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

The postpartum period begins approximately one hour after delivery and expulsion of the placenta and lasts for six to eight weeks. This period involves not only physiological recovery but also complex psychosocial processes. Changes in parental responsibilities, family dynamics, self-perception, and body image are key components of the postpartum period. The first year after childbirth is considered a particularly sensitive period for women in terms of both physical and psychological health. This sensitivity arises not only from physical recovery but also from the responsibility of caring for a newborn and the effort required to adapt to psychosocial changes.

Because the majority of maternal deaths occur within the first month postpartum and most neonatal deaths occur during the first month of life, the postpartum period is considered a critical time for maternal and newborn health. Stress, anxiety, fatigue, and reduced self-care experienced during this period, when not adequately managed, may increase the risk of postpartum anxiety and postpartum depression. Postpartum depression not only negatively affects maternal physical and mental health but is also associated with early cessation of breastfeeding, impaired mother-infant bonding, delays in child language and behavioral development, disruptions in childhood vaccination schedules, and adverse health outcomes for the entire family. If left untreated, postpartum depression may lead to long-term negative consequences for mothers, children, and families.

The World Health Organization's postpartum care guidelines emphasize the importance of preventive care, counseling services, mental health assessment, family planning, and physical evaluation of both the mother and the infant during the first six weeks postpartum. Counseling topics include breastfeeding, umbilical cord care, emotional well-being, screening for postpartum depression, assessment of domestic violence risk, nutrition, hygiene, safe sexual practices, exercise, iron and folic acid supplementation, and psychosocial support. Despite these recommendations, significant gaps remain in the provision of mental health services during the postpartum transition period, and systematic evaluation of maternal emotional well-being by health professionals is often insufficient. This highlights the need for supportive, non-pharmacological interventions during the postpartum period.

Stress, metabolic changes, and hormonal fluctuations during pregnancy and the postpartum period may increase anxiety levels and contribute to the development of postpartum depression, which is the most common psychiatric disorder following childbirth. Postpartum depression affects not only maternal health but also child development and parenting behaviors. When untreated, it can have profound and lasting negative effects on mothers, children, and families. Early identification of postpartum mental health problems and the implementation of supportive interventions are therefore of critical importance.

Mandala is an art form known to promote psychological relaxation and is typically composed of circular or geometric patterns. Mandalas may be used as a meditation tool and help direct attention to the present moment. Carl Gustav Jung described mandala techniques as therapeutic tools that reflect the individual's inner world and support psychological balance. Mandala practices are generally categorized as unstructured mandalas, which involve free drawing within a circle, and structured mandalas, which involve coloring predefined patterns. Structured mandala coloring is considered an art-based therapeutic approach that enhances attention, mindfulness, and emotional regulation. Although previous studies have demonstrated positive effects of mandala coloring on stress, anxiety, and emotional well-being, research examining its effects on postpartum anxiety and postpartum depression among postpartum women is limited. Therefore, this study aims to investigate the effects of a structured mandala coloring activity on postpartum anxiety and postpartum depression.