Laughter is the Best Medicine? A Cross-Sectional Study of Cardiovascular Disease Among Older Japanese Adults

The foundations of mind-body medicine: Love, good relationships, and happiness modulate stress and promote health

Although stress is an everyday fact of life, it can lead to poor health outcomes, particularly when intense or prolonged. However, humans have unique cognitive abilities and thus may be able to combat stress by engaging critical psychological defence mechanisms. In this review, we discuss the field of mind-body medicine, which focuses on improving our understanding of the mechanisms underlying this response and developing interventions that might be used to limit the effects of chronic stress. We review the findings of past and current research in this field that has focused on the impact of psychological, emotional, and behavioural factors, including love, social connectedness, and happiness on human health and the amelioration of pain as well as other signs and symptoms of disease. While these studies have not yet led to confirmed, quantifiable conclusions, the overall weight of evidence suggests that happiness (defined as a personal sense of well-being) may be directly associated with improved health parameters and reductions in debilitating symptoms. Collectively, these findings suggest that interventions designed to promote stress mitigation, notably those that encourage social activity, may lead to significant improvements in human health.

Reduced number of teeth with and without dental prostheses and low frequency of laughter in older adults: Mediation by poor oral function

PURPOSE

Laughter is expected to have health-protective effects, but the potential link between tooth loss and laughter remains unclear. Therefore, this study aimed to examine the association between tooth loss and a low frequency of laughter among older adults in Japan, to elucidate whether this association could be mitigated by dental prostheses, and to evaluate the magnitude of the association mediated by poor oral function.

METHODS

We used cross-sectional data from 157,708 functionally independent participants aged ≥65 years (46.3% male) from the Japan Gerontological Evaluation Study. A modified Poisson regression model was applied to examine the association between the number of remaining teeth (≥20/10-19/0-9), dental prostheses use, and infrequent laughter (i.e., laughing never or almost never). Causal mediation analysis was performed to assess whether the association was mediated by difficulties in eating hard foods, choking, or dry mouth.

RESULTS

Among the participants, 9,129 reported infrequent laughter. Participants with ≤9 and 10-19 teeth who did not use dental prostheses had a 1.29 and 1.14 times higher likelihood of infrequent laughter than those with ≥20 teeth, respectively. Furthermore, difficulty eating hard foods, choking, and dry mouth mediated 22.8%, 0.4%, and 4.3% of the association between fewer remaining teeth and infrequent laughter, respectively. Meanwhile, we did not find evidence for the differences in infrequent laughter between participants with ≤19 teeth using dental prostheses and those with ≥20 teeth.

CONCLUSIONS

Tooth loss among individuals without dental prostheses was associated with infrequent laughter, and this association was mediated by poor oral function.

Association between laughter, frailty, and depression in rheumatoid arthritis patients

OBJECTIVE

This study aimed to determine whether there are associations between laughter, disease activity, frailty, and depression in rheumatoid arthritis (RA) patients.

METHODS

A total of 240 patients were included in this prospective cohort study on frailty in RA patients between March 2021 and June 2022. Patients were divided into the following four groups according to the frequency of laughter: "almost every day," "1-5 days per week," "1-3 days per month," and "never or almost never." Patient characteristics were compared among the four groups by analysis of variance. Factors associated with laughter were identified by multivariable logistic analysis.

RESULTS

The mean 28-joint Disease Activity Score using CRP was 1.91, with 70.7% of patients in remission and 12.6% in low disease activity. For the "almost every day" (42.5% of patients), "1-5 days per week" (40.0%), "1-3 days per month" (11.3%), and "never or almost never" (6.3%) groups, scores of the Kihon Checklist (KCL) for assessing frailty status were 3.5, 4.6, 7.3, and 8.1 (p < .001), respectively, and scores of the Beck Depression Inventory (BDI-II) were 8.4, 10.7, 15.1, and 16.5 (p < .001), respectively. Multivariable analysis revealed that KCL (OR: 0.81, 95% CI: 0.73-0.90) and BDI-II (OR: 0.91, 95% CI: 0.86-0.95) scores were independently associated with the frequency of laughter.

CONCLUSION

Frailty and depression were associated with laughter in RA patients with controlled disease activity. Interventions aimed at not only disease activity control but also frailty prevention may lead to a life filled with laughter.

Does online communication mitigate the association between a decrease in face-to-face communication and laughter during the COVID-19 pandemic? A cross-sectional study from JACSIS study

