Suicide among Malaysian adolescents

Suicide among Malaysian adolescents: epidemiology, risk factors, school-based prevention, and policy implications

Suicide among adolescents is a critical public health concern globally, and Malaysia is no exception, given the substantial burden of youth mental health problems and the central role of schools in the lives of young people. Schools offer universal access, opportunities for early identification, and settings to deliver prevention, literacy, and intervention efforts within everyday routines (Marsh & Mathur, 2020; Margaretha et al., 2023; Donovan et al., 2023). In Malaysia, substantial evidence links emotional and behavioral problems in children and teens to distress, reduced academic engagement, and risk behaviors, underscoring the school as a strategic site for prevention and care (Sahril et al., 2021; Idris et al., 2019; Taufik et al., 2022). The COVID-19 era further amplified stressors for students and teachers, highlighting the need for robust, school-centered mental health systems that can adapt to disruption and maintain access to supports (Amran & Jamaludin, 2021; Wider et al., 2023; Deris, 2023). This synthesis integrates Malaysian and international evidence to outline why suicide prevention and mental health supports in Malaysian schools matter, and how policy and practice can be advanced in culturally appropriate, resource-sensitive ways (Hamzah & Othman, 2024; Anwar‐McHenry et al., 2020; Anwar‐McHenry et al., 2016).

Prevalence, burden, and public health significance of youth mental health and suicidality in Malaysia

• Malaysian youth experience significant mental health problems, with large population-based studies reporting high levels of emotional and behavioral issues in school-age children, including anxiety, depression, conduct problems, and related difficulties. For example, a large population-based study identified a range of mental health problems among Malaysian children, with notable prevalences for conduct problems, peer-relations problems, and emotional problems; these issues have relevance for suicidality given their associations with distress and impairment (Sahril et al., 2021; . A separate longitudinal study found measurable emotional and behavioral problems among Malaysian children, demonstrating stability over time and illustrating the persistent nature of youth mental health needs that can escalate toward suicidal distress if unaddressed (Idris et al., 2019). In addition, national health surveillance data indicate substantial levels of anxiety (approximately two-fifths of adolescents in some samples) and notable proportions with depression and stress, underscoring a significant public health burden that intersects with academic functioning (Taufik et al., 2022). Collectively, these findings support the view that mental health is integral to Malaysia’s youth well-being and educational trajectories, and that suicide risk cannot be separated from the broader landscape of adolescent distress (Sahril et al., 2021; Idris et al., 2019; Taufik et al., 2022).

  
  

• Suicidal ideation and related risk are present within Malaysian youth, particularly in the context of competing risk factors such as loneliness, depression, and other emotional problems. Although national-level figures for completed suicide among adolescents are not consistently reported in the cited Malaysian literature, studies focusing on adolescent mental health consistently show co-occurrence of suicidal ideation with anxiety, depression, and other risk behaviors in school-aged populations, reinforcing the relevance of school-based screening and early intervention to prevent progression to self-harm or suicide Cheah et al., 2021;, (Singh et al., 2022). In addition, research indicates that secondary-school students with anxiety or depressive symptoms are more likely to engage in smoking, alcohol use, and illicit drug use, all of which compound suicide risk and complicate prevention efforts within schools Cheah et al., 2021). These patterns align with global evidence linking mental health problems in adolescence to elevated suicide risk, underscoring the public health imperative in Malaysia (Taufik et al., 2022).

  
  

• The COVID-19 pandemic intensified mental health burdens among Malaysian youth, with reports of increased school-related stress, disrupted routines, and barriers to access to care during lockdowns. Studies from Malaysia document heightened distress during unplanned school closures and transitions to remote learning, with potential consequences for suicidal thoughts and behaviors if supports are not available (Amran & Jamaludin, 2021; Wider et al., 2023; Deris, 2023). These pandemic-era findings underscore the importance of resilient, school-centered mental health infrastructures that can sustain prevention and care during crises (Amran & Jamaludin, 2021; Wider et al., 2023; Deris, 2023).

