MEDIATORS OF DEPRESSION ON BAROREFLEX DYSFUNCTION IN POSTPARTUM ORTHOSTATIC HYPOTENSION WITH FAMILY SCAPEGOATING ABUSE

Authors

  • Kartheek Balapala Ranganayakulu Doctoral Researcher, Faculty of Medicine, Lincoln University College, Selangor, Malaysia
  • Suriyakala Perumal Chandran Research Supervisor, Associate Professor, Faculty of Medicine, Lincoln University College, Selangor, Malaysia
  • Nesan Gaayatri Researcher, City University, Kuala Lumpur, Malaysia
  • Rebecca C. Mandeville Licensed Marriage Family Therapist and Clinical Complex Trauma Treatment Professional, United States of America

DOI:

https://doi.org/10.46827/ejphs.v9i1.241

Keywords:

family scapegoating abuse, orthostatic hypotension, post-partum, baroreflex

Abstract

Background: Orthostatic hypotension (OH) poses cardiovascular risks to postpartum women amid physiological shifts, yet its interplay with psychosocial stressors like family scapegoating abuse (FSA) remains underexplored. Methods: This cross-sectional study recruited 666 postpartum women aged 20-30 years from Ndola, Zambia health facilities. OH diagnosis involved supine and standing blood pressure measurements. FSA-25 and DASS-21 assessed psychosocial factors. Structural equation modeling tested mediation pathways; ROC analysis determined FSA-25 cutoffs. Results: OH prevalence reached 13.96%, strongly linked to elevated FSA (χ²(3) = 223.72, p < 0.001). Depression heightened OH risk (Coef. = 0.248, p < 0.001), with employment and FSA partially mediating (employment: Coef. = -0.112 for OH, 0.055 for depression, both p < 0.005; FSA: Coef. = 0.865 for depression, p < 0.001). Anxiety amplified effects; education attenuated depression; BMI directly predicted OH (Coef. = 0.077, p < 0.001). Stress influenced depression without OH impact; parity and symptom severity showed no significance. ROC identified an FSA cutoff of 4.00 for depression-aligned grading. Conclusions: FSA, employment, anxiety, education, and BMI mediate depression's role in postpartum OH. Routine integrated screening with FSA ordinal scales could enhance maternal cardiovascular care. 

 

Author Biographies

  • Kartheek Balapala Ranganayakulu, Doctoral Researcher, Faculty of Medicine, Lincoln University College, Selangor, Malaysia

    Dr. Kartheek Balapala Ranganayakulu is a doctoral research scholar in medical physiology & applied clinical sciences and a senior research fellow (FAAMRI) at Afromed Academy of Medical Research and Innovation. Dr. Balapala advocates the concept of visualization in medical/clinical sciences for better comprehension at medical institutions around the globe and serves as an Associate editor and board member for international medical research journals. He has been mentoring medical graduates for the past 18 years across the globe and in Africa. He published over 50 journal papers and nearly 30 books on medical concepts in eight different languages across the European Union and the globe, with LAP Lambert Academic Publishers. His book on the mind mapping techniques for medical concepts based on Leonardo da Vinci’s concept of mind mapping, which is implied for medical students, is a remarkably novel contribution to twenty-first century medical knowledge.

    ORCID: https://orcid.org/0000-0003-2405-5105,

    SCOPUS ID: 58697441600

  • Suriyakala Perumal Chandran, Research Supervisor, Associate Professor, Faculty of Medicine, Lincoln University College, Selangor, Malaysia

    Dr. Suriyakala Perumal Chandran is academic supervisor and researcher at Lincoln University College, Malaysia, and serves as an Associate Professor in the Faculty of Medicine. She is recognized for her commitment to academic excellence and fostering research capacity within the institution.

    ORCID: https://orcid.org/0000-0001-6904-7980

  • Nesan Gaayatri, Researcher, City University, Kuala Lumpur, Malaysia

    Ms Gaayatri Nesan is an educational professional with leadership experience in developing and implementing DECE and BECE programmes. Worked with children for 12 years. Expertise includes curriculum design, constructive alignment, accreditaton compliance and academic governance. Scholarly interests center on teacher development, pedagogical effectiveness and program evaluation.