Laughter has a protective effect on human health. The spread of coronavirus disease 2019 (COVID-19) has changed opportunities for face-to-face communication and might decrease opportunities for laughter. This cross-sectional study aimed to investigate whether the decrease in face-to-face communication during the COVID-19 pandemic is associated with a decrease in laughter. Additionally, we investigated whether an increase in online communication mitigates this association. Data from the "Japan COVID-19 and Society Internet Survey (JACSIS)," conducted between August and September 2020, were used. Participants aged 15-79 years were included in this study. The outcome was a decrease in laughter before the onset of the COVID-19 pandemic. The explanatory variables were decreased face-to-face communication with friends and increased online communication (text message, telephone, and video contact). Causal mediation analysis was used to calculate prevalence ratios (PRs) and 95 % confidence intervals (CIs) of the controlled direct effects of increased online communication. Furthermore, the proportions eliminated (PEs) by an increase in online communication were calculated. Among the 25,482 participants, 40.4 % had decreased face-to-face communication and 21.4 % had a decreased frequency of laughter. After adjusting for confounders, a decrease in face-to-face communication was significantly associated with a decrease in laughter (PR = 1.62, 95 %CI = 1.55-1.70). PEs for decrease in laughter were 27.2 % (95 %CI = -2.0 to 56.4) for text-based communication, 36.1 % (95 %CI = 12.3-59.8) for telephone-based communication, and 28.6 % (95 %CI = 0.6-56.6) for video-based communication. Although a decrease in face-to-face communication was associated with a decrease in laughter during the COVID-19 pandemic, online communication, particularly telephone-based communication, mitigated this association.

Subjective Happiness, Frequency of Laughter, and Hypertension: A Cross-Sectional Study Based on the Japan Gerontological Evaluation Study (JAGES)

In recent years, positive psychological factors, such as subjective happiness and laughter, have been reported to be associated with cardiovascular disease. In this study, we examined the relationship of hypertension with subjective happiness and frequency of laughter using the data from the Japan Gerontological Evaluation Study (JAGES). Of the 138,294 respondents, 26,368 responded to a version of the self-administered questionnaire that included a question about the frequency of laughter in the JAGES 2013. In total, 22,503 (10,571 men and 11,932 women) were included in the analysis after excluding those with missing responses regarding a history of hypertension, frequency of laughter, and subjective happiness. The prevalence of hypertension in this study was 10,364 (46.1%). Multivariate logistic regression analysis showed that age, female sex, obesity, infrequent chewing, former and current drinker, seeing three to five friends, and the absence of hobbies were positively associated with hypertension. However, infrequent laughter/high level of subjective happiness, frequent laughter/high level of subjective happiness, being underweight, and current smoker were negatively associated with hypertension. As per the findings of this study, it was determined that subjective happiness was negatively associated with hypertension. Therefore, this study suggests that having more opportunities to feel happiness may be important in preventing hypertension.

Types of Sports and Exercise Group Participation and Sociopsychological Health in Older Adults: A 3-Yr Longitudinal Study

PURPOSE

This study aimed to identify the association between a specific sports type and exercise group participation and longitudinal changes in sociopsychological health among community-dwelling older adults.

METHODS

Three years of data from the Japan Gerontological Evaluation Study were used, comprising a total of 33,746 men and 36,799 women age ≥65 yr. To determine the relationship between 20 types of sports and exercise group participation in 2016 (baseline) and changes in depressive symptoms (Geriatric Depression Scale (GDS-15)), self-rated health (4-point scale), subjective well-being (11-point scale), and frequency of laughter (days per month) from 2016 to 2019, we performed linear regression analyses with conducting a multivariate adjustment for potential confounders using an inverse probability weighting method.

RESULTS

The mean changes over 3 yr were +0.32 and +0.28 in GDS-15, -0.06 and -0.05 in self-rated health, -0.08 and -0.06 in subjective well-being, and -1.21 and -1.19 in frequency of laughter, in men and women, respectively. Men playing golf in a group were more likely to suppress an increase in the GDS-15 ( B = -0.11, 95% confidence interval, -0.18 to -0.05) and decreases in self-rated health (0.04, 0.02 to 0.06), subjective well-being (0.07, 0.02 to 0.12), and frequency of laughter (0.45, 0.11 to 0.80). Women participating in walking, weight exercises, and hiking groups were more likely to prevent an increase in the GDS-15 (-0.12, -0.19 to -0.04; -0.09, -0.18 to -0.01; and -0.16, -0.30 to -0.03, respectively) and decreases in self-rated health (0.03, 0.01 to 0.05; 0.03, 0.01 to 0.06; and 0.08, 0.04 to 0.12, respectively).

CONCLUSIONS

Golf in older men and walking, weight exercises, and hiking in older women could be recommended as an effective program for promoting sociopsychological health among older adults in Japan.

The Association between Laughter and Functional Dyspepsia in a Young Japanese Population

The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population.

METHODS

This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire.

RESULTS

The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)).

CONCLUSION

In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

Occasions for laughter and dementia risk: Findings from a six-year cohort study

AIM

Currently, there is little evidence on the relationship between laughter and the risk of dementia, and since laughter is mainly a social behavior, we aimed to examine the association between various occasions for laughter and the risk of dementia in Japanese older adults.

METHODS

We draw upon 6-year follow-up data from the Japan Gerontological Evaluation Study, including 12 165 independent older adults aged 65 years or over. Occasions for laughter were assessed using a questionnaire, while dementia was diagnosed using the standardized dementia scale of the long-term care insurance system in Japan. Cox proportional hazards models were estimated, yielding hazard ratios and 95% confidence intervals (CIs).

