Risk factors for anxiety and depression among ever-married women in Zambia: evidence from the 2023–24 demographic and health survey

Objective To identify key risk factors and examine province-wise inequalities in the prevalence of anxiety and depression among ever-married women aged 15–49 years in Zambia. Methodology This study analyzed cross-sectional data from 13,951 women in the 2023–24 Zambia Demographic and Health Survey (ZDHS), which offers nationally representative coverage. Anxiety and depression were assessed using the generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) scales and dichotomized as “Yes” (score ≥10) or “No” (score <10). Stepwise survey-weighted multivariable logistic regression was used to identify associated risk factors. Findings Significant risk factors included older age (40–44 years: anxiety adjusted odds ratio (AOR)=5.75, 95% confidence interval (CI) 2.35–14.07; depression AOR=5.43, 95% CI 2.81–10.48), secondary or higher education (anxiety AOR=2.34, 95% CI 1.22–4.52), and household construction materials (anxiety AOR=2.27, 95% CI 1.31–3.95; depression AOR=1.56, 95% CI 1.00–2.44). Women’s decision-making autonomy was associated with lower odds both anxiety (AOR=0.44, 95% CI 0.29–0.67) and depression (AOR=0.49, 95% CI 0.34–0.71). Women residing in Copperbelt, central, and southern province showed a higher burden of anxiety and depressive symptoms. Conclusions Findings highlight critical provincial inequities, underscoring the need for strengthened and equitable mental health systems in Zambia. Older age, higher education, adverse household materials, and residence in certain provinces were associated with increased risk, whereas women’s empowerment was associated with reduced risk of anxiety and depression. Mental health programs should prioritize empowering women and addressing provincial inequities.