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Background: Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy. Methods: CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety. Results: Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06-2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD-0.73, 95% CI-1.07--0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI-8.39--1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies. Limitations: There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression. Conclusion: Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.
This chapter proposes ecospirituality as the missing dimension in Education for Sustainability. The period 2005–2014 is the UNESCO Decade for Education for Sustainable Development, and the transdisciplinary field of Education for Sustainability (EfS) has the goal of fostering an environmental stewardship approach to life on Earth. But EfS rarely includes a spiritual dimension which has the potential to ground students’ experience in a recasting of the I-It to an I-Thou relationship with Nature. Extreme consumerism, burgeoning human population, and spiritual impoverishment have led to a radical disconnection of humans from Nature, and many young people fear the future, believing themselves to be powerless to change direction. While the exploitation of Nature has underpinnings in the Abrahamic religions which privilege the human over the rest of creation, in recognition of the convergence of cosmology, ecology, and spirituality through ecospirituality, religions are beginning to recast themselves to take account of the global ecological crisis. Thomas Berry (2000) describes this recasting as “moments of grace,” where humanity begins to understand its deep connection within the evolution of the universe and that human wellbeing is intimately entwined with the wellbeing of Earth’s ecosystems. Indeed humans would seem to be born with an empathetic orientation toward Nature. Thus, positive age-appropriate ecospiritual experiences are critical for developing concern for the environment, without which children may develop “ecophobia” (Sobel, 1999). The chapter concludes with a discussion of approaches and resources for ecospirituality education.