Orthostatic Hypotension and Psychosocial Adversity Among Postpartum Women in Zambia: A Cross-Sectional Analysis: doi: 10.7417/CT.2026.2034

Background: Orthostatic hypotension (OH) represents a link between haemodynamic instability and psychosocial adversity in low-resource settings. Objectives: 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. Methods: In a community-based cross-sectional study, 666 women aged 20–30 years within one year postpartum 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 with the FSA-25 and mental health symptoms with the DASS-21. Descriptive statistics, chi-square tests, logistic regression, and structural equation modelling evaluated direct, indirect, and moderated associations with OH. Results: OH was identified in 93 women (13.9%). Overall, 24.6% reported some FSA, with 20.4% experiencing moderate-to-severe scapegoating. Higher depressive symptoms showed a positive direct association with OH, while anxiety and FSA contributed indirect pathways. Stress related to OH primarily through FSA, and employment status neither independently predicted OH nor provided a stable moderating effect on the stress–OH relationship. Conclusions: OH is a critical 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.