Orthostatic Hypotension and Psychosocial Adversity Among Postpartum Women in Zambia: A Cross-Sectional Analysis

Orthostatic hypotension (OH) represents a link between haemodynamic instability and psychosocial adversity in low-resource settings.

To estimate the prevalence of OH among postpartum women in Ndola, Zambia, and examine associations with family scapegoating abuse (FSA) and symptoms of depression, anxiety, and stress.

In a community-based cross-sectional study, postpartum women aged 20-30 years within one year of delivery (N = 666) underwent active-stand blood pressure testing. OH was defined as a ≥20 mmHg fall in systolic and/or ≥10 mmHg fall in diastolic pressure within 3 minutes of standing. FSA was measured using the FSA-25 and mental health symptoms using the DASS-21. Descriptive statistics, chi-square tests, logistic regression (including a stepwise sensitivity model), and structural equation modelling (SEM) evaluated direct, indirect, and moderated associations with OH.

OH was identified in 93 (13.9%) women. Any FSA was reported by 164 (24.6%) women, and moderate-to-severe scapegoating was present in 136 (20.4%). In SEM, depressive symptoms showed a positive direct association with OH, with indirect pathways involving anxiety and FSA, while stress related to OH primarily through FSA. In logistic regression, Stress_G(1) was associated with lower odds of OH (OR = 0.109, 95% CI: 0.042-0.280), whereas employment status was not independently associated with OH; interaction estimates with employment were unstable. In the stepwise model, Stress_G(1) was the only retained significant predictor of OH.

OH is a clinically relevant postpartum finding in this Zambian cohort and co-occurs with substantial family scapegoating and internalising symptoms. Integrating orthostatic blood pressure assessment with structured psychosocial screening may help identify women at heightened risk for dizziness, falls, and persistent mood and anxiety problems, supporting more holistic postpartum care in similar low-resource settings.