Prenatal and Postnatal Practices of Healthcare Workers in Identifying Postpartum Psychosis: An Exploratory Study in First-Level Hospitals, Lusaka, Zambia
Introduction: Childbirth marks the beginning of motherhood, but women are at risk of developing psychiatric disorders like anxiety, depression, and postpartum psychosis (PPP) after delivery. PPP is a rare yet severe condition that can develop rapidly, putting both mother and child at risk. Due to lack of standard screening procedures, PPP is often underdiagnosed and underreported. This study explored healthcare workers’ practices in identifying postpartum psychosis in first-level hospitals. Methods: Data were collected through in-depth interviews and focus group discussions with 54 healthcare workers from 5 hospitals. Analysis revealed four main themes: 1. Healthcare workers’ prenatal and postnatal practices informed by knowledge levels. 2. Identification of PPP and referrals. 3. Training and support needs. 4. Barriers and facilitators to screening. Results: Healthcare workers have limited understanding of PPP, hindering effective screening. PPP screening is not standard in antenatal and postnatal care, leading to potential underdiagnosis. Overwhelming client numbers and inadequate staffing further hinder screening. Conclusion: This study highlights critical gaps in healthcare workers’ practices regarding PPP screening. Targeted interventions, including training and support, are needed to improve early detection and management, protecting the mental well-being of mothers and their children.
References
[1]
Kowalska, J., Dulnik, M., Guzek, Z. and Strojek, K. (2022) The Emotional State and Social Support of Pregnant Women Attending Childbirth Classes in the Context of Physical Activity. Scientific Reports, 12, Article No. 19295. https://doi.org/10.1038/s41598-022-23971-7
[2]
Ayers, S., Wright, D.B. and Thornton, A. (2018) Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale. Frontiers in Psychiatry, 9, Article No. 409. https://doi.org/10.3389/fpsyt.2018.00409
[3]
Slomian, J., Honvo, G., Emonts, P., Reginster, J. and Bruyère, O. (2019) Consequences of Maternal Postpartum Depression: A Systematic Review of Maternal and Infant Outcomes. Women’s Health, 15, 1-55. https://doi.org/10.1177/1745506519844044
[4]
Stevens, A.W.M.M. (2023) Bipolar Disorder during Pregnancy and the Postpartum Period: Patients Considerations, Course of Bipolar Disorder and Impact of Sleep Loss. PhD Thesis, Research and Graduation Internal, Vrije Universiteit Amsterdam.
[5]
American Psychiatric Association (2017) DSM-5 Task Force. Diagnostic and Statis-tical Manual of Mental Disorders: DSM-5. 5th Edition, American Psychiatric Association Publishing.
[6]
Perry, A., Gordon-Smith, K., Jones, L. and Jones, I. (2021) Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sciences, 11, Article No. 47. https://doi.org/10.3390/brainsci11010047
[7]
Osborne, L.M. (2018) Recognizing and Managing Postpartum Psychosis: A Clinical Guide for Obstetric Providers. Obstetrics and Gynecology Clinics of North America, 45, 455-468. https://doi.org/10.1016/j.ogc.2018.04.005
[8]
Rodriguez-Cabezas, L. and Clark, C. (2018) Psychiatric Emergencies in Pregnancy and Postpartum. Clinical Obstetrics & Gynecology, 61, 615-627. https://doi.org/10.1097/grf.0000000000000377