RESULTS

The multivariable hazard ratio of dementia incidence for all participants in the groups for high versus low variety of occasions for laughter was 0.84 (95% CI: 0.72-0.98, P for trend <0.001). A greater variety of occasions for laughter was associated with a lower risk of dementia 0.78 (95% CI: 0.63-0.96, P for trend <0.001) among women, but was less pronounced for men, with significant associations only for the medium group. Laughing during conversations with friends, communicating with children or grandchildren, and listening to the radio were primarily associated with decreased risk.

CONCLUSION

A greater variety of laughter occasions in individual and social settings was associated with a reduced risk of dementia. Geriatr Gerontol Int 2022; 22: 392-398.

Effects of a laughter program on body weight and mental health among Japanese people with metabolic syndrome risk factors: a randomized controlled trial

Background

While there have been several intervention studies on the psychological effects of laughter, few have examined both the psychological and physical effects. This study investigates the effects of a laughter program on body weight, body mass index (BMI), subjective stress, depression, and health-related quality of life (HRQOL) among Japanese community-dwelling individuals using a randomized controlled trial with a waitlist.

Methods

Overall, 235 participants (37 men and 198 women) aged 43–79 years (mean 66.9, median 67.0) were randomized into laughter intervention and control groups (n = 117 and n = 118, respectively) to participate in a 12-week laughter program. Body weight, subjective stress, subjective well-being, and HRQOL were measured at the baseline, with a 12-week follow-up. The laughter program intervention’s effects on these factors were analyzed using an analysis of covariance adjusted by age, sex, risk factors, medication, and area. Furthermore, Pearson’s correlation and a general linear model analyzed the relationship between participants’ BMI and psychological index changes.

Results

The comprehensive laughter program significantly improved the mean body weight (p = 0.008), BMI (p = 0.006), subjective stress (p = 0.004), subjective well-being (p = 0.002), optimism (p = 0.03), and physical component summary (PCS) scores of HRQOL (p = 0.04). A similar tendency occurred for the mean changes in BMI and subjective stress score by area, sex, and age. Moreover, there was a significant and negative correlation between the change in BMI and PCS change (p = 0.04).

Conclusion

The comprehensive 12-week laughter intervention program, mainly comprising laughter yoga, significantly improved physical and psychological functions such as body weight, BMI, subjective stress, subjective well-being, and HRQOL among predominantly elderly Japanese community-dwelling individuals with metabolic syndrome risk factors. Moreover, PCS improved among participants who reduced BMI after the intervention. These results suggest that the laughter program may help reduce body weight in participants with metabolic syndrome risk factors by reducing stress and improving HRQOL and mental health factors, such as subjective well-being and optimism.

Trial registration

Registered with the University Hospital Medical Information Network Clinical Trials Registry UMIN-CTR000027145 on 27/04/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03038-y.

Association between visual status and the frequency of laughter in older Japanese individuals: the JAGES cross-sectional study

Objective

Although the beneficial effects of laughter are abundantly reported, the physical function that is required as a premise for laughter has not been studied. The aim of this study is to investigate the association between visual status and frequency of laughter in a population-based sample of older adults.

Methods and analysis

We analysed cross-sectional data of community-dwelling independent individuals aged ≥65 years (n=19 452) in Japan. The outcomes were frequency of laughter and number of opportunities to laugh. We used multivariable logistic regression analysis with multiple imputations to investigate the association between visual status and laughter.

Results

The number of participants who laughed almost every day was 8197 (42.1%). After adjusting for individual covariates in the multivariable logistic regression analysis with multiple imputations, visual status was found to be significantly associated with the frequency of laugher and the number of opportunities to laugh (p for trend <0.01). Compare to 'normal vision', while excellent/very good vision was associated with increased frequency and number of opportunities to laugh (ORs: 1.72 and 1.25, respectively), poor vision decreased the frequency and number of opportunities to laugh (ORs: 0.86 and 0.87, respectively).

Conclusions

There is a link between visual impairment and laughter, with poor vision having a negative impact while good vision has a positive effect. Improving vision may lead to laughter promotion.

Does laughing with others lower the risk of functional disability among older Japanese adults? The JAGES prospective cohort study

While laughter is evoked mainly in social contexts, the potential link between laughter in daily life and health benefits is unclear. This study aimed to examine the association between laughter in daily life and the onset of functional disability among older adults in Japan. Data were obtained from a 6-year follow-up cohort of 12,571 participants (46.1% male) in the Japan Gerontological Evaluation Study, aged ≥65 years, who could independently perform daily activities. We evaluated their laughter in daily life from three perspectives: the types of situations in which people laugh, the number of situations in which people laugh with others, and the persons with whom people laugh. Using the Cox proportional hazards model, the risk of functional disability was estimated. A total of 1420 functional disabilities were observed during follow-up. After adjusting for potential confounders, participants who laughed with others (e.g., during conversations with friends) were at a reduced risk of functional disability (hazard ratio, 0.77; 95% confidence interval, 0.65-0.92) than those who laughed alone (e.g., during watching television). Similarly, the number of situations to laugh with others was inversely associated with the risk of functional disability (P_trend < 0.001). Laughing in a conversation with friends reduced the risk of functional disability by approximately 30% compared to laughing alone. Overall, laughing with others was associated with a reduced risk of functional disability. Having more situations to laugh with others or at least the situation to laugh with friends might contribute to reducing the risk of functional disability later in life.

