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

J Korean Acad Nurs. 2015 Apr;45(2):221-230. Korean.
Published online April 30, 2015.
© 2015 Korean Society of Nursing Science
Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women
Mi Youn Cha,1 and Hae Sook Hong2
1Department of Nursing, Uiduk University, Pohang, Korea.
2College of Nursing, Kyungpook National University, Daegu, Korea.

Address reprint requests to: Hong, Hae Sook. College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-422, Korea. Tel: +82-53-420-4932, Fax: +82-53-421-2758, Email:
Received August 11, 2014; Revised August 21, 2014; Accepted January 15, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. ( If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.



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.

Keywords: Laughter therapy; Middle-aged women; Serotonin; Depression; Quality of life


Figure 1
Path Analysis of depressions subgroups with control group.
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Table 1
Contents of Laughter Therapy Program
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Table 2
Homogeneity Test of General Characteristics (N=64)
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Table 3
Pre-score of Serotonin and QOL of Subjects (N=64)
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Table 4
Effect of Laughter Therapy on Serotonin, Depression and QOL within Group (N=64)
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This manuscript is a condensed form of the 1st author’s doctoral dissertation from Kyungpook National University.

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