Orthostatic Hypotension, Stress, Employment, and Family Scapegoating Abuse in Postpartum Women of Zambia

Abstract

Introduction: Orthostatic hypotension (OH) is characterized by a significant drop in blood pressure upon standing, which can lead to dizziness and increased cardiovascular risk. Postpartum women are particularly vulnerable to this condition due to physiological changes, with psychosocial stressors like family scapegoating abuse and mental health challenges potentially exacerbating the risk. Employment status may influence the relationship between stress and OH, though this has not been well explored in low-resource settings. Methods: This cross-sectional study involved 666 postpartum women aged 20–30 years from Ndola, divided by parity (one or three children). OH was diagnosed based on a drop in blood pressure (≥20 mmHg systolic or ≥10 mmHg diastolic) after standing. Psychosocial stressors were measured using the Family Scapegoating Abuse Questionnaire (FSA-25) and the Depression Anxiety Stress Scale (DASS-21). Logistic regression was used to analyze how employment might moderate the relationship between stress and OH. Results: The prevalence of OH was found to be 13.96%. Approximately 25% of participants reported experiencing family scapegoating abuse. Chi-square tests revealed a significant association between higher FSA scores and the presence of OH (χ2(3) = 223.72, p < 0.001). The moderation analysis showed that stress significantly reduced the odds of OH (Stress_G(1) OR = 0.109, p < 0.001). Employment status alone was not a predictor of OH (p = 0.399), but the interaction between stress and employment was statistically significant (p = 0.013), suggesting a moderating effect, although the individual interaction coefficients were unstable. Conclusion: This study underscores the complex interaction between physiological and psychosocial stressors in influencing postpartum OH. It highlights the need for integrated postpartum care that addresses cardiovascular, psychosocial, and occupational factors, especially in resource-limited settings. Comprehensive screening and interdisciplinary interventions are essential to improving maternal cardiovascular outcomes, and further longitudinal studies are needed to better understand the causal and moderating mechanisms at play.