INTRODUCTION:

Aging is an essential, natural part of life and it is a normal process of time related transition, begins with birth and continues throughout life. According to statistical report by United Nations-department of economic and social affairs population division shows that, globally 703 million older persons aged 65 or over in 2019. In that continent wise statistics shows that eastern and south eastern Asia has largest number 260 million of the world’s older population and followed by Europe and Northern America having over 200 million world’s older population.¹ According to statistical report on aging and health by WHO shows that in developed countries approximately 20–15% aged over 65 suffer from mild and moderate forms of depression and 1 to 3% of people suffering severe depression.²

In Sanskrit language, the word ‘mandala’ means ‘circle’ or ‘centre’. These circles are spiritual symbols which represents the universe. Mandala art have concentric circles that grow outwardly and these represent congruence with universe and mind The major benefits of this mandala art therapy include stress-relief, reduce depression and anxiety, acquire positive thoughts This is not just a fun activity; it is also a therapeutic activity everyone can do by self at home, office, bus, train, almost from anywhere.³ In India, elderly persons aged 60 years and above constitute 8.6% of the total population, which is projected to reach 19% by 2050⁴. Thus, depression among elderly population is likely to be an important cause of disease burden in the future. So, it is necessary to undertake the present study with an interventional programme colouring mandala art for reducing elderly depression among people lives in the old age homes.

OBJECTIVES:

1. To assess the level of depression before and after Mandala art among the elderly persons.

2. To assess the effectiveness of colouring mandala art on level of depression among the elderly persons after the intervention.

3. To associate the pre-test level of depression among elderly persons with selected socio demographic and clinical data variables.

HYPOTHESIS:

H1: There will be significant difference in the level of depression before and after colouring mandala art among elderly persons live in old age home.

H2: There will be significant association between the levels of depression among elderly persons with their selected socio demographic and clinical data variables.

MATERIAL AND METHODS:

In this study quantitative research approach and pre-experimental, one group pre-test post-test design was adopted. The setting of the study is selected old age home in Thrissur. By using Non-Probability purposive sampling technique 30 samples was selected. The tool for the present study consists of Socio demographic, clinical data questionnaire which include total 16 questions. It will be filled by the participants after getting informed consent. It includes age, gender, education status, marital status, religion, family type, duration of stay, type of admission, Duration of sleep, medication history, previous hospitalization, previous surgery, hobby, activity of daily living and mobility. For assessing level of depression standardized Beck's Depression Inventory scale was used. Validity and reliability of the tool was established. Researcher took training in mandala art therapy and develop 8 different types of Mandela arts. The investigator conducts the pre-test by on day 1, intervention provided 8 consecutive days (day 2 – day 9) and post-test done at 10^th day after intervention. The data were analysed using both descriptive and inferential statistics for accomplishing the present objectives of the study. Frequencies and percentages were used to assess the level of depression before and after Mandala art among the elderly persons. Paired t test to compare the effectiveness of colouring mandala art on level of depression among the elderly persons after the intervention. Chi-square was used to associate the pre-test level of depression with selected socio demographic and clinical data variables.

Tools and techniques:

The tool for the present study consists of Socio demographic, clinical data questionnaire and standardized Beck's Depression Inventory.

In Socio -demographic and clinical data questionnaire there are a total of 16 questions. It will be filled by the participants after getting informed consent. It includes age, gender, education status, marital status, religion, family type, duration of stay, type of admission, duration of sleep, medication history, previous hospitalization, previous surgery, hobby, activity of daily living and mobility. Beck's Depression Inventory scale it is a 21-item self-report scale that evaluates key symptoms of depression. Individual scale items are scored on a 4-point continuum (0=least, 3=most), with a total summed score range of 0–63. 0 – 13 Minimal depression, 14 – 19 Mild depression, 20 – 28 Moderate depression, 29 – 63 severe depression. The ICVI score for socio demographic and clinical data questionnaire and beck's depression inventory scale is 1,1 respectively. The reliability of the tool was tested using test re-test method. The reliability score obtained for beck's depression inventory scale is 0.84. The validity and reliability of the tool was established.

Intervention:

The intervention is Colouring mandala art. Researcher took an online course in colouring mandala art therapy and got the certificate. Develop 8 different types of pre drawn mandala art and validated from experts. Provides the pre-drawn mandala arts and each participant were given 30 minutes to color one mandala art per day. Each person colour the mandala art in their own idea. It was continued for 8 consecutive days.

RESULT:

Section I: Sociodemographic and clinical data variable.

Table 1: Frequency and percentage of elderly persons according to sociodemographic variables age, gender, religion, education, marital status, type of family, duration of stay in old age home and nature of admission (n =30)

Sociodemographic and clinical data variables	Characteristic	Frequency (f)	(%)
Age	60 – 70	16	53.33
	71 – 80	11	36.67
	>80	3	10
Gender	Female	7	23.33
	Male	23	76.67
Religion	Hindu	14	46.67
	Muslim	0	0
	Christian	16	53.33
Education	School	9	30
	College	13	43.33
	Professional	8	26.67
Marital status	Single	17	56.67
	Married	1	3.33
	Widow	12	40
	Divorce/separated	0	0
Type of family	Joint	13	43.33
	Nuclear	17	56.67
Duration of stay in old age	<1year	1	3.33
	1 – 4 years	17	56.67
	>4 years	12	40
Nature of admission	Voluntary	23	77.67
	Forced	6	20
	Others	1	3.33

Table 1 shows that 16(53.33%) samples were in the age group of between 60-70. Majority of the samples 23 (76.67%) were females. 16(53.33%) samples belong to Christian religion and 13(43.33%) have primary level education. More than half of the sample 17(56.67%) were single. More samples 17(56.67%) came from nuclear family. There have been 17 samples (56.67%) lives in old age home between 1-4 years and 23 (76.67%) admitted in the old age home as voluntarily.

