Effects of Laughter Therapy on Depression and Sleep among Patients at Long-term Care Hospitals

Ji Hyoung Han; Kyung Min Park; Heeok Park

doi:10.7475/kjan.2017.29.5.560

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Han, Park, and Park: Effects of Laughter Therapy on Depression and Sleep among Patients at Long-term Care Hospitals

Original Article

Korean J Adult Nurs 2017;29(5):560-568.

Published online: 9 October 2017

DOI: https://doi.org/10.7475/kjan.2017.29.5.560

Effects of Laughter Therapy on Depression and Sleep among Patients at Long-term Care Hospitals

Ji Hyoung Han, MSN, RN¹, Kyung Min Park, Ph.D., RN², Heeok Park, Ph.D., RN^2,

¹Department of Nursing Hosan University, Gyeongsan, Korea

²College of Nursing Keimyung University, Daegu, Korea

Corresponding author: Park, Heeok College of Nursing Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3924, Fax: +82-53-580-3916, E-mail: hopark@kmu.ac.kr

- This manuscript is extracted from JiHyoung Han's master's thesis.

Received 5 June 20177 October 2017 Accepted 23 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of the study was to investigate the effects of laughter therapy on depression and sleep among patients at two long-term care (LTC) hospitals.

Methods

Forty-two residents from two LTC hospitals participated in this study. Twenty-one residents at one LTC hospital received the laugher therapy treatment and 21 at the other LTC hospital received no treatment as a comparison group. The laugher therapy protocol consisted of singing funny songs, laughing for diversion, stretching, playing with hands and dance routines, laughing exercises, healthy clapping, and laughing aloud. The participants engaged in the protocol 40 minutes twice a week (Monday/Thursday) for a total of eight sessions held in the patients’ lounge.

Results

Findings showed that depression and sleep improved in the treatment group compared to the comparison group (t=-7.12, p<.001; Z=-4.16, p<.001).

Conclusion

To improve depression and sleep among patients at LTC hospitals, offering laughter therapy strengthening physical activities might be beneficial to patients.

Keywords: Laughter, Depression, Sleep, Long-term care

REFERENCES

1. Health Insurance Review & Assessment Service. Status of me-dicalinstitutions [Internet]. Seoul: Health Insurance Review & Assessment Service;2015. [cited 2015 Oct 15]. Available from:. http://opendata.hira.or.kr/op/opc/yadmOpCloPrsnt.do?searchType=&dateType=&frYear=2015&frMonth=09&ykihoPl cTpCd=&ykihoPlcTpCdNm=&clCd=28&shwSbjtCd=.

2. Eun Y, Ko SH, Kim MJ, Kim JS, Park MH. Introduction to gerontological nursing. Seoul: Hyeonmunsa;2010.

3. Park EO. Effects of visiting laughter therapy on depression and insomnia among the vulnerable elderly. Journal of Korean Academy of Community Health Nursing. 2013; 24(2):205–13. https://doi.org/10.12799/jkachn.2013.24.2.205.

4. Almeida OP, Pfaff JJ. Sleep complaints among older general practice patients: association with depression. British Journal of General Practice. 2005; 55(520):864–6.

5. Park YH. Physical activity and sleep patterns in elderly who visited a community senior center. Journal of Korean Academy of Nursing. 2007; 37(1):5–13.

6. Redeker NS. Sleep in acute care settings: an integrative review. Journal of Nursing Scholarship. 2000; 32(1):31–8.

7. Jang HY, Kim TI. Sleep patterns and it's influencing factors of hospitalized elderly in long-term care hospital. Journal of the Korean Data & Information Science Society. 2016; 27(3):773–89.

8. Won WY, Lee CU. Pharmacological treatment of psychiatric disorders of the elderly. The Journal of the Korean Medical Association. 2010; 53(11):972–83. https://doi.org/10.5124/jkma.2010.53.11.972.

9. Takeda M, Hashimoto R, Kudo T, Okochi M, Tagami S, Mori-hara T, et al. Laughter and humor as complementary and alternative medicines for dementia patients. BMC Complement and Alternative Medicine. 2010; 10(1):28. https://doi.org/10.1186/1472-6882-10-28.

10. Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Alternative Therapies in Health Medicine. 2001; 7(2):62–76.

