The Effect of a Mandala-Coloring Activity on Stress and Anxiety in Mothers With Infants Hospitalized in NICU

Background: Mothers of infants in neonatal intensive care units (NICUs) experience significant psychological stress and anxiety, disrupting maternal-infant bonding, impairing breastfeeding, and maternal well-being. Purpose: This randomized controlled trial investigated the effects of mandala coloring activities on maternal stress and state anxiety among mothers with infants hospitalized in the NICU. Methods: This randomized controlled trial was conducted among mothers residing in the mother hotel of a state hospital in southeast Turkey, whose infants were hospitalized in the NICU. Seventy-two mothers of NICU infants were randomly assigned to either the mandala coloring group (n = 36) or the control group (n = 36). Data were collected using the socio-demographic information form, Visual Analog Scale (VAS), and the State-Trait Anxiety Inventory-State Subscale (STAI-State). Stress and anxiety levels were assessed at baseline (T1), Day 4 (T2), and Day 7 (T3). Results: No significant differences were found between groups at T1 for VAS and STAI-State scores ( P > .05). At T2 and T3, the mandala coloring group exhibited significantly lower stress and anxiety scores compared to the control group ( P < .001). Large effect sizes were observed for both stress ( η p 2 = 0.867) and anxiety ( η p 2 = 0.798), demonstrating the significant impact of mandala coloring on reducing maternal distress over time. Implications for Practice and Research: Mandala coloring is a simple, low-cost, non-pharmacological intervention that may reduce stress and anxiety in mothers with infants in the NICU. Integrating structured art activities into psychosocial support programs for NICU mothers may enhance maternal mental health and promote mother-infant bonding.