  
  

The school as a focal setting for adolescent suicide prevention in Malaysia

• Schools are uniquely positioned to address suicidality and broader mental health needs due to universal access, established daily contact with students, and the potential to normalize help-seeking within familiar environments. Global syntheses emphasize that school-based mental health services can improve access to care, reduce stigma, and support ongoing engagement with counseling and supports in the school context; Malaysia can leverage these advantages given its large youth cohort in schools (Marsh & Mathur, 2020; Margaretha et al., 2023; Donovan et al., 2023). In Malaysia, the density of youth in the education system supports a prevention-focused, whole-school approach rather than responses that occur only in crisis situations Bohnenkamp et al., 2015).

  
  

• A multi-tiered, school-wide framework—combining universal psychoeducation, targeted supports, and indicated interventions for students at elevated risk—has become a global best practice model for school mental health and suicide prevention. This approach aligns with Malaysia’s policy directions and ongoing efforts to embed mental health within educational systems, requiring leadership, capacity-building for staff, and integration with health services and community resources (Marsh & Mathur, 2020; , (Hamzah & Othman, 2024; , Margaretha et al., 2023). Empirical work highlights that well-implemented MTSS/three-tier frameworks can enhance student well-being, mitigate disruptive outcomes, and facilitate safer school reintegration following distress or psychiatric events (Marsh & Mathur, 2020).

  
  

• In Malaysia, several school-focused initiatives demonstrate how literacy, counseling, and preventive strategies can be effectively integrated into schools. For example, school-based CBT-oriented modules and literacy programs have been developed with content validity and tested with school counselors, indicating feasibility for scale within Malaysian schools (Bohnenkamp et al., 2022). Training for school nurses and teachers to enhance mental health competencies has shown feasibility and potential for expanding school-based supports (Bohnenkamp et al., 2022; Saw et al., 2023). Additionally, national and regional studies emphasize the importance of teacher and staff well-being and resilience as a crucial component of the school climate that promotes student mental health and safety (Kee et al., 2022; Zin et al., 2023; Alzahari et al., 2023). Together, these findings suggest that a well-designed, culturally informed, and adequately resourced school mental health system can address suicidality more effectively in Malaysia (Marsh & Mathur, 2020; Bohnenkamp et al., 2022), Bohnenkamp et al., 2015), Margaretha et al., 2023), (Warren et al., 2024).

• Policy and governance context support school-based mental health as part of a broader public health agenda. Malaysia’s National Mental Health Policy foregrounds accessibility, equity, continuity, and intersectoral collaboration, creating a policy foundation for school-based mental health integration (Hamzah & Othman, 2024). Realizing policy in practice requires attention to implementation capacity, cross-professional collaboration, and sustainable funding, all central to successful school-based suicide prevention and mental health promotion in Malaysia (Hamzah & Othman, 2024; Anwar‐McHenry et al., 2020; Anwar‐McHenry et al., 2016). International syntheses reinforce that effective school mental health systems rest on multi-tiered supports, governance connecting schools with health services, and ongoing evaluation—principles aligning with the Malaysian policy environment and can guide implementation (Marsh & Mathur, 2020; , (Hamzah & Othman, 2024; , Margaretha et al., 2023).

  
  

Risk factors, protective factors, and vulnerable populations among Malaysian adolescents

• Risk factors for suicidal distress among Malaysian youths include mental health problems such as anxiety and depression, loneliness, and related distress, which are prevalent in studies of Malaysian adolescents and linked to higher risk for self-harm ideation or risky behaviors. For instance, anxiety, depression, and loneliness are associated with increased risk behaviors (smoking, alcohol, drugs) and distress that can elevate suicide risk (Taufik et al., 2022; Cheah et al., 2021; Singh et al., 2022). The global literature on LMICs emphasizes psychosocial stressors, family dynamics, and access-to-care barriers as key risk drivers for youth suicidality in settings such as Malaysia (Renaud et al., 2022).

