The effectiveness of laughter-based interventions on psychological, physiological and educational outcomes in nursing students: A systematic review and meta-analysis

Abstract

Aim: To evaluate the effectiveness of laughter-based interventions across psychological, physiological and educational outcomes in nursing students. Background: Nursing education may involve educational, emotional and clinical demands that could impact students' well-being and academic success. Laughter-based interventions may help to reduce these challenges. Design: Systematic review and meta-analysis. Methods: A comprehensive search was conducted between March 1-15, 2025, using seven international and two national databases. Randomized controlled and controlled studies comparing laughter-based interventions with control groups were included. Data extraction was performed independently by two reviewers and risk of bias was assessed using the Cochrane RoB tool. Meta-analyses and subgroup analyses based on intervention timing (regular term vs. special or transitional periods) were performed using RevMan (version 5.4). Results: Eighteen studies with 1366 participants were included. Laughter-based interventions significantly reduced stress (SMD = -1.26, 95 % CI [-1.83, -0.69], p < 0.0001), anxiety (SMD = -1.19, 95 % CI [-1.87, -0.50], p = 0.0007) and salivary cortisol levels (SMD = -0.86, 95 % CI [-1.23, -0.48], p < 0.00001). Improvements were also observed in well-being, happiness and sleep quality. Subgroup analyses showed benefits in both regular and transitional periods, though effects did not consistently differ by timing. No significant effects were found for depression, pulse rate, or academic self-efficacy. Conclusion: Laughter-based interventions appears to be a promising complementary approach to promote psychological well-being and physiological stress regulation in nursing students. Further high-quality research is needed to clarify academic effects and guide implementation.