023). Clinical trials on the pharmacological treatment of long COVID: A systematic review. Journal of Medical Virology, 95(1), e28289. https://doi.org/10.1002/jmv.28289

3)            Program is unnecessarily capitalized on line 214

• Thanks for letting us know. We have modified this typo (page 5, line 223).

4)            The text in line 271 is confusing to me, as the authors mention that 6 papers met inclusion criteria, but then only account for 2 between the two publication years explicitly mentioned (2013 and 2022)

• Thanks for pointing us this improvement. We have included the percentage within the parentheses (page 7, line 280).

5)            Line 183 mentions that inclusion of quantitative results was an inclusion criteria, yet line 276 mentions that papers with only qualitative results were included. This should be clarified.

• Thank you for letting us know this misunderstanding. In line 276, authors are explaining the “study design” which is further analyzed in Supplementary material. Only those studies which included quantitative results were included. But those studies following a qualitative design, which provided quantitative outcomes were included as well. Those records which did not provide quantifiable results (explicitly, as research protocols) or they provided them with no extension enough (congress papers) were excluded.

6)            In Table 3, “Trainning” is misspelled

• Thanks a lot for pointing us this typo. We have amended it (page 10).

Conclusions

1)            In line 584, “address” should read “addressed”

• Thanks for letting us know. We have amended it (page 15, line 601).

2)            The readability of the sentence in lines 587-588 could be improved

• Thanks for letting us know. We have amended it (page 15, line 605).

.And finally, we would like to sincerely thank your time to revise this manuscript and helping us for its improvement.

Reviewer 4 Report

The current review paper may provide a unique perspective on the emerging technologies of AR and MR systems linked with haptic devices.

However, the following comments may be made to inform researchers about what is going on in this area, particularly with regard to mental health care employing MR technology:

- Revise the manuscript's acronyms; for example, what is RCTs?

- Including images that highlight the influence of MR on mental health care immersion, such as how the Hololens can help in this field.

- Ergonomics criteria can be used to these systems, including perception and muscle fatigue caused by the use of Hololens or other devices.

Author Response

Dear reviewer.

We do really appreciate your kind report about our manuscript.

Please see below the point-by-point response to each comment suggested.

Kind regards,

Authors.

The current review paper may provide a unique perspective on the emerging technologies of AR and MR systems linked with haptic devices.

• Thank you very much for your kind feedback.

However, the following comments may be made to inform researchers about what is going on in this area, particularly with regard to mental health care employing MR technology:

- Revise the manuscript's acronyms; for example, what is RCTs?

• Thanks for let us know about this typo. We have explained the acronym (page 1, line 26).

- Including images that highlight the influence of MR on mental health care immersion, such as how the Hololens can help in this field.

• Thank you very much for pointed out this improvement. However, as we did not perform a MR based trial, which involve participants (but we did a systematic review), we cannot provide our own images. If reviewers have any image suitable for this topic, that would like to share with us for publication in the present manuscript, we will be more than happy to include it.

- Ergonomics criteria can be used to these systems, including perception and muscle fatigue caused by the use of Hololens or other devices.

• Once again, thanks for highlighting this enhancement. We have included this information in Discussion section (page 14, lines 568-569).
• Finally, we would like to sincerely thank your time to revise this manuscript and helping us for its improvement.

Round 2

Reviewer 4 Report

I think this work can be published in the current form.

Author Response

Dear reviewer.

Thank you very much for helping us to improve the manuscript, as well as to make the text more understandable and readable. 

The paper was under extensive English editing by MDPI English editing service.

We have already submitted the improved version. Hopefully, it will clarify the written message. 

Kind regards,

Authors