Evidence Summary

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Laughter or humour interventions improve depression and anxiety symptoms by a small to moderate amount. Laughter interventions also improve sleep quality by a small amount.

Zhao J, Yin H, Zhang G, et al. A meta-analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults. J Adv Nurs. 2019;75:2435-48.

Review question

In adults, do laughter or humour interventions reduce symptoms of depression or anxiety or improve sleep quality?


Many people have feelings of depression or anxiety and sometimes do not sleep well. Laughter can have positive effects on people’s emotions and overall health. This review looks at the effect of interventions that use laughter or humour to reduce feelings of depression or anxiety or improve quality of sleep.

How the review was done

The researchers did a systematic review of studies available up to December 2018. They found 10 randomized controlled trials that included 814 adults. Most people were 60 years of age or older, and most were women.

The key features of the studies were:

  • some people had no specific health conditions; some had schizophrenia, chronic obstructive lung disease, breast cancer, depression, or Parkinson disease;
  • laughter interventions were assessed in 7 studies and included activities such as talks and discussions, learning laughter techniques, laughter yoga, or breathing and physical exercises;
  • humour interventions were assessed in 3 studies and included skills training, watching humorous movies, or interactions with clowns or similar persons and tailored to residents’ specific needs;
  • laughter or humour interventions were mostly done for 1 to 2 hours, once or twice per week, for 2 to 12 weeks; and
  • most interventions were done by trained professionals and compared with usual care.

What the researchers found

Compared with usual care or control, laughter or humour interventions reduced depression and anxiety symptoms by a small to moderate amount immediately after the intervention. Laughter interventions also improved sleep quality by a small amount compared with usual care.


Laughter and humour interventions reduce symptoms of depression or anxiety compared with usual care or control interventions. Laughter interventions improve sleep quality compared with usual care.

Laughter or humour interventions vs control* for outcomes immediately after the intervention


Number of trials (number of people)

Effect† of interventions

Depression scale score

9 trials (750 people)

Small to moderate improvement

Anxiety scale score

7 trials (599 people)

Moderate improvement

Sleep quality scale score‡

2 trials (133 people)

Small improvement

*7 trials compared laughter interventions with usual care or usual lifestyle. 3 trials compared humour interventions with usual care, watching different types of movies, or another control intervention.

†Amount of improvement was small (mean difference between groups of 2 points out of 21 on the Pittsburgh Sleep Quality Index), small to moderate (standardized mean difference [SMD] between groups ≥0.2 and <0.5), or moderate (SMD ≥0.5 and <0.8).

‡For laughter interventions vs usual care.


Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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