Clinician Article

A meta-analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults.

  • Zhao J
  • Yin H
  • Zhang G
  • Li G
  • Shang B
  • Wang C, et al.
J Adv Nurs. 2019 Nov;75(11):2435-2448. doi: 10.1111/jan.14000. Epub 2019 May 9. (Review)
PMID: 30882915
Read abstract Read evidence summary
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 6/7
  • FM/GP/Mental Health
    Relevance - 6/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 5/7
  • Geriatrics
    Relevance - 4/7
    Newsworthiness - 4/7
  • Hospital Doctor/Hospitalists
    Relevance - 3/7
    Newsworthiness - 3/7
  • Internal Medicine
    Relevance - 3/7
    Newsworthiness - 3/7


AIM: To quantify the effect of laughter and humour interventions on depression, anxiety, and sleep quality in adults.

DESIGN: A meta-analysis of randomized controlled trials.

DATA SOURCES: PubMed, Embase, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Data were searched from their inception up to December 2018.

REVIEW METHODS: The reporting of this meta-analytical review was conducted according to the guidelines of the Cochrane Collaboration. Two reviewers selected the studies, extracted the data, and evaluated the risk of bias (Cochrane Collaboration bias assessment tool) of the included papers independently.

RESULTS: Ten studies comprising 814 participants were included. Meta-analysis showed that these interventions significantly decreased adults' depression, anxiety, and improved their sleep quality. The results of subgroup analysis showed that depression benefits more from long-term laughter intervention.

CONCLUSIONS: This meta-analysis revealed that laughter and humour interventions are effective in relieving depression, anxiety, and improve sleep quality in adults. More studies with high quality and follow-up assessment should be conducted for future research.

IMPACT: This review synthesized current evidence using laughter and humour interventions to reduce negative emotion and promote better results in adults, especially with respect to target the applicability between different populations or intervention methods. In addition, humour and laughter interventions are safe, convenient, interesting and can promote interpersonal relationship in both patients and medical workers, which have great feasibility and potential to be used as an aspect of psychotherapy for clinical and nursing to improve well-beings in adults.

Clinical Comments

FM/GP/Mental Health

Interesting work. There are problems: the specific kinds of laughter therapy (laugh yoga and laugh Qi-gong) are not widely available, significant heterogeneity in the studies, etc. Engaging depressed, anxious, or sleep-deprived patients in laughter could be misunderstood. That said, it's worth a try; now I can say "studies show..."

General Internal Medicine-Primary Care(US)

As is typical of the mental health literature, this study highlights a paucity of large, rigorous studies. In this instance, the random effects meta-analysis magnifies (over-weights) the impact of the very small studies included and diminishes that of the one larger negative trial that accounted for half of the subjects included. It is hard to draw any conclusion besides the need for better research.


I was surprised when I saw the title. I didn't know that there were sufficient RCTs of humour interventions to justify a meta-analysis. In fact the included studies are clinically fairly heterogenous and have substantial potential risk of bias. I am not convinced enough (yet) to alter my practice, but I am convinced enough that I would like to see a larger, more robust trial.

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