Association between Laughter and Lifestyle Diseases after the Great East Japan Earthquake: The Fukushima Health Management Survey

We investigated the association between the frequency of laughter and lifestyle diseases after the Great East Japan Earthquake. We included 41,432 participants aged 30-89 years in the Fukushima Health Management Survey in fiscal year 2012 and 2013. Gender-specific, age-adjusted and multivariable odds ratios of lifestyle diseases were calculated using logistic regressions stratified by evacuation status. Those who laugh every day had significantly lower multivariable odds ratios for hypertension (HT), diabetes mellitus (DM) and heart disease (HD) for men, and HT and dyslipidemia (DL) for women compared to those who do not, especially in male evacuees. The multivariable odds ratios (95% confidence intervals) of HT, DM and HD (non-evacuees vs. evacuees) for men were 1.00 (0.89-1.11) vs. 0.85 (0.74-0.96), 0.90 (0.77-1.05) vs. 0.77 (0.64-0.91) and 0.92 (0.76-1.11) vs. 0.79 (0.63-0.99), and HT and DL for women were 0.90 (0.81-1.00) vs. 0.88 (0.78-0.99) and 0.80 (0.70-0.92) vs. 0.72 (0.62-0.83), respectively. The daily frequency of laughter was associated with a lower prevalence of lifestyle disease, especially in evacuees.

The Smiles of Older People through Recreational Activities: Relationship between Smiles and Joy

Recreational activities are found to increase people's smiles, arising joy in older people, but there is limited research on this topic within the Japanese context. This cross-sectional study aimed to measure the quality and frequency of smiles in older people living in rural settings using a smile analysis application. The participants comprised 13 females aged over 65 years who lived in Unnan City, Japan, and regularly attended recreational meetings. In this study, the recreational activity that the participants joined was a game called Mattoss. A video camera captured the participants' faces, while a smile assessment application assessed their facial expressions for smiles and joy. A total of 2767 smiles were recorded. For validity, we calculated the Spearman's rho score between smile and joy, which was 0.9697 (p < 0.001), while for reliability, we determined the Spearman's rho score for each participant, which exceeded 0.7 (p < 0.001). Surges of smiles were induced by one's own mistakes, successes, and big mistakes in the game and by severe or mild judgments by the referee. High validity and reliability of smile evaluation were demonstrated. The study found that smiling increased during recreational activities. Therefore, recreational activities can be encouraged for older people living in rural communities.

Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan

PURPOSE

Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults.

METHODS

Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis.

RESULTS

The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses.

CONCLUSION

There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.

Does variety of social interactions associate with frequency of laughter among older people? The JAGES cross-sectional study

OBJECTIVE

Several studies have reported that laughter is associated with health benefits. In addition, social interactions, such as social relationships, social participation and so forth, have shown the association with not only health but also individual emotion. In this study, we conducted a cross-sectional study to examine the association between variety of social interactions and the frequency of laughter.

DESIGN

Cross-sectional study.

SETTING

Sampled from 30 municipalities in Japan.

PARTICIPANTS

Non-disabled Japanese men (n=11 439) and women (n=13 159) aged ≥65 years using data from the Japan Gerontological Evaluation Study, which was conducted during October to December in 2013.

PRIMARY OUTCOME MEASURES

Laughing almost every day by self-reported questionnaire.

RESULTS

Poisson regression analysis with robust error variance was used to calculate prevalence ratios (PRs) for laughing almost every day according to each social relationship and its potential community-level environmental determinants. The prevalence of laughing almost every day tended to increase with increased variety in each social interaction after adjusting, instrumental activities of daily living, number of living together, working status, depression, self-reported economic status and residence year. Among men and women, multivariate-adjusted PRs (95% CIs) by comparing participants with the highest and lowest categories were 1.18 (1.04 to 1.35) and 1.16 (1.04 to 1.29) in positive life events; 1.26 (1.10 to 1.45) and 1.09 (0.96 to 1.24) in perceived positive changes in the area; 1.15 (1.04 to 1.28) and 1.17 (1.07 to 1.28) in social participations; 2.23 (1.57 to 3.16) and 1.47 (1.02 to 2.12) in social relationships and 1.25 (1.08 to 1.45) and 1.29 (1.15 to 1.45) in positive built environments. These associations were also preserved after the restriction of participants who were not in depression.

CONCLUSIONS

This study shows that a greater variety of each social relationships and the potential community-level environmental determinants are associated with higher frequencies of laughter in Japan.

Does Laughter Predict Onset of Functional Disability and Mortality Among Older Japanese Adults? The JAGES Prospective Cohort Study

Background

While laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan.

Methods

The data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1–5 days/week, 1–3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model.

Results

During follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (P for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (P for trend = 0.39).

Conclusions

Low frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.

