Prevalence and Antecedents of Postpartum Psychosis among Postnatal Mothers in Lusaka Zambia’s First level Hospitals

Abstract

Background: Maternal mental health remains an under‑researched area in Zambia, with postpartum psychosis (PPP) representing the most severe but least documented psychiatric emergency among postnatal mothers. This study investigated the prevalence and antecedents of postpartum psychosis among postnatal mothers in Lusaka’s first‑level hospitals. Methods: Guided by the Health Belief Model (HBM), the research adopted convergent parallel mixed methods research design cross-sectionally. The study population comprised 398 postnatal mothers above 2 weeks postpartum and attended to a questionnaire that integrated the Choongo Postpartum Psychosis Scale (CPPS-8) while qualitative insights came through interviews conducted on 22 family and healthcare workers. Results: Results revealed that 23% of mothers screened positive for PPP, a prevalence substantially higher than global estimates of 1 – 2 per 1000. Key antecedents included substance use (38%), prior psychiatric history (32%), and family history of mental illness (12%). Substance use emerged as the strongest predictor (Estimate = 4.27, Wald χ² = 35.33, p < .001), with mothers engaging in alcohol or tobacco use being over three times more likely to screen positive. Regression analyses showed psychosocial and clinical factors explained up to 61% of variance in PPP screening outcomes, while demographic variables were weak predictors. Conclusion: PPP, though rare, poses significant risks to maternal and infant wellbeing if undetected. PPP is a significant maternal health challenge in Zambia, shaped by psychosocial vulnerabilities and systemic gaps. Strengthening screening, training, and community sensitization is essential to safeguard maternal and infant wellbeing.