Journal List > J Korean Acad Nurs > v.45(2) > 1003058

Cha and Hong: Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women



This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects.


A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL.


Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001).


Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.

Figures and Tables

Figure 1

Path Analysis of depressions subgroups with control group.

Table 1

Contents of Laughter Therapy Program

Table 2

Homogeneity Test of General Characteristics (N=64)


Cont.=Control group; Exp.=Experimental group; ND=None depression; MD=Moderate depression; SD=Severe depression.

Table 3

Pre-score of Serotonin and QOL of Subjects (N=64)


Cont.=Control group; Exp.=Experimental group; ND=None depression; MD=Moderate depression; SD=Severe depression; QOL=Quality of life.

Table 4

Effect of Laughter Therapy on Serotonin, Depression and QOL within Group (N=64)


*ANCOVA adjusted for pre score; p<.05; p<.01; §Contrast; Repeated Measures ANOVA of variance of contrast variables. Index 1,2 and 3 Inicate to 1: pre-test, 2: post-test after 5 times, and 3: post-test after 10 times; Cont.=Control group (n=14); Exp.=Experimental group (n=50); ND=None depression (n=15); MD=Moderate depression (n=19); SD=Severe depression (n=16); QOL=Quality of life.


This manuscript is a condensed form of the 1st author’s doctoral dissertation from Kyungpook National University.


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