Uncovering Hidden Curricula: Use of Dark Humor in Anatomy Labs and its Implications for Basic Sciences Education

Humor is subjective within most settings, but within the anatomy laboratory, it is likely to be significantly more contentious. While humor may be considered a component of the hidden curriculum of medical education, it has yet to be studied specifically from a basic sciences perspective. This study sought to understand if, when, how, and why humor may be used in anatomy labs and the implications this may have in basic sciences education. A survey consisting of demographic and qualitative items was designed to sample widely from academics, students, and health professionals with anatomy laboratory experience. A total of 185 respondents, representing 9 countries participated following purposive sampling and snowball recruitment. Findings of significance were 72% of respondents who had experienced dark humor within the anatomy lab. Themes identified from free-text pertained to the use of internal and external barometers to ascertain the appropriateness of humorous remarks and the use of humor as a mechanism for diffusing stress. Polarity in responses concerning the acceptability of dark humor and rude mnemonics was also observed. This study highlighted that while dark humor may be a perceived tension release, many individuals make use of very specific internalized gauges to determine when and what humor may be appropriate. The data emphasized the need for not only future humanistic-focused anatomy but also basic sciences, education research, to better understand and have ideal educational experiences for all. Finally, this study provided further evidence of the impact of the hidden curriculum associated with the use of humor within educational and professional settings.

Longitudinal Trends in Blood Pressure Associated With the Frequency of Laughter: The Circulatory Risk in Communities Study (CIRCS), a Longitudinal Study of the Japanese General Population

Background

The frequency of laughter has been associated with cardiovascular disease and related biomarkers, but no previous studies have examined association between laughter and changes in blood pressure levels. We sought to identify temporal relationships between frequency of laughter in daily life and systolic and diastolic blood pressure changes in participants from 2010 through 2014.

Methods

Participants were 554 men and 887 women aged 40–74 years who answered self-administered questionnaire quantifying frequency of laughter at baseline. We measured participant blood pressure levels twice using automated sphygmomanometers for each year from 2010 to 2014. The associations between laughter and changes in blood pressure over time were analyzed using linear mixed-effect models.

Results

There was no significant difference in blood pressure according to frequency of laughter at baseline in either sex. Men with frequency of laughter 1 to 3 per month or almost never had significantly increased systolic and diastolic blood pressure levels over the 4-year period (time-dependent difference: 0.96 mm Hg (95% confidence interval [CI], −0.2 to 1.8; P = 0.05). Changes in blood pressure associated with infrequent laughter (ie, 1 to 3 per month or almost never) were evident in men without antihypertensive medication use over 4 years (0.94 mm Hg; 95% CI, −0.2 to 2.0; P = 0.09) and men who were current drinkers at baseline (1.29 mm Hg; 95% CI, −0.1 to 2.3; P = 0.04). No significant difference was found between frequency of laughter and systolic (0.23 mm Hg; 95% CI, −1.0 to 1.5; P = 0.72) and diastolic (−0.07 mm Hg; 95% CI, −0.8 to 0.7; P = 0.86) blood pressure changes in women.

Conclusions

Infrequent laughter was associated with long-term blood pressure increment among middle-aged men.

Real Men Don't Cry: Skill Expressing Discrete Emotions Differentially Predicts Cardiovascular Disease Risk in Men and Women

BACKGROUND

Expressing emotions effectively is central to social functioning and has links to health and cardiovascular disease (CVD) risk. Previous work has linked the ability to smile to lower CVD risk in men but has not studied other expressions or considered the context of these skills.

PURPOSE

To test whether the ability to express fear, anger, sadness, happiness, and disgust cross-sectionally predict CVD risk in both genders and whether links are moderated by the ability to decode others' emotional signals.

METHODS

A community sample of 125 men and women (30-75 years) provided trait emotion data before a laboratory visit where blood was drawn and performance-based assessments of the ability to signal and decode emotions were administered. Expressive accuracy was scored using FaceReader software. Projected CVD risk was calculated using Framingham, a New Zealand (NZ) specific, and Atherosclerosis CVD (ASCVD) risk algorithms.

RESULTS

Accuracy expressing happiness predicted lower projected risk, whereas greater accuracy expressing fear and sadness predicted higher risk. Gender frequently moderated these links; greater accuracy expressing happiness predicted lower risk in men but not women. Conversely, greater accuracy expressing fear predicted higher risk in men, whereas greater accuracy expressing sadness predicted lower risk in women but, again, higher risk in men. The ability to accurately decode others' emotions moderated some links.

CONCLUSIONS

The ability to signal emotion has complex links to health parameters. The ability to flexibly regulate expressions in accordance with gender norms may be one useful way of thinking about adaptive expressive regulation.

Specific types of sports and exercise group participation and socio-psychological health in older people

Older people who engage in sports and exercise in a group render greater benefits for socio-psychological aspects compared to exercising alone. The aim of this study was to identify the prevalence of specific types of sports and exercise groups and the association with self-rated health, depressive symptoms, and frequency of laughter among community-dwelling older people. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study and analysed 63,465 males and 68,497 females aged ≥65 years. The top three most popular types among males were golf (11.3%), walking (8.4%), and ground golf (6.3%). Among females, the top three were fitness exercises (13.8%), walking (8.3%), and weight exercises (6.2%). After adjusting for potential confounders, engaging in golf with a group was significantly related with excellent self-rated health (prevalence ratio, PR, 1.31 in male and 1.78 in female), low depressive symptoms (PR, 0.70 and 0.71), and a high frequency of laughter (PR, 1.12 and 1.13). Among females, walking displayed a significant relationship with all three characteristics (PR, 1.23, 0.79, and 1.06, respectively). Golf in older males and walking in older females might be the first choice for an effective programme to spread sports and exercise groups within the older Japanese community.