    ORCID: https://orcid.org/0009-0006-0434-8284

  • Rebecca C. Mandeville, Licensed Marriage Family Therapist and Clinical Complex Trauma Treatment Professional, United States of America

    Ms Rebecca C. Mandeville is a licenced marriage and family therapist, certified complex

    trauma treatment professional and founder of Family Scapegoating Abuse (FSA) Education. Mandeville coined the term “Family Scapegoating Abuse”. She has over two

    decades of clinical experience

    ORCID: https://orcid.org/0009-0000-2713-7785

References

Ahad, Ahmed A., et al. (2023). Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus, vol. 15, no. 5, 26 May 2023, https://www.cureus.com/articles/147634-understanding-and-addressing-mental-health-stigma-across-cultures-for-improving-psychiatric-care-a-narrative-review#!/.

Balapala, K. R., Rebecca C. Mandeville, & Mandy Sizalobuhle Mpofu (2024). Impact of a Seminar Intervention on Psychological Well-Being Among Medical Students: A Study of Family Scapegoating Abuse and Mental Health. European Journal of Public Health Studies, vol. 8, no. 1, https://oapub.org/hlt/index.php/EJPHS/article/view/202.

Campos Munoz, Alejandro, et al. (2023). Orthostasis (Archived). StatPearls, StatPearls Publishing, 17 July.

Cheng, Yu-Chien, et al. (2011). Gender Differences in Orthostatic Hypotension. The American Journal of the Medical Sciences, vol. 342, no. 3, 2011, pp. 221-25. https://doi.org/10.1097/maj.0b013e318208752b

Ebong, Imo A., et al. (2024). The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review. Journal of the American College of Cardiology, vol. 84, no. 3, pp. 298-314. https://doi.org/10.1016/j.jacc.2024.05.016

Freeman, Roy, et al. (2011). Consensus Statement on the Definition of Orthostatic Hypotension, Neurally Mediated Syncope and the Postural Tachycardia Syndrome. Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society, vol. 21, no. 2, 2011, pp. 69-72. https://doi.org/10.1007/s10286-011-0119-5

Hamilton-Giachritsis, C. E., & Kevin D. Browne (2025). A Retrospective Study of Risk to Siblings in Abusing Families. Journal of Family Psychology: JFP: Journal of the Division of Family Psychology of the American Psychological Association (Division 43), vol. 19, no. 4, pp. 619-24. https://doi.org/10.1037/0893-3200.19.4.619

Juraschek, S. P., et al. (2018). Postural change in blood pressure is associated with clinical cardiovascular disease events independent of established cardiovascular risk factors. Journal of the American Heart Association 6(8).

Lewis, R. (2025). Scapegoating in dysfunctional families. Richard Lewis Blog. Retrieved from https://richard-lewis.co.uk/scapegoating/

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. Retrieved from https://doi.org/10.1016/0005-7967(94)00075-u

Lovibond, S. H., and P. F. Lovibond. Depression Anxiety Stress Scales (DASS--21, DASS--42). APA PsycTests, 1995. https://psycnet.apa.org/doi/10.1037/t01004-000

MentalHealth.com. (2025). Toxic families and the scapegoat role. Retrieved from https://www.mentalhealth.com/library/toxic-families-navigating-the-challenges-of-being-a-family-scapegoat

Ringer, M. (2023). Orthostatic Hypotension. StatPearls. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28846238/

Smith, J., Doe, A., & Brown, K. (2020). Validation of the Family Scapegoating Abuse Questionnaire (FSA25) in clinical populations. Journal of Family Violence, 35(4), 301-310.

Velten, A. P. C., et al. (2020). Prevalence of orthostatic hypotension and pressure variation in a large population sample. Arquivos Brasileiros de Cardiologia, 114(6), 1040-1048. https://doi.org/10.36660/abc.20180354

Verwoert, G. C., et al. (2008). Orthostatic hypotension and risk of cardiovascular events. European Heart Journal 4(8).

Wright, L. Postural (1962). Hypotension in Late Pregnancy. 'The Supine Hypotensive Syndrome'. British Medical Journal, vol. 1, no. 5280, 1962, pp. 760-62.

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Published

2026-02-13

Issue

Vol. 9 No. 1 (2026)

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Articles

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How to Cite

MEDIATORS OF DEPRESSION ON BAROREFLEX DYSFUNCTION IN POSTPARTUM ORTHOSTATIC HYPOTENSION WITH FAMILY SCAPEGOATING ABUSE. (2026). European Journal of Public Health Studies, 9(1). https://doi.org/10.46827/ejphs.v9i1.241