11. Cha MY, Hong HS. Effect and path analysis of laughter therapy on serotonin, depression and quality of life in middle- aged women. Journal of Korean Academy of Nursing. 2015; 45(2):221–30. https://doi.org/10.4040/jkan.2015.45.2.221.

12. Jung HW, Yoon CH, Cho NR, Lee MK, Lee JB. The effect of laughter therapy on sleep in the community-dwelling elderly. Korean Journal of Family Medicine. 2009; 30(7):511–8. https://doi.org/10.4082/kjfm.2009.30.7.511.

13. Kim YS, Jeon SS. The influence of one-time laughter therapy on stress response in the elderly. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2009; 18(3):269–77.

14. Ko HJ, Youn CH. Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly. Geriatrics and Gerontology International. 2011; 11(3):267–74. https://doi.org/10.1111/j.1447-0594.2010.00680.x.

15. Lee HK, Byeon DH, Park YS, Kim JS, Gil JH. Effects of the laughter therapy on blood pressure, depression and quality of life in rural elderly women. Journal of the Korea Academia-Industrial cooperation Society. 2013; 14(4):1810–9. https://doi.org/10.5762/kais.2013.14.4.1810.

16. Lee KI, Eun Y. Effect of laugher therapy on pain, depression and sleep with elderly patients in long term care facility. Journal of Muscle and Joint Health. 2011; 18(1):28–38. https://doi.org/10.5953/JMJH.2011.18.1.028.

17. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed.Hillsdale, New Jersey: L. Erlbaum;1988.

18. Seo SY, Chang SY. Effect of laughing therapy on sleep, depression and self-esteem of elderly women in senior home. Journal of Regional Studies. 2011; 19(4):211–25.

19. Kwon YC, Park JH. Korean version of Mini-Mental State Examination (MMSE-K). Part I: development of the test for the elderly. Journal of Korean Neuropsychiatr Association. 1989; 28(1):125–35.

20. Kee BS. A preliminary study for the standardization of geriatric depression scale short form-Korea version. Journal of Korean Neuropsychiatr Association. 1996; 35(2):298–307.

21. Choi HJ, Kim SJ, Kim BJ, Kim IJ. Korean versions of self-reported sleep questionnaires for research and practice on sleep disturbance. The Korean Journal of Rehabilitation Nursing. 2012; 15(1):1–10. https://doi.org/10.7587/kjrehn.2012.1.

22. Han GI. Laughter therapy. Seoul: Samho MEDIA;2014.

23. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975; 12(3):189–98.

24. Won CW, Yang KY, Rho YG, Kim SY, Lee EJ, Yoon JL, et al. The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. Journal of the Korean Geriatrics Society. 2002; 6(2):107–20.

25. Yesavage JA, Sheikh JI. 9/Geriatric Depression Scale (GDS) recent evidence and development of a shorter violence. Clinical Gerontologist. 1986; 5(1-2):165–73. https://doi.org/10.1300/J018v05n01_09.

26. Chae KS. Effects of the laughing and music therapy on the depression and activities of autonomic nervous system for elderly with dementia. Journal of Korean Biological Nursing Science. 2015; 17(3):245–52. https://doi.org/10.7586/jkbns.2015.17.3.245.

27. Lee JS, Kim KS, Kim MY, Oh SM, Oh SH, Lee HS. The effects of laughter therapy on sleep disturbance and depression among hemodialysis patient. Journal of Clinical Nursing Research. 2006; 9:107–50.

28. Ersser S, Wiles A, Taylor H, Wade S, Walsh R, Bentley T. The sleep of older people in hospital and nursing homes. Journal of Clinical Nursing. 1999; 8(4):360–8. https://doi.rog/10.1046/j.1365-2702.1999.00267.x.

29. Lee IS, Bae GH, Baek JS. Laughter therapy introduction. Seoul: Changjisa;2009.

Figure 1.

Flowchart of participants included for data analysis.

Table 1.

