Effects of clown visits on stress and mood in children and adolescents in psychiatric care—Protocol for a pilot study

Abstract

Scientific evidence has shown that healthcare clowning can decrease the level of stress and anxiety in pediatric patients. However, little attention has been devoted to the potentially beneficial impact of clown visits in the child and adolescent psychiatry setting. Therefore, this pilot study aims at investigating short-term effects of clown visits by RED NOSES Clowndoctors Austria on stress and mood levels of children and adolescents in psychiatric care. The sample will consist of approximately 50 children and adolescents in inpatient psychiatric wards who receive clown visits on a weekly basis over four consecutive weeks. The examined intervention, i.e., the clown visits, is an integral part within the selected psychiatric institutions. Using a non-controlled pre-/post-test design, the level of salivary cortisol and self-reported stress and mood will be measured as primary outcomes before and immediately after each clown visit. Additionally, self-reported effects on care staff at the health care facilities will be assessed based on a questionnaire after each clown visit within the same time period of four weeks. Secondary outcome measures (i.e., health-related quality of life, emotional and conduct problems, perceived chronic stress) will be assessed at baseline and at close-out assessment after the four intervention weeks. Further control variables and potential moderators are included at baseline. Due to the nested data structure, multilevel modeling will be used to analyze the data. To our knowledge, this is the first study to examine the stress-reducing and mood-improving effects of clown visits on inpatients in child and adolescent psychiatry. Results will be relevant for the design of future large-scale RCTs and might provide valuable implications for the use of healthcare clowning to reduce stress and improve mood in children and adolescents in psychiatric care. The study is registered at ClinicalTrials.gov (Identifier: NCT04844398).

Clown care in the clinical nursing of children: a meta-analysis and systematic review

“…Children represent a special group, susceptible to feelings of fear, resistance, and other sad emotions in the hospital environment; these emotional responses can increase the risk associated with operation and anesthesia, which is not conducive to their postoperative recovery; hence, providing effective nursing interventions for children in the hospital is crucial ( 31 ). The psychological needs of children differ from the traditional behavior patterns of medical staff, which leads to poor medical experiences such as the “needle phenomenon” and “white coat phenomenon,” which can aggravate the resistance of children and affect the effectiveness of clinical treatment and nursing care ( 32 , 33 ). The results of this meta-analysis have shown that clown care is beneficial in reducing the pain degree, anxiety level, and crying time of children and the anxiety level of caregivers, which may be promoted in clinical care.…”

Gülmek Neden İyileştirir? Terapide Mizah Kullanımı Üzerine Bir Derleme

“…In clown therapy, doctors, often dressed as clowns, help surgical or oncological patients cope with the stress and anxiety they experience during their treatment (Boscarelli 2017). In hospitals, especially in pediatric settings (Koller andGriski 2008, Markova et al 2021) in pediatric intensive care units (Mortamet et al 2017), children and adolescents in psychiatric care (Zemp et al 2022) and in the examination of sexually abused children (Tener et al 2010) clowning is used therapeutically. It has also been observed that the use of clowning therapeutically during venous blood sampling has positive effects on pain and anxiety (Meiri et al 2016, Kurudirek et al 2021.…”