F
requent family conflicts, especially between her parents, coupled with a strained relationship with her mother led Fatiha (not her real name) to develop severe depression at just 12 years old.
Now 13, the girl became increasingly withdrawn, cried frequently, and struggled with feelings of worthlessness — which eventually led her to harm herself by slashing her wrists.
Her change in behaviour was noticed by a concerned teacher, who took the time to listen to the Form One student’s struggles and later referred her to a psychiatrist.
During her initial consultation, Fatiha was found to be at high risk of self-harm, prompting her immediate admission for close monitoring and treatment.
The case was among those handled by Dr Ruziana Masiran, Consultant Psychiatrist and Senior Lecturer at the Child & Adolescent Psychiatry Clinic, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia (UPM).
Speaking to Bernama, Dr Ruziana shared that following six family therapy sessions with her mother, Fatiha and her mom have begun learning to communicate more openly and understand each other's emotions.
“Their relationship is now much closer. Fatiha has become cheerful again and is gradually making academic and co-curricular progress that her mother is proud of.
“Although she initially required medication, she no longer needs it and currently attends only follow-up sessions at the clinic,” Dr Ruziana said.
GROWING TREND
Highlighting the current landscape, Dr Ruziana noted that mental health issues among adolescents in Malaysia are increasingly being recognised as a serious public health concern.
She explained that today’s teenagers face unique challenges compared to previous generations, making them more susceptible to mental health struggles.
Dr Ruziana Masiran.
“The impact of the COVID-19 pandemic cannot be overlooked. Isolation during lockdowns between 2020 and 2021, school closures, and mounting financial pressures within families have all contributed to mental health issues that persist to this day,” she said.
Dr Ruziana added that the prolonged isolation also deprived many adolescents of crucial social development milestones during a formative stage in their lives.
She pointed out that digital and social media have become dominant forces in the lives of teenagers, encouraging constant online connectivity, which in turn fuels anxiety linked to the ‘fear of missing out’ (FOMO) and exposes them to cyberbullying.
“Excessive screen time negatively affects sleep quality, lowers self-esteem, and contributes to body image concerns as teens frequently compare themselves to others online.
“This pervasive digital lifestyle has significantly reduced meaningful, real-world social interactions, which are essential for emotional growth,” she said.
When asked about contributing factors to adolescent mental health issues, Dr Ruziana cited several, including biological elements. She explained that the teenage brain—particularly the prefrontal cortex, which is responsible for emotional regulation and decision-making—is still in development.
“Socially, teenagers navigate a range of daily stressors, whether at home or in school. These include academic pressure, examinations, fatigue, and comparisons with peers. Some also endure physical or emotional bullying,” she said.
Within the family context, she noted that poor communication and a lack of emotional support are significant contributors to emotional distress.
“Many teenagers who show signs of depression or anxiety often do so in response to unresolved family issues,” Dr Ruziana said, adding that ongoing family conflicts—including divorce, abuse, neglect, or parents with untreated mental illness—can have a profound impact on a teenager’s mental well-being.
STUDIES
According to Dr Ruziana, data from the National Health and Morbidity Survey (NHMS) and various local studies reveal a concerningly high prevalence of mental health issues among Malaysian teenagers.
“The NHMS 2022 found that one in four adolescents aged 13 to 17 exhibited symptoms of depression, anxiety, or stress. The transition from lower to upper secondary school is identified as a particularly vulnerable period,” she said.
She noted that teenagers with low self-esteem, poor emotional regulation, learning difficulties, chronic illnesses, or physical disabilities are at significantly higher risk of developing mental health problems.
The survey also highlighted that teens from families experiencing parental mental illness, single parenthood, persistent marital conflict, or domestic violence are more prone to emotional and psychological struggles.
“Parents who are emotionally unstable, depressed, anxious, or aggressive can hinder their child’s emotional development. When teens don’t feel safe at home, they’re less likely to open up about their problems. This leads to emotional suppression, isolation, and a growing sense of hopelessness,” she explained.
"Economically, studies show that low-income families (the B40 group) have limited access to mental healthcare. In addition, low parental education levels are linked to a lack of awareness about emotional needs and communication within the family," she said, adding that mental health issues are more prevalent among teenage girls.
Dr Ruziana also noted that environmental factors play a role, with teenagers living in urban areas found to be at higher risk of emotional stress due to greater academic pressure, excessive screen time, increased exposure to social media, and a lack of physical activity.
REDUCING DEPENDENCY ON MEDICATION
While medication is often a key part of treating mental health conditions—particularly among teenagers—Dr Ruziana believes it is time to reduce this dependency.
She stressed that psychiatric care should be holistic, addressing all aspects of a patient’s life rather than focusing solely on pharmaceutical intervention.
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“People need to understand that not every teenager with mental health issues requires medication—only those in truly critical need.
“Psychiatrists also examine other important factors such as parenting styles, family dynamics, and school environments, all of which greatly influence a teen’s emotional well-being and behaviour,” she said.
Dr Ruziana urged Malaysian society and families to shift away from viewing medication as the only remedy for mental illness.
“Medication can be helpful, but it’s not the only solution for emotional or behavioural issues in children. Many families in Malaysia have witnessed meaningful changes after undergoing family therapy. Teens who previously struggled to regulate their emotions often show improvement after just a few sessions.
“As parents begin to understand the pressures their children face, relationships tend to grow closer. This proves that with mutual support and cooperation, many issues can be resolved in a healthy and harmonious way—without complete reliance on medication,” she added.
THE NEED FOR FAMILY THERAPY
Expanding on the issue, Dr Ruziana stressed that it is time for family therapy to be recognised as a key alternative in addressing teen mental health challenges in Malaysia.
She said the country must strengthen the role of family therapy within its healthcare system, as many mental health issues among adolescents are rooted in strained family relationships.
“Many teens don’t just need individual treatment—they need the support of a compassionate and understanding family. In a country like Malaysia, where family values hold deep significance, this approach is not only culturally appropriate but also more sustainable in the long run,” she explained.
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By promoting family therapy, she added, the healthcare system can address the mental health of teenagers more holistically while also reinforcing the family institution. This, she noted, aligns with the Malaysia MADANI vision, which upholds strong family relationships, mental well-being, and social harmony.
Dr Ruziana said family therapy involves all members of a household to better understand and support the affected teenager.
“Often, when one teen shows signs of mental distress—be it depression, anxiety, or anger—it’s connected to underlying stress at home, miscommunication, or unresolved family conflict.
“Through family therapy, each member learns how to listen, express emotions constructively, and solve problems collaboratively. It gives parents and siblings insight into what the teen is truly experiencing,” she said.
She added that family therapy typically involves six to 12 sessions, held weekly or biweekly, and may include extended family such as grandparents, uncles, or aunts.
“Ideally, everyone in the household should take part. Some families may require more sessions depending on the severity of issues. The therapy is structured—starting with introductions, followed by assessments and targeted interventions, and concluding once tangible improvements are seen,” Dr Ruziana said.
The ultimate goal, she emphasised, is to create a more cohesive and nurturing home environment.
“When supporting a child, we cannot ignore the broader family dynamics—how parents communicate, discipline, show affection, or give attention. These all play critical roles in a child’s emotional health,” she said, expressing hope that more family therapists will be trained in line with the Malaysia MADANI values of compassion, humanity, and family strength.
