Psychosis, a debilitating mental health condition characterized by a disconnection from reality, poses significant challenges to individuals, families, and healthcare systems globally [1,2]. It is a multifactorial disorder influenced by genetic, environmental, and socioeconomic determinants [2]. Adolescents and young adults are particularly vulnerable, as the onset of psychotic disorders such as schizophrenia frequently occurs during this critical developmental period [3,4]. Globally, psychosis affects approximately 3% of the population, with profound implications for educational attainment, employment, and social functioning [4,5]. Meanwhile the sub-Saharan Africa (SSA) prevalence of psychosis ranges from 3.9% to 8% [6].

Multiple risk factors have been implicated in the development of psychosis; urban residence, substance use (such as cannabis and opioids), and low educational attainment among others [7,8]. Despite advances in understanding its etiology and treatment in high-income countries, there’s dearth of data from SSA to guide policy and clinical interventions [9]. Existing studies in SSA highlight unique challenges, such as the role of traditional healers in care pathways and the impact of infectious diseases like HIV on mental health, which are rarely addressed in global frameworks [10,11]. Zambia, like many SSA nations, faces a silent crisis in mental healthcare, with psychosis often undiagnosed, stigmatized, or inadequately managed [12,13]. In addition, Zambia has fewer psychiatrists serving its population of approximately 19 million, and mental health receives less than 1% of the national health budget [14]. Adolescents and young adults, who constitute over 60% of Zambia’s population, are especially at risk due to high rates of substance use, unemployment, and exposure to trauma [15].

The scarcity of robust epidemiological data on psychosis in Zambia hinders effective public health responses [16]. At LUTH, clinicians anecdotally report rising cases of psychosis among youths, yet the prevalence, demographic patterns, and associated risk factors remain unquantified. This knowledge gap has dire consequences: without evidence, policymakers cannot allocate resources effectively, and healthcare providers lack guidance for contextually relevant interventions [17]. Furthermore, cultural beliefs attributing psychosis to spiritual causes often delay biomedical treatment, leading to advanced illness stages at presentation [18]. Compounding this issue, Zambia’s mental health infrastructure is fragmented, with LUTH serving as one of the few referral centers for complex cases [13]. The hospital’s role as a teaching institution also underscores the need for localized research to train future healthcare workers in evidence-based practices [19]. Without understanding the sociodemographic and clinical correlates of psychosis in this setting, efforts to reduce its burden will remain fragmented and ineffective [20].

Furthermore, the study is justified by two interrelated factors (developmental outcomes of the affected persons, and rising substance abuse rates) [21]. Severity of developmental consequences of untreated psychotic young people, such as disrupted education, social exclusion, and long-term disability, perpetuating cycles of poverty [3,21]. In Zambia, social safety nets are weak, these outcomes place immense strain on families and communities [12]. Even though substance use is a modifiable risk factor among young adults and adolescents, there’s emerging evidence of substance use; 49% of cannabis use, 24.3% of alcohol abuse [22], 60% of inhalants and solvents such as glue sniffing [12,23] and emerging substances such codeine-containing cough syrups, heroin, and methamphetamine use are rising, particularly in urban centers like Lusaka and Livingstone [15,24].

Therefore, this study, conducted at LUTH, aimed at addressing established gaps by examining the factors associated with psychosis among adolescents and young adults in Zambia, a population disproportionately affected by systemic inequities.