  
  

• Mental health literacy and stigma are critical determinants of help-seeking and timely intervention. Depression literacy programs in Malaysia have demonstrated reductions in stigma and improvements in help-seeking intentions among adolescents, underscoring an actionable prevention lever that can be scaled within schools Ibrahim et al., 2020). Determinants of mental health literacy among young Malaysian adolescents indicate that targeted education and culturally appropriate delivery can improve recognition and response to distress, which is essential for early identification of suicidal risk (Singh et al., 2022). However, stigma and low mental health literacy remain significant barriers to care, underscoring the need for systematic school-based efforts to build knowledge, norms, and pathways to support individuals (Rajagopal et al., 2023).

  
  

• Protective factors within school contexts include mental health literacy among students and staff, a supportive school climate, constructive adult relationships, and a sense ofconnectedness with family and peers. Programs emphasizing school connectedness, inclusive policies, and peer-support structures have shown promise in reducing suicide risk in youth and shaping protective environments within schools (Mueller et al., 2021; Canady, 2019; Smith-Millman & Flaspohler, 2018). In Malaysia, evidence indicates the protective role of literacy initiatives, school-based counseling, and well-supported school nurses in creating safer, more responsive school environments Bohnenkamp et al., 2022; Saw et al., 2023; Bohnenkamp et al., 2015; Donovan et al., 2023).

  
  

• Vulnerable subpopulations require targeted attention. Evidence from global and diverse settings notes higher suicide risk among sexual and gender minority youth and among ethnic minority groups, often linked to stigma, discrimination, and reduced access to supportive resources. In Malaysia, ethnic minority students demonstrate relationships between mental health symptoms and risk behaviors, underscoring the need for culturally sensitive school-based programs addressing specific community contexts Cheah et al., 2021; . International work on LGBTQ+ youth highlights unique risks and the importance of inclusive school environments to prevent suicidality, suggesting that culturally competent, affirmative school policies are essential components of prevention in Malaysia as well Stilwell et al., 2025), Gallo & Morris, 2022).

  
  

COVID-19 era and implications for prevention and practice

• The pandemic intensified stressors for adolescents and educators in Malaysia, underscoring the fragility of school-based supports during crises. Studies during COVID-19 show increased stress in students from remote or disrupted learning contexts and highlight needs for telehealth and digital training to sustain prevention and treatment efforts when in-person services are limited (Amran & Jamaludin, 2021; , (Deris, 2023). The pandemic thus strengthens the case for resilient, scalable, school-centered mental health systems that can operate through crises while maintaining prevention, early identification, and intervention functions (Wider et al., 2023; , (Deris, 2023).

  
  

Interventions, capacity-building, and implementation considerations in Malaysia

• School-based mental health literacy and counseling are feasible entry points in Malaysia. Programs focused on improving mental health literacy have demonstrated reductions in stigma and improved recognition of mental health issues Ibrahim et al., 2020; . Determinants of mental health literacy among young adolescents indicate that locally adapted curricula and materials can improve responses to distress within school settings (Singh et al., 2022).

  
  

• Capacity-building for gatekeeping and frontline providers within schools is essential. Training for school nurses and teachers to enhance mental health competencies has shown feasibility and improved preparedness to support student mental health, offering a practical avenue for scaling supports in Malaysian schools Bohnenkamp et al., 2022), (Saw et al., 2023). A coordinated, whole-school approach can reduce stigma, improve recognition of distress, and facilitate timely referrals in line with national policy goals (Hamzah & Othman, 2024; Anwar‐McHenry et al., 2020; Anwar‐McHenry et al., 2016).

  
  

• Evidence-informed program design and evaluation are critical. Multitiered school-based models (MTSS) emphasize implementation fidelity, data-informed decision-making, and regular evaluation to ensure effective outcomes and scalable adoption (Marsh & Mathur, 2020; Warren et al., 2024). The Malaysian literature emphasizes the role of school-based cognitive-behavioral modules (STAR-CBT) and validated content for counselors, representing practical tools that can be integrated into local curricula and school routines (Saw et al., 2023). Telemedicine and digital platforms provide opportunities to expand access to expertise while maintaining the central role of schools in prevention and early intervention (Deris, 2023).

