The Effect of Art-Based Mandala Coloring Activity on Postpartum Anxiety and Postpartum Depression

NCT07312812 | Not Yet Recruiting

• 1 other identifier: AFYON-HSU-MANDALA-2025
• Study Type: interventional
• Target: 60
• Locations: 0 countries
• Sites: N/A

Brief Summary

The postpartum period is a critical time for women's physical and psychological health, during which significant hormonal, emotional, and social changes occur. During this period, many women experience increased stress, anxiety, and emotional vulnerability while adapting to new parental responsibilities and caring for a newborn. When these challenges are not adequately managed, they may contribute to the development of postpartum anxiety and postpartum depression, which can negatively affect maternal well-being, mother-infant bonding, breastfeeding practices, and child development. Despite the importance of postpartum mental health, non-pharmacological and easily accessible supportive interventions remain limited. This randomized controlled experimental study aims to evaluate the effect of a structured, art-based mandala coloring activity on postpartum anxiety and postpartum depression among postpartum women. The study will be conducted at Afyonkarahisar Health Sciences University Health Practice and Research Center, Obstetrics and Gynecology Clinic, and will include women who have recently given birth at this institution. Eligible participants will be randomly assigned to either an intervention group or a control group. Women in the intervention group will receive individual training in mandala coloring before hospital discharge and will be provided with mandala coloring materials for home use. They will be encouraged to engage in the mandala coloring activity over an eight-week period and will be followed through regular telephone contacts. In addition to monitoring participation in the activity, individualized supportive counseling will be provided based on participants' needs. Women in the control group will receive routine postpartum care without any additional intervention. Postpartum anxiety and postpartum depression levels will be assessed at multiple time points during the study to examine changes over time. This study seeks to determine whether mandala coloring, as a low-cost and non-pharmacological art-based activity, may serve as a supportive approach to improve psychological well-being during the postpartum period. The findings may contribute to the development of accessible interventions aimed at supporting maternal mental health in the early postpartum period.

Conditions

Postpartum Depression; Postpartum Anxiety

Keywords

woman; postpartum; depression; anxiety; mandala

Outcome Measures

Primary Outcomes (1)

• Postpartum Depression

  Change in postpartum depression level measured by the Edinburgh Postnatal Depression Scale (EPDS). This scale was developed to determine whether there is a risk of depression in mothers during the postpartum period . The scale consists of 10 items in a four-point Likert format scored between 0 and 3. The minimum score that can be obtained from the scale is 0 and the maximum score is 30. The cut-off score of the scale is 13. Scores above this value indicate a high risk of depression.

  Baseline, week 4, and week 8

Secondary Outcomes (1)

• Postpartum Anxiety

  Baseline, week 4, and week 8

Study Arms (2)

Mandala Coloring Activity Group

EXPERIMENTAL

Women who agree to participate in the study will receive individual mandala coloring training by the researcher before hospital discharge. The training will last approximately 20 minutes and will consist of three stages. In the first stage, participants will be informed about mandala coloring. In the second stage, an assistant researcher will demonstrate the coloring process using a sample mandala. The participant will then perform a brief practice on a small sample mandala. In the third stage, a mandala coloring set will be provided for participants to use at home. Following the training, participants will be followed for eight weeks with weekly telephone contacts. The first telephone contact will take place during the first week. During this contact, the personal information form and the postpartum anxiety and postpartum depression scales will be administered to collect baseline data. In subsequent contacts, the frequency and duration of mandala coloring activities will be assessed

Behavioral: Mandala Coloring Activity

Standard of care group

NO INTERVENTION

Women in the control group will not receive any intervention. However, postpartum anxiety and postpartum depression scales will be administered by telephone at weeks 1, 4, and 8. During the first week, demographic information will also be collected using a personal information form.

Interventions

Mandala Coloring Activity BEHAVIORAL

Structured mandala coloring training and home practice.

Mandala Coloring Activity Group

Eligibility Criteria

• Age: 18 Years - 49 Years
• Gender Eligibility Details: Eligibility is limited to women in the postpartum period who have given birth.
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Able to speak and understand Turkish
• Voluntarily agree to participate in the study and have signed the informed consent form
• years of age or older
• Literate
• Have not received any psychiatric diagnosis and are not currently receiving psychological or psychiatric support (therapy, counseling, or medication treatment)
• Have not experienced any complications during delivery
• Have a newborn with no malformation or anomaly
• Have a newborn with no complications

You may not qualify if:

• Have previously received psychological or psychiatric treatment or are receiving such treatment during the data collection period,
• Have a serious neurological or psychiatric disorder that affects cognitive functioning,
• Have serious health problems that prevent communication or participation in the study,
• Have not provided informed consent,
• Are unable to speak or understand Turkish,
• Have experienced complications during delivery,
• Have a newborn with a malformation or anomaly,
• Have a newborn with any complications.

Sponsors & Collaborators

• Afyonkarahisar Health Sciences University: lead

MeSH Terms

Conditions

Depression, Postpartum; Depression; Anxiety Disorders

Condition Hierarchy (Ancestors)

Puerperal Disorders; Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Depressive Disorder; Mood Disorders; Mental Disorders; Behavioral Symptoms; Behavior

Central Study Contacts

Cahide Çevik, PhD

CONTACT

+905055189244; cahide.cevik@afsu.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Public health Nursing

Model Details: This study uses a randomized, parallel-group interventional design. Eligible postpartum women are randomly assigned to either an intervention group or a control group using a lottery-based randomization method. The two groups are followed concurrently throughout the study period without crossover between groups. Participants in the intervention group receive a structured, art-based mandala coloring intervention in addition to routine postpartum care, while participants in the control group receive routine postpartum care only. Outcomes are assessed at multiple predefined time points to evaluate changes over time and to compare the effects of the intervention between groups.

Study Record Dates

• First Submitted: December 17, 2025
• First Posted: December 31, 2025
• Study Start: January 15, 2026
• Primary Completion: April 15, 2026
• Study Completion: April 15, 2026
• Last Updated: January 7, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share