The Impact of Mandala Coloring Meditation on Post-Traumatic Stress Disorder in Mothers of Premature Infants Hospitalized in Neonatal Intensive Care Units Publisher



Pouraboli B ; Alimohammadi F ; Fakhr A S
Source: Journal of Neonatal Nursing Published:2026

Abstract

Background Mothers of preterm infants admitted to neonatal intensive care units (NICUs) are at increased risk of developing post-traumatic stress disorder (PTSD). This study evaluated the association between mandala coloring meditation and PTSD symptoms in these mothers. Methods This quasi-experimental pretest–posttest study was conducted in 2022–2023 in NICUs affiliated with Tehran University of Medical Sciences. Eighty-two eligible mothers were recruited using convenience sampling and allocated to intervention (n = 41) and control (n = 41) groups. Five participants were lost to follow-up; therefore, data from 77 mothers (38 in the intervention group and 39 in the control group) were included in the final analysis. Participants were enrolled on the second day of their infants' hospitalization. The intervention group received 11 consecutive daily sessions of mandala coloring meditation, whereas the control group received routine care. PTSD symptoms were assessed at baseline and one month after the intervention. Because baseline PTSD scores differed significantly between groups, post-intervention comparisons were adjusted for baseline values. ANCOVA assumptions were evaluated before analysis, and changes over time were additionally examined using a linear mixed-effects model. Results Baseline PTSD scores were significantly higher in the intervention group than in the control group (8.81 ± 1.52 vs. 7.83 ± 1.76; P = 0.011). At one-month follow-up, mothers in the intervention group had significantly lower PTSD scores than those in the control group (P < 0.001). The group difference remained significant after adjustment for baseline values. However, because the homogeneity of regression slopes assumption was violated for the total PTSD score, the adjusted ANCOVA findings for the overall PTSD score were interpreted cautiously, and the primary inference regarding changes over time was based on the linear mixed-effects model. Conclusion Mandala coloring meditation was associated with lower PTSD symptom scores among mothers of preterm infants hospitalized in NICUs. Given the quasi-experimental design, convenience sampling, baseline imbalance between groups, and the analytical limitations for the total PTSD score, causal inference should be made cautiously. Further randomized controlled trials are warranted to confirm these findings. © 2026 Neonatal Nurses Association.