Emotional Effects on Factors Associated with Chronic Low Back Pain

PURPOSE

Although chronic low back pain (CLBP) has profound effects on patients, society, and economy, its causes are difficult to identify. Psychogenic effects or social stress is known to affect CLBP; hence, investigation of its underlying causes requires a multifactorial approach. We determined the factors associated with CLBP by using an Internet-based survey. To prevent CLBP, we need to understand its cause and background.

PATIENTS AND METHODS

A total of 1000 participants either with (+) or without (-) CLBP answered the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), which assesses five domains of CLBP: low back pain, lumbar function, walking ability, social life function and mental health. We also administered a new questionnaire for participants, that comprised five different domains: Body, Lifestyle, Emotion, Diet, and Social. To evaluate psychogenic effects on CLBP, we added two original factors, namely outshout and HIE, which have not yet been studied. HIE is a traditional concept (sense) of "feeling cold" or "chilly." All participants completed both questionnaires.

RESULTS

Multivariate logistic regression analysis extracted four factors (sleep, room temperature, outshout, and HIE) that were associated with CLBP. The mental health domain was assessed using the JOABPEQ for each of these factors. The factors outshout and HIE differed between CLBP (+) and CLBP (-) patients. CLBP (-) participants also showed a difference in Sleep and HIE factors.

CONCLUSION

Among psychogenic effects, Emotion was common to all the four extracted factors. There was no common physical divisor. Therefore, we hypothesized that acute low back pain might develop into CLBP in the presence of psychological stress or other emotional factors such as outshout or HIE. Hence, we need to consider both physical and psychogenic effects in the prevention and treatment of CLBP. Furthermore, appropriate evaluation and treatment of psychological stress may be effective in reducing CLBP.

Associations of Frequency of Laughter With Risk of All-Cause Mortality and Cardiovascular Disease Incidence in a General Population: Findings From the Yamagata Study

Background

Positive and negative psychological factors are associated with mortality and cardiovascular disease. This study prospectively investigated associations of daily frequency of laughter with mortality and cardiovascular disease in a community-based population.

Methods

This study included 17,152 subjects ≥40 years old who participated in an annual health check in Yamagata Prefecture. Self-reported daily frequency of laughter was grouped into three categories (≥1/week; ≥1/month but <1/week; <1/month). Associations of daily frequency of laughter with increase in all-cause mortality and cardiovascular disease incidence were determined using Cox proportional hazards modeling.

Results

During follow-up (median, 5.4 years), 257 subjects died and 138 subjects experienced cardiovascular events. Kaplan-Meier analysis revealed that all-cause mortality and cardiovascular disease incidence were significantly higher among subjects with a low frequency of laughter (log-rank P < 0.01). Cox proportional hazard model analysis adjusted for age, gender, hypertension, smoking, and alcohol drinking status showed that risk of all-cause mortality was significantly higher in subjects who laughed <1/month than in subjects who laughed ≥1/week (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.16–3.09). Similarly, risk of cardiovascular events was higher in subjects who laughed ≥1/month but <1/week than in subjects who laughed ≥1/week (HR 1.62; 95% CI, 1.07–2.40).

Conclusion

Daily frequency of laughter represents an independent risk factor for all-cause mortality and cardiovascular disease in a Japanese general population.

Reduction of radiation-related anxiety promoted wellbeing after the 2011 disaster: 'Fukushima Health Management Survey'

After the Fukushima disaster in 2011, affected residents experienced increased radiation-related anxiety and reduced subjective wellbeing. We investigated whether reduction of radiation-related anxiety promoted wellbeing among evacuees in Fukushima and assessed the role of mental health distress as a mediator. We used data from questionnaire surveys of evacuees in the 2011 and 2012 fiscal years (N = 34 312). We used radiation risk perception as an indicator of radiation-related anxiety and the frequency of laughter as an indicator of wellbeing. We measured changes in radiation risk perception from 2011 and 2012, and the frequencies of laughter and mental health distress (Kessler 6-item scale) in 2012, and investigated associations between radiation risk perception and frequency of laughter with and without covariates of mental health distress. Perceived genetic risk in 2011 had a significant inverse association with the frequency of laughter. Lowering of radiation risk perception was significantly associated with the frequency of laughter in the absence of covariates of mental health distress, but not in their presence. Lowering of radiation risk perception was also significantly associated with low mental health distress. Reduction of radiation-related anxiety promoted wellbeing via alleviation of mental health distress.

Impact of social relationships on income-laughter relationships among older people: the JAGES cross-sectional study

OBJECTIVES

Laughter has a positive and quantifiable effect on certain aspects of health, and previous studies have suggested that income influences the emotion. However, it is unknown whether social relationship-related factors modify the association between equivalised income and laughter among older people. In the present study, we examined the relationship between equivalised income and the frequency of laughter. In addition, we examined the impact of social relationship-related factors on the association between equivalised income and frequency of laughter using a cross-sectional study design.