  
  

• Policy, governance, and funding are pivotal. The National Mental Health Policy provides a foundation for integrating mental health into education, but translating policy into practice requires capacity building, interprofessional collaboration, and sustained resources (Hamzah & Othman, 2024). Implementation science and governance models that connect schools with health services and community resources can support the development of robust, culturally appropriate, and sustainable school-based mental health systems in Malaysia (Warren et al., 2024).

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Concrete implications and recommendations for Malaysia (policy, practice, and research)

• Strengthen mental health literacy and competencies among students and school staff. Implement validated training programs for teachers and school nurses, with ongoing evaluation of knowledge, attitudes, and help-seeking behaviors, ensuring training content is culturally appropriate for Malaysia’s diverse student populations Ibrahim et al., 2020; , Bohnenkamp et al., 2022).

  
  

• Scale and sustain school-based mental health services within a whole-school framework. Expand accessible school-based counseling, peer-support structures, and classroom-level wellness promotion, with attention to staffing, workload, and alignment with curricula (Marsh & Mathur, 2020; , Bohnenkamp et al., 2022), Bohnenkamp et al., 2015).

  
  

• Invest in policy-practice alignment and capacity-building. Leverage Malaysia’s National Mental Health Policy to guide implementation in schools, ensuring clear governance, interprofessional collaboration, and adequate funding for training, staffing, and evaluation (Hamzah & Othman, 2024; , Anwar‐McHenry et al., 2020; , Anwar‐McHenry et al., 2016).

  
  

• Promote culturally informed, targeted interventions for vulnerable groups. Develop and test inclusive mental health and suicide prevention programs that address ethnic minority groups and LGBTQ+ youth, including supportive school climates, anti-stigma campaigns, and affirmative policies to reduce discrimination Cheah et al., 2021; , Stilwell et al., 2025).

  
  

• Integrate technology thoughtfully to expand access. Utilize telemedicine and digital tools to expand reach to remote settings and provide training for school-based providers, ensuring privacy, equity, and alignment with in-person services (Deris, 2023).

  
  

• Prioritize evaluation and fidelity monitoring. Implement robust evaluation frameworks to monitor program fidelity, process outcomes, and student-level mental health indicators, contributing to scalable learning and sustainable practice improvements (Warren et al., 2024).

  
  

• Address the postvention and family/community dimensions. Develop postvention protocols and family engagement strategies, drawing on broader school-based suicide prevention evidence that emphasizes community involvement to mitigate secondary distress and prevent contagion effects after suicides in schools (Granello & Zyromski, 2018; , Orlins et al., 2025).

  
  

Conclusion

Suicide among Malaysian adolescents is best addressed through a comprehensive, school-centered strategy that integrates mental health literacy, accessible supports, and coordinated care with health services and families. The evidence from Malaysia points to significant mental health needs among youth, associations between anxiety/depression and suicidal ideation, and the potential for school-based programs to reduce stigma, increase help-seeking, and provide prevention and early intervention within familiar settings (Taufik et al., 2022; Cheah et al., 2021; Ibrahim et al., 2020; Bohnenkamp et al., 2022), Bohnenkamp et al., 2015). The policy environment in Malaysia supports school-based mental health as a public health priority, but effective practice requires sustained investment in training, interprofessional collaboration, and monitoring to translate policy into meaningful improvements in youth well-being and safety (Hamzah & Othman, 2024; , Anwar‐McHenry et al., 2020; Anwar‐McHenry et al., 2016). By advancing culturally informed, evidence-based, and resource-conscious school mental health systems, Malaysia can strengthen protections for its youth, reduce suicidality, and promote sustained educational and life-course success for all students (Marsh & Mathur, 2020; Bohnenkamp et al., 2022).

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