The effect of laughter yoga-based mental health strengthening training on caregiver burden, positive mental health, perceived stress, and salivary cortisol levels of mothers with special needs children

This study aimed to determine the effects of Laughter Yoga-Based Mental Health Empowerment Training, applied to mothers of children with special needs, on caregiver burden, positive mental health, perceived stress, and salivary cortisol levels. This research is an experimental, parallel-group randomized controlled trial designed with a pre-test-post-test design. The study was conducted between November 2024 and January 2025. The study group consisted of mothers of children with special needs receiving education at a Rehabilitation Center in Konya province. A total of 40 individuals were included in the study, 20 in the intervention group and 20 in the control group. Data were collected using a Personal Information Form, the Zarit Caregiver Burden Scale, the Positive Mental Health Scale, and the Perceived Stress Scale. Saliva samples were collected from the mothers to determine their cortisol levels. Mothers in the intervention group received eight weeks of "Laughter Yoga-Based Mental Health Empowerment Training" administered by the researcher. Mothers in the control group received no intervention. Descriptive statistics, dependent and independent samples t-tests, and chi-square tests (Pearson chi-square/Fisher exact test) were used to analyze the data. Mixed ANOVA analysis was used to evaluate time and group interaction. Based on the findings, a statistically significant difference was determined between the two groups in terms of mean scores on the "Caregiver Burden Scale" after the intervention (p<0.05). Furthermore, the group*time interaction was found to be significant (p<0.05), and in terms of the time effect, a decrease in caregiver burden was observed in mothers in the intervention group, and this effect was above the moderate level (p=0.011; Cohen d=0.63). The study also showed that the change in "Positive Mental Health Scale" scores over time differed between the intervention and control groups, the group*time interaction was significant (p<0.05), and in terms of the time effect, an increase in positive mental health levels was observed in mothers in the intervention group, and this effect was at a high level (p<0.001; Cohen d=-1.09). The study found no statistically significant difference in mean scores on the "Perceived Stress Scale," and further analysis revealed that the group*time interaction was also insignificant (p>0.05). A decrease in the time effect was observed in both groups. The study found that the change in "Salivary Cortisol Level" scores over time differed between the intervention and control groups, with a significant group*time interaction (p<0.05). Furthermore, in terms of the time effect, mothers in the intervention group experienced a decrease in salivary cortisol levels, and this effect was significantly higher (p<0.001; Cohen d=1.36). According to the findings of the study, Laughter Yoga-Based Empowerment Training was found to be effective in reducing the caregiving burden on mothers. However, no significant change was observed in the mothers' perceived stress levels. The statistically significant group*time interaction in terms of positive mental health and salivary cortisol levels indicates that the mental health empowerment training applied to mothers has positive effects over time. These results show that mental health empowerment training can provide significant improvements in some psychological and biological indicators over time. In line with these findings, it can be said that empowerment training applied to mothers is an effective nursing intervention that can be applied to mothers with children with special needs.