Psychosis and Associated Factors among Adolescents and Young Adults at LUTH in Zambia

Background Psychosis poses a significant burden in sub-Saharan Africa, yet data on risk factors in Zambia remains scarce. Understanding the factors associated with psychosis among adolescents and young adults is critical for effective intervention strategies. Methods We conducted a cross-sectional study to determine the correlates of psychosis at Livingstone university teaching hospital (LUTH). We collected sociodemographic and clinical variables. Psychosis was the outcome variable, while independent variables included age, sex, residence, employment, marital status, developmental milestones, depression, anxiety, substance use (cannabis, alcohol, and opioids), criminal history, and hematologic and liver biochemical markers. We conducted both descriptive and inferential analyses using statcrunch. Results The median age (with interquartile range) was comparable between participants diagnosed with psychosis (21 (19–23) and those without psychosis (20 (17–23). Of the study population (n=427), 84% (n=199) of participants with psychosis were male and 16% (n=38) were female. On multivariable analysis, the following variables were significantly associated with psychosis; Poor insight into mental illness was strongly associated with reduced odds of psychosis (AOR: 0.34, 95% CI 0.18, 0.64, p=0.0007), and opioid use was inversely associated (AOR: 0.43, 95%CI 0.19, 0.98, p=0.045). Conclusion This study highlights Zambia’s high burden of psychosis among young males and underscores cannabis as a modifiable risk factor. The paradoxical protective role of opioids warrants further investigation. Our findings emphasize the need for context-specific interventions, such as mental health literacy programs and harm-reduction strategies targeting substance use. Addressing systemic gaps in Zambia’s mental health infrastructure and integrating culturally sensitive diagnostic tools are critical to mitigating psychosis-related outcomes.