The Effect of Mandala Art Therapy on the Psychological Well-Being and Perception of Social Support in Elderly People

The proportion of the elderly population is rapidly increasing worldwide, and it is projected that the number of individuals aged 60 and over will reach two billion by 2050 (World Health Organization [WHO], 2022).The aging process is closely linked not only to physiological changes but also to changes in mental and social health. Social isolation, loneliness, role loss, and physical limitations in advanced age can lead to negative consequences such as depression, anxiety, and decreased life satisfaction (Holt-Lunstad et al., 2015; Courtin and Knapp, 2017). Therefore, supporting the mental well-being of older individuals and strengthening social ties are among the priority goals of healthy aging policies (WHO, 2021). Psychological well-being in older individuals is related to social support. A study on older individuals found that high perceived social support in older adults increases life satisfaction and psychological well-being (Antonucci et al., 2014). Social support plays a protective role in preventing negative mental states such as loneliness, hopelessness, and anxiety in older adults (Chao, 2011). Family and peer support, in particular, strengthen the psychological well-being of older adults (Gariépy et al., 2016). Consequently, there is a strong and positive relationship between the perception of social support and psychological well-being in older adults. Therefore, interventions implemented for older adults by strengthening their social support networks play an important role in protecting their mental and physical health. Art therapy and creative activities are among the effective interventions that support the mental well-being of older adults. Group practices, particularly those involving mandala programs, have positive effects on anxiety and stress (Czamanski-Cohen et al., 2021). Mandala practices implemented in a group setting increase social interaction and strengthen perceptions of social support (Moon and Kim, 2020). While the existing literature has examined the effects of art therapy, music therapy, and creative activities on depression, anxiety, and life satisfaction in the elderly (Windle et al., 2018; Tymoszuk et al., 2019), studies examining psychological well-being and perceived social support together are limited. Studies evaluating mandala practices for the elderly population in Turkey using standardized scales are also limited. This study will be one of the first studies conducted in Turkey to examine the effects of mandala activities on both psychological well-being and perceived social support using the same model.It is believed that the findings will contribute to the evidence-based use of art-based group programs for older adults in clinical care and community-based studies. This study aims to examine the effects of mandala art therapy on psychological well-being and perceived social support in older adults.Studies on mandala art therapy have shown that it supports depression, anxiety, and spiritual well-being in the elderly mental health field. In a randomized controlled trial conducted in Taiwan, older adults were randomly assigned to a 20-minute activity of mandala painting, plaid painting, free drawing, or reading. The mandala painting group showed significant decreases in feelings of "relaxation," "safeness," and "comfort" (more positive feelings) compared to the control group (Koo et al., 2020). In a quasi-experimental single-group pre-post study conducted in Tehran, elderly people attending a daycare center painted mandalas twice a week for two weeks; When DASS-21 scores were examined, a significant decrease (p = 0.001) was observed in depression, anxiety, and stress levels (Amadi et al., 2023). In a study in India, mandala coloring was applied to elderly individuals living in nursing homes, a significant decrease (p < 0.01) was noted in Beck Depression Inventory (BDI) scores compared to pre- and post-test (Sreetha et al., 2021). In a 20-week art therapy intervention for depressed elderly women in Brazil, the therapy was found to significantly reduce depression and anxiety symptoms in the Geriatric Depression Scale (GDS), Beck Depression Inventory, and Beck Anxiety Inventory (Ciasca et al., 2018).

Inclusion criteria

Participation criteria for the study include willingness to participate, being 60 years of age or older, scoring 24 or higher on the Mini Mental State Examination -

Exclusion criteria

Exclusion criteria include severe Alzheimer's disease and dementia, having undergone regular art therapy/psychotherapy within the last three months, and being visually impaired.

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