DESIGN

Cross-sectional study and binomial regression analysis.

SETTING

We sampled from 30 municipalities in Japan.

PARTICIPANTS

We examined 20 752 non-disabled Japanese individuals aged ≥65 years using data from the Japan Gerontological Evaluation Study.

PRIMARY OUTCOME

Frequency of laughter.

RESULTS

Laughter increased significantly with an increase in equivalent income (p for trend <0.0001). Prevalence ratios (PR) for laughing almost every day were calculated according to quartile equivalised income after adjusting for age, instrumental activities of daily living, depression, frequency of meeting friends, number of social groups and family structure. The results revealed that PRs in Q4 (men; ≥€24 420, women; ≥€21 154) were 1.21 (95% CI 1.13 to 1.30) among men and 1.14 (95% CI 1.08 to 1.20) among women, as compared with Q1 (men; <€12 041, women; <€9518), respectively. After excluding participants with depression, the association remained significant. In addition, we found inadequate social relationships and living alone were associated with a lower frequency of laughter. In comparison with the lowest equivalent income with meeting friends less frequently and living alone, the PRs of the highest equivalent income with meeting friends frequently and living with someone were higher, respectively.

CONCLUSIONS

The results revealed a significant relationship between equivalent income and the frequency of laughter. Social relationships and family structure were also associated with the frequency of laughter.

Social participation and risk of influenza infection in older adults: a cross-sectional study

OBJECTIVES

Influenza infection can cause severe pneumonia, which is sometimes fatal, particularly in older adults. Influenza results in 3-5 million cases of severe illness and about 250 000 to 500 000 deaths annually worldwide. Social participation in the context of influenza infection is controversial because, although social participation is beneficial in maintaining physical function and mental health, it also increases the risk of contact with infected people. This study examined the association between social participation and influenza infection in Japanese adults aged 65 years or older.

DESIGN

Cross-sectional study.

SETTING

Japanese functionally independent adults aged 65 years or older.

PARTICIPANTS

Among the respondents to the Japan Gerontological Evaluation Study (JAGES) 2013 survey, which took place during the period from October to December 2013, 12 231 men and 14 091 women responded to questions on influenza vaccination and influenza infection.

OUTCOME MEASURES

Using JAGES data for 12 231 men and 14 091 women aged ≥65 years, we examined the association between social participation and influenza infection. The association between influenza infection and number of groups in which respondents participated was investigated among adults aged≥65 years, stratified by vaccination status and sex.

RESULTS

Unvaccinated women who participated in two or more social activities were 2.20 times (95% CI 1.47 to 3.29) as likely to report an influenza infection as those who reported no social participation. In contrast, vaccinated women who participated in two or more social groups had no additional risk of influenza infection as compared with female elders with no social participation. Among men, participation in social activities was not significantly associated with influenza infection, regardless of vaccination status.

CONCLUSIONS

Social participation was associated with a higher risk of influenza infection among unvaccinated older women, which suggests a need for further efforts to promote influenza vaccination, particularly among socially active elderly women.

Homeostatic effect of laughter on diabetic cardiovascular complications: The myth turned to fact

AIMS

Laughter has been used for centuries to alleviate pain in morbid conditions. It was not until 1976 that scientists thought about laughter as a form of therapy that can modulate hormonal and immunological parameters that affect the outcome of many serious diseases. Moreover, laughter therapy was shown to be beneficial in type 2 diabetes mellitus (T2DM) by delaying the onset of many diabetic complications. Laughter is also described to influence the cardiovascular and endothelial functions and thus may protect against diabetic cardiovascular complications. In this review, we outline the different biochemical, physiological and immunological mechanisms by which laughter may influence the overall state of wellbeing and enhance disease prognosis. We also focus on the biological link between laughter therapy and diabetic cardiovascular complications as well as the underlying mechanisms involved in T2DM.

METHODS

Reviewing all the essential databases for "laughter" and "type 2 diabetes mellitus".

RESULTS

Although laughter therapy is still poorly investigated, recent studies show that laughter may retard the onset of diabetic complications, enhance cardiovascular functions and rectify homeostatic abnormalities associated with T2DM.

CONCLUSIONS

Laughter therapy is effective in delaying diabetic complications and should be used as an adjuvant therapy.

Humor, laughter, learning, and health! A brief review

Human emotions, such as anxiety, depression, fear, joy, and laughter, profoundly affect psychological and physiological processes. These emotions form a set of basic, evolved functions that are shared by all humans. Laughter is part of a universal language of basic emotions that all humans recognize. Health care providers and educators may utilize the power of laughter to improve health and enhance teaching and learning. This is an important consideration because teaching is not just about content: it is also about forming relationships and strengthening human connections. In this context, when used effectively, humor is documented to build relationships and enhance performance. Specifically, humor improves student performance by attracting and sustaining attention, reducing anxiety, enhancing participation, and increasing motivation. Moreover, humor stimulates multiple physiological systems that decrease levels of stress hormones, such as cortisol and epinephrine, and increase the activation of the mesolimbic dopaminergic reward system. To achieve these benefits, it is important to use humor that is relevant to the course content and not disparaging toward others. Self-effacing humor illustrates to students that the teacher is comfortable making mistakes and sharing these experiences with the classroom. In this brief review, we discuss the history and relationship between humor, laughing, learning, and health with an emphasis on the powerful, universal language of laughter.