[9]
Hosseini Tabaghdehi, M., Kolahdozan, S., Keramat, A., Shahhossein, Z., Moosazadeh, M. and Motaghi, Z. (2019) Prevalence and Factors Affecting the Negative Childbirth Experiences: A Systematic Review. The Journal of Maternal-Fetal & Neonatal Medicine, 33, 3849-3856. https://doi.org/10.1080/14767058.2019.1583740
[10]
Namujju, J., Muhindo, R., Mselle, L.T., Waiswa, P., Nankumbi, J. and Muwanguzi, P. (2018) Childbirth Experiences and Their Derived Meaning: A Qualitative Study among Postnatal Mothers in Mbale Regional Referral Hospital, Uganda. Reproductive Health, 15, Article No. 183. https://doi.org/10.1186/s12978-018-0628-y
[11]
Fink, G., Melero-Dominguez, M., Chembe, M., de Vernisy-Romero, D., Tembo, T., Billima, T., et al. (2024) Feasibility and Acceptability of the Problem Management for Moms Programme for Improving Maternal Mental Health in Zambia: An Open-Label Trial. The Lancet Psychiatry, 11, 965-974. https://doi.org/10.1016/s2215-0366(24)00256-6
[12]
Lewis, G., Blake, L. and Seneviratne, G. (2022) Delusional Misidentification Syndromes in Postpartum Psychosis: A Systematic Review. Psychopathology, 56, 285-294. https://doi.org/10.1159/000526129
[13]
Zhong, Q., Gelaye, B., Fricchione, G.L., Avillach, P., Karlson, E.W. and Williams, M.A. (2018) Adverse Obstetric and Neonatal Outcomes Complicated by Psychosis among Pregnant Women in the United States. BMC Pregnancy and Childbirth, 18, Article No. 120. https://doi.org/10.1186/s12884-018-1750-0
[14]
Ng’anjo Phiri, S., Fylkesnes, K., Moland, K.M., Byskov, J. and Kiserud, T. (2016) Rural-urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District. PLOS ONE, 11, e0145196. https://doi.org/10.1371/journal.pone.0145196
[15]
Levey, E.J., Zhong, Q., Rondon, M.B., Sanchez, S., Li, J., Williams, M.A., et al. (2018) The Psychometric Properties of the 16-Item Version of the Prodromal Questionnaire (PQ-16) as a Screening Instrument for Perinatal Psychosis. Archives of Women’s Mental Health, 21, 563-572. https://doi.org/10.1007/s00737-018-0833-2
[16]
Yang, J.M.K., Jones, I. and Di Florio, A. (2022) Puerperal Psychosis. In: Percudani, M., Bramante, A., Brenna, V. and Pariante, C., Eds., Key Topics in Perinatal Mental Health, Springer International Publishing, 139-154. https://doi.org/10.1007/978-3-030-91832-3_9
[17]
Hunter, L.A., Catapano, L.A., Nagle-Yang, S.M., Williams, K.E. and Osborne, L.M. (2021) Textbook of Women’s Reproductive Mental Health. American Psychiatric Association Publishing.
[18]
Lonia, M., Katowa-Mukwato, P. and Mweemba, P. (2016) Psychological Distress during the Perinatal Period: Using Edinburgh Postnatal Depression Scale (EPDS) General Health Questionnaire (GHQ-12) and the Study Specific Measure of Perinatal Distress (SSMPD) on a Zambian Cohort. Journal of Preventive and Rehabilitative Medicine, 1, 44-52.
[19]
VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L. and Cohen, L.S. (2017) The Global Prevalence of Postpartum Psychosis: A Systematic Review. BMC Psychiatry, 17, Article No. 272. https://doi.org/10.1186/s12888-017-1427-7
[20]
Zambia Statistics Agency (2022) 2022 Census of Population and Housing Summary Report Volume II. Zambia Statistics Agency.