Contents of Laughter Therapy

Session	Contents	Time (mins)
Introduction	Light hugs/handshakes, laughing, complementing	5
Session 1~8
Main stage Session 1	Singing funny songs: 'namheangyeolcha', laughing for diversion:'laughing while complementing the positive qualities of other participants'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'the effects of laughing'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Main stage Session 2	Singing funny songs: 'namheangyeolcha', laughing for diversion: 'laughing while complementing the positive qualities of other participants'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'effective laughing methods'	5
	Laughing exercises,	5
	Healthy clapping, laughing out loud	5
Main stage Session 3	Singing funny songs: 'the spring of home town', laughing for diversion: 'thankful laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'becomes happy with laughing'	5
	Laughing exercises,	5
	Healthy clapping, laughing out loud	5
Main stage Session 4	Singing funny songs: 'the spring of home town', laughing for diversion: 'thankful laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'force a laugh becomes real laughing'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Main stage Session 5	Singing funny songs: 'wind of winter', laughing for diversion: 'mirror laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'emotional expression'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Main stage Session 6	Singing funny songs: 'wind of winter', laughing for diversion: 'mirror laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'complementing a positive things'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Main stage Session 7	Singing funny songs: 'namheangyeolcha', ‘the spring of home town’ laughing for diversion: 'you are the best laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'even when happy or boring'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Main stage Session 8	Singing funny songs: 'wind of winter’. ‘the spring of home town’, laughing for diversion: 'you are the best laughing'	5
	Stretching, playing with hands & dance routines	5
	Lecture: 'laughing is practice and habit'	5
	Laughing exercises	5
	Healthy clapping, laughing out loud	5
Closing stage	Positive meditation	5
Session 1~8	Expression of thoughts and feelings, saying good-bye	5

Table 2.

Characteristics of Participants at the Long-term Care Hospitals (N=37)

Characteristics	Categories	Treatment group (n=19)	Comparison group (n=18)	x² or t or Z	p
Characteristics	Categories	n (%)/M± SD	n (%)/M± SD	x² or t or Z	p
Gender	Male	11 (57.9)	8 (44.4)	0.67	.313
Gender	Female	8 (42.1)	10 (55.6)
Age (year)	65~79	12 (63.2)	10 (55.6)	0.22	.446
Age (year)	≥80	7 (36.8)	8 (44.4)
Education	≤ Elementary school	11 (57.9)	13 (72.2)	0.83	.286
Education	≥ Middle school	8 (42.1)	5 (27.8)
Medical diagnosis	CVD	9 (47.4)	8 (44.4)	0.25	.882
	MCI	4 (21.0)	3 (16.7)
	Others^†	6 (31.6)	7 (38.9)
Sleeping pills^‡	Yes	5 (26.3)	6 (33.3)	0.22	.457
Sleeping pills^‡	No	14 (73.7)	12 (66.7)
Antidepressants	Yes	5 (26.3)	5 (27.8)	0.01	.605
Antidepressants	No	14 (73.7)	13 (72.2)
Hospitalization	≤1 year	11 (57.9)	11 (61.1)	0.04	.554
Hospitalization	＞1 year	8 (42.1)	7 (38.9)
Cognition		26.47±2.86	25.94±2.62	-0.59	.562
ADL		12.00±3.63	10.83±2.68	-1.35	.179
Depression		8.37±1.54	8.17±1.98	-0.35	.730
Sleep		8.98±3.08	9.22±3.39	-0.28^§	.783

CVD=cerebrocardiovascular disease; MCI=mild cognitive impairment; ADL=activity of daily living;

^† Parkinson's disease, cancer, arthritis, fracture, diabetes mellitus, Sjogren's syndrome;

^‡ Lunapam, Stilnox;

^§ Mann-Whitney U test.

Table 3.

Difference in Depression and Sleep between the Two Groups (N=37)

Variables	Groups	Pretest	Posttest	Difference	Paired t or Z	p	t or Z	p
Variables	Groups	M± SD	M± SD	M± SD	Paired t or Z	p	t or Z	p
Depression	Treatment (n=19)	8.37±1.54	5.32±1.20	-3.05±1.31	8.96＜	＜.001	7.12	＜.001
Depression	Comparison (n=18)	8.17±1.98	7.94±2.49	-0.22±1.17	0.81	.429
Sleep	Treatment (n=19)	8.68±3.38	6.53±2.34	-2.42±1.22	-3.62^† ＜	＜.001	4.16^‡	＜.001
Sleep	Comparison (n=18)	9.22±3.39	8.83±3.13	-0.39±0.92	-0.88^†	.378

^† Wilcoxon matched pairs signed ranks test;

^‡ Mann-Whitney U test.

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