Greater ability to express positive emotion is associated with lower projected cardiovascular disease risk

Positive emotion is associated with lower cardiovascular disease (CVD) risk, yet some mechanisms remain unclear. One potential pathway is via emotional competencies/skills. The present study tests whether the ability to facially express positive emotion is associated with CVD risk scores, while controlling for potential confounds and testing for sex moderation. Eighty-two men and women underwent blood draws before completing self-report assessments and a performance test of expressive skill. Positive expressions were scored for degree of 'happiness' using expression coding software. CVD risk scores were calculated using established algorithms based on biological, demographic, and behavioral risk factors. Linear regressions revealed a main effect for skill, with skill in expressing positive emotion associated with lower CVD risk scores. Analyses also revealed a sex-by-skill interaction whereby links between expressive skill and CVD risk scores were stronger among men. Objective tests of expressive skill have methodological advantages, appear to have links to physical health, and offer a novel avenue for research and intervention.

Does the ability to express different emotions predict different indices of physical health? A skill-based study of physical symptoms and heart rate variability

OBJECTIVES

The outward expression of emotion has been frequently associated with better health outcomes, whereas suppressing emotion is thought to contribute to worse physical health. However, work has typically focused on trait expressive tendencies and the possibility that individual differences in the ability to express specific emotions may also be associated with health has not been widely tested.

DESIGN

A cross-sectional study of community dwelling adults.

METHODS

One hundred and twenty-eight participants aged 18-88 years completed questionnaires assessing demographics and health status, before attending a testing session in which resting heart rate variability (HRV) was assessed. Participants then completed a performance-based test of expressive regulatory skill in which they were instructed to enhance and suppress their emotional expressions while they watched film clips validated to elicit amusement, sadness, and anger. Participants rated subjective emotional experience before and after each clip, and their degree of expressivity was scored using FACS-based Noldus FaceReader.

RESULTS

Missing data resulted in a final sample size of 117. Linear regressions controlling for age, sex, diagnoses, and trait emotion revealed that greater ability to enhance sad expressions was associated with higher HRV while the ability to enhance expressions of joy was associated with lower symptom interference. In parallel models, the ability to flexibly regulate (both enhance and suppress) expressions of joy and sadness was also associated with lower symptom interference.

CONCLUSIONS

Findings suggest that the ability to regulate expressions of both sadness and joy is associated with health indices even when controlling for trait affect and potential confounds. The present findings offer early evidence that individual differences in the ability to regulate the outward expression of emotion may be relevant to health and suggest that expressive regulatory skills offer a novel avenue for research and intervention. Statement of contribution What is already known on this subject The tendency to outwardly express felt emotion generally predicts better health, whereas expressive suppression typically predicts worse health outcomes. Most work has been based on trait assessments; however, the ability to regulate the expression of felt emotion can be objectively assessed using performance-based tests. Prior work in mental health suggests that the ability to flexibly up- and downregulate the expression of emotion predicts better outcomes. What does this study add The first evidence that the ability to flexibly regulate expressions predicts indices of health. Skill in both expressing and suppressing facial expressions predicts better reported health. Skills with different emotions differentially predict symptom interference and cardiac vagal tone.

Association between poor psychosocial conditions and diabetic nephropathy in Japanese type 2 diabetes patients: A cross-sectional study

AIMS/INTRODUCTION

It is suggested that a positive psychosocial condition has a good effect on health and glycemic control. However, there has been no research to evaluate the association between positive psychosocial factors and diabetic nephropathy (DN). The aim of the present study was to evaluate the association between psychosocial factors and DN in patients with type 2 diabetes.

MATERIAL AND METHODS

To assess psychosocial condition, six indicators (happiness score, Life Orientation Test-revised score as an indicator of dispositional optimism, laughter frequency, self-awareness of stress, social network and social support) were assessed by a self-administered questionnaire, and associations between these psychosocial indicators and the presence of DN were examined.

RESULTS

A cross-sectional analysis of patients with (n = 123) and without DN (n = 220) showed that a high score for happiness (odds ratio [OR] per 1 standard deviation 0.71, 95% confidence interval [CI] 0.57-0.89, P = 0.003), high Life Orientation Test-revised score (OR per 1 standard deviation 0.77, 95% CI: 0.61-0.98, P = 0.035), less self-awareness of stress (OR 0.56, 95% CI: 0.34-0.90, P = 0.017), high connection of social network (OR 0.55, 95% CI: 0.35-0.87, P = 0.010) and high social support (OR 0.61, 95% CI: 0.38-0.96, P = 0.035) were associated with a reduced risk of prevalence of DN. Similar results were observed even after adjustment for the following conventional risk factors of DN: age, sex, duration of diabetes, hemoglobin A1c, hypertension, dyslipidemia and current smoking.

CONCLUSIONS

The present study showed that five out of six prespecified indicators of psychosocial condition were significantly associated with the presence of DN in Japanese patients with type 2 diabetes.