[21]
Howard, L.M. and Khalifeh, H. (2020) Perinatal Mental Health: A Review of Progress and Challenges. World Psychiatry, 19, 313-327. https://doi.org/10.1002/wps.20769
[22]
Akkineni, R., Ganjekar, S., Satyanarayana, V., Kondapuram, N., Tiwari, K., Medisetti, S., et al. (2025) The Impact of Perinatal Mental Health Training on Knowledge and Practice of Primary Care Physicians: A Systems Strengthening Initiative in Telangana, India. BMC Primary Care, 26, Article No. 88. https://doi.org/10.1186/s12875-025-02782-5
[23]
Forde, R., Peters, S. and Wittkowski, A. (2019) Psychological Interventions for Managing Postpartum Psychosis: A Qualitative Analysis of Women’s and Family Members’ Experiences and Preferences. BMC Psychiatry, 19, Article No. 411. https://doi.org/10.1186/s12888-019-2378-y
[24]
Goyal, D., Rabemananjara, K.M., Lara-Cinisomo, S. and Le, H. (2023) Healthcare Worker’s Understanding of Perinatal Depression and Maternal Mental Health Service Needs in Rural Kenya. Mental Health & Prevention, 29, Article ID: 200260. https://doi.org/10.1016/j.mhp.2023.200260
[25]
Ng’oma, M., Meltzer-Brody, S., Chirwa, E. and Stewart, R.C. (2019) “Passing through Difficult Times”: Perceptions of Perinatal Depression and Treatment Needs in Malawi—A Qualitative Study to Inform the Development of a Culturally Sensitive Intervention. PLOS ONE, 14, e0217102. https://doi.org/10.1371/journal.pone.0217102
[26]
Fekih-Romdhane, F., El Hadathy, D., González-Nuevo, C., Malaeb, D., Barakat, H. and Hallit, S. (2023) Development and Preliminary Validation of the Postpartum Psychotic Experiences Scale (PPES). Psychiatry Research, 329, Article ID: 115543. https://doi.org/10.1016/j.psychres.2023.115543
[27]
Rimvall, M.K. and Jeppesen, P. (2024) The Problem of Overestimating the Value of Self-Report Measures of Psychotic Experiences. Psychiatry Research, 333, Article ID: 115769. https://doi.org/10.1016/j.psychres.2024.115769
[28]
Chukwuere, P.C., Zenani, N.E., Mthimunye, K., Godbold, R. and Shahrour, G. (2025) The Integration and Associated Challenges of Mental Health Competencies in Undergraduate Nursing Education: A Scoping Review. BMC Nursing, 24, Article No. 336. https://doi.org/10.1186/s12912-025-02942-z
[29]
Meredith, C., McKerchar, C. and Lacey, C. (2023) Indigenous Approaches to Perinatal Mental Health: A Systematic Review with Critical Interpretive Synthesis. Archives of Women’s Mental Health, 26, 275-293. https://doi.org/10.1007/s00737-023-01310-7
[30]
American College of Obstetricians and Gynecologists Committee (2023) Treatment and Management of Mental Health Conditions during Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstetrics Gynecology, 141, 1262-1288.
[31]
Lugo-Candelas, C., Talati, A., Glickman, C., Hernandez, M., Scorza, P., Monk, C., et al. (2023) Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions. Biological Psychiatry, 93, 934-941. https://doi.org/10.1016/j.biopsych.2023.01.026
Rugkåsa, J., Tveit, O.G., Berteig, J., Hussain, A. and Ruud, T. (2020) Collaborative Care for Mental Health: A Qualitative Study of the Experiences of Patients and Health Professionals. BMC Health Services Research, 20, Article No. 844. https://doi.org/10.1186/s12913-020-05691-8
[34]
Sihre, H.K., Simons, A., Gill, P., Lindenmeyer, A. and Fazil, Q. (2019) Women’s Experiences of Severe Postnatal Psychiatric Illness: A Systematic Review Protocol. Systematic Reviews, 8, Article No. 173. https://doi.org/10.1186/s13643-019-1085-6
[35]
Motrico, E., Bina, R., Kassianos, A.P., Le, H., Mateus, V., Oztekin, D., et al. (2023) Effectiveness of Interventions to Prevent Perinatal Depression: An Umbrella Review of Systematic Reviews and Meta-Analysis. General Hospital Psychiatry, 82, 47-61. https://doi.org/10.1016/j.genhosppsych.2023.03.007