Table 2: Frequency and percentage of elderly persons according to sociodemographic variables hobby, how often family members visit in the old age home and duration of sleep (n=30)

Sociodemographic and clinical data variables	Characteristic	Frequency (f)	(%)
Any hobby	Yes	8	26.67
	No	22	73.33
Family member visit	Every week	0	0
	Every month	11	36.67
	Every 6 month	17	56.67
	Once in a while	0	0
	Never	2	6.67
On medication	Yes	16	53.33
	No	14	46.67
Previous hospitalization	Yes	21	70
	No	9	30
Previous surgery	Yes	5	16.67
	No	25	83.33
Activity of daily living	Independent	28	93.33
	Partially	2	6.67
	Dependent	0	0
Mobility	Independent	25	83.33
	Using stick	5	16.67
	Wheel chair	0	0

Table 2 shows that majority 22 (73.33%) of the samples had no hobbies and 17(56.67%) samples family members visit the old age home in every 6 months. More than half of the samples 16(53.33%) are on medication. Majority of the samples 21(70%) had previous history of hospitalization and more persons 25(83.33%) had no history of previous surgery. Most of the samples 28(93.33%) doing their daily activities independently and 25 (83.33%) were mobilizing independently.

Section II: Assessment of level of depression among elderly persons before and after colouring mandala art

Figure 1: level of depression among elderly people before and after the intervention of colouring mandala art (n=30)

Bar diagram shows in pre-test most of the samples 23(76.67%) had moderate level of depression and 7 (23.33%) had mild level of depression. In post-test 18 (60%) samples had moderate level of depression 11 (36.67%) samples had mild level of depression and 1 (3.33%) sample had minimal level of depression. (see fig 1)

Section III: Effect of mandala colouring art on depression among elderly person

Table 3: Mean, standard deviation and t value of pre-test and post-test level of depression among the old age persons (n=30)

	Mean	SD	t value	df	P value
Pre-test	23.47	4.066	5.492	29	<0.01**
Post-test	19.57	3.626

(t_29
=2.045, p<0.05), **Highly significant p <0.01

Table 2 inferred that the mean pre-test score is 23.47 whereas of post-test is 19.57. The calculated paired t value (5.492) was greater than the table t value (2.043) at degree of freedom (df) 29. Hence H₁is accpted. Does it can be interpreted that there is significant difference in depression among elderly person before and after colouring Mandala art.

Section IV: Association between pre-test depression and selected sociodemographic and clinical data variables

In chi-square test the clinical data variable activity of daily living had significant association with pre-test level of depression among elderly persons at p value 0.008 (p< 0.05). Hence research hypothesis H₂ was accepted.

DISCUSSION:

In this present study the mean pre-test is 23.47 whereas of post-test is 19.57. The calculated paired t value (5.492) was greater than the table value of degree of freedom (df) 29. Does it can be interpreted that there is significant difference in depression among elderly person before and after colouring Mandala art.

CONCLUSION:

This study implies that colouring mandala art was effective in reduction in level of depression among elderly people who are living in the selected old age home Thrissur. Thus, colouring mandala art can be used as a therapeutic tool for patients to prevent the occurrence of depression among elderly people. Based on the current study findings, the researcher distributed copy of mandala art to all the participants for continuing the activity. Researcher discussed the findings with the in charges of old age homes

LIMITATION:

· The study was conducted among the elderly from a selected old age homes at Thrissur only. So generalization must be done with caution.

· The period of data collection is limited to 9 days.

· Experimental study with control group could have shown much better result.

· Sample size were too small limited to 30 which limits the generalization of the study findings.

RECOMMENDATIONS:

Based on the findings of the study, the recommendations offered for future research were

· A similar study can be conducted, replicated on a large sample to generalize the study findings.

· A similar study can be conducted with experimental research design having control group and experimental group.

· A comparative study can also be done to compare the effect of colouring mandala art with other therapies such as laughter therapy, massage therapy, music therapy, yoga therapy etc.

· A similar study can be conducted as comparative study between elderly residing in old age home and elderly residing in their homes.

CONFLICT OF INTEREST:

No Conflict of Interest.

ETHICAL CLEARANCE:

The ethical clearance was taken from the institutional research and ethical committee, JMMC and RI, Thrissur on 03.06.2019 with IEC study reference number; 25/19/IEC/JMMCandRI

REFERENCE:

1. United Nations reports on World Population Ageing 2019: Highlights. 2019: Available: from: https://www.un.org/en/ development/desa/population/publications/pdf/ageing. (Accessed on 6/6/2019)

2. WHO Report on Aging and Health .2016. Available from https://www.WHO.int (Accessed on 22/12/2018)

3. Williams E. Eight benefit of coloring mandala art therapy. Stress relief coloring for adult. 2017.3(2). 134: Avaliable from: https://www.stressreliefcoloringapp.com/8-benefits-of-coloring-mandalas-for-your-mind-body/ 17:18:53.

4. Agarwal A, Lubet A, Mitgang E, Mohanty S, Bloom DE. Population aging in India: Facts, issues, and options. Bonn; 2016. Report No.: 10162. Available from: https://ideas.repec.org/p/gdm/ wpaper/13216.html.

Received on 19.12.2020 Modified on 18.01.2021

Int. J. Nur. Edu. and Research. 2021; 9(2):185-188.

DOI: 10.5958/2454-2660.2021.00045.4