6.3 Mental health

20.4 per cent in 2015. 234 Previously, intravenous drug users were most at risk of contracting HIV, but sexual transmission is currently responsible for almost 80 per cent of new infections. Among young people who bear disproportionate burdens of HIV, those most at risk include MSM (men who have sex with men), transgender youth, young people who inject drugs and young sex workers. Since 1990, the profile of the HIV epidemic in Malaysia has progressively shifted, with the proportion of female/male infection increasing from 1:99 in 1990 to 1:4 in 2013. 235 In 2014, 0.08 per cent of young women aged 15-24 were living with HIV. 236

There is also likely a link between the lack of knowledge of and access to SRH information and services and child marriage (discussed in section

5 above) and teen pregnancy. Whilst the adolescent fertility rate in Malaysia is comparatively low for South-East Asia, there has been a steady increase since 2008. 237

Childbearing at a young age leads to school dropout and low employment opportunities and is also connected to reproductive health issues. According to data from the National Registration Department, out of the approximately 532,158 children born to unmarried parents between 2010 and 2015, making these children vulnerable to being unregistered; 16,270 were born to teenage mothers. 238

In addition to providing adolescents with knowledge in relation to reproductive health, comprehensive sexuality education provides information on safe sex, issues of consent, respect for others’ choices and also how to identify signs of sexual abuse. In respect of the last point, a poll conducted in 2017 found that almost 50

per cent of adolescents believed that teenagers were being pressured to have sex, a further 38 per cent responding that teenagers were ‘maybe’

pressured into having sex. 239 The poll found a variety of concerns raised by respondents including sexual abuse/rape (including by a family member), grooming and threats/requests for sexually explicit photographs. A vast majority (95 per cent) responded that there was a need for education to protect against sexual abuse.

Some efforts have been made to improve SRH education and services, and the Government has expressed commitment to improving SRH

education in schools. 240 For example, in 2009, a National Adolescent Health Plan of Action (2006- 2020), a National Policy on Reproductive Health and Social Education and an associated Action Plan were introduced. SRH was integrated into the National Service Training Curriculum in 2011 as well as into schools (the PEKERTI programme aimed at 12-15-yearolds), and by 2016, more than 300,00 teenagers had received training on SRH. Further, there are currently 17 youth-friendly centres, known as kafe@TEEN, which have provided access to SRH information and services to over 1.2 million youths. 241

According to the NHMS, rates of depression and

anxiety among adolescents increased between

2012 and 2017. The prevalence of depression among Malaysian adolescents aged 13-17 was around 20 per cent in 2017. 242

The state of Selangor reported the highest rate at 22.6 per cent, and depression was slightly more prevalent among males than females (18.9 per cent compared to 17.7 per cent) and more prevalent among those of Indian ethnicity at 33.1 per cent. 243 Around 40 per cent

of adolescents suffered from anxiety, with higher

rates among girls than boys (42.3 per cent compared to 37.1 per cent). Those of Indian ethnicity and Bumiputera Sabah ethnicity reported the highest rates at 47 per cent, and anxiety was more prevalent in Sabah than other states. Stress affected around 10 per cent

234 235 236

237 238

239 240

241 242 243 Tey, Nai P. ‘The State of the Youth in Malaysia’, Population Statistics Malaysia 2018, Population Studies Unit (PSU), 2019, p. 130-131. Ibid. Asadullah, M. Niaz, ‘The Changing Status of Women in Malaysian Society‘, Population Statistics Malaysia 2018, Population Studies Unit (PSU), 2019, p. 109. See the main Situation Analysis of Women and Children in Malaysia. See Ruxyn, T., ‘More than 530,000 innocent children are labelled as ‘illegitimate’ in Malaysia’, Says, 11 November 2016: https://says. com/my/news/more-than-530-000-illegitimate-children-registered-with-jpn UNICEF, ‘Teen Relationships: Adolescents’ Poll 2017. See ‘MOE urges schools not to take sex education lightly’, Malay Mail, 22 February 2019: https://www.malaymail.com/news/ malaysia/2019/02/22/moe-urges-schools-not-to-take-sex-education-lightly/1725789 Tey, Nai P. ‘The State of the Youth in Malaysia’, Population Statistics Malaysia 2018, Population Studies Unit (PSU), 2019, p. 145. Based on DASS (Depression and Anxiety Stress Scale)-21 Scoring. Institute for Public Health, Ministry of Health, National Health and Morbidity Survey (NHMS) 2017: Key Findings from the Adolescent Health and Nutrition Surveys – Infographic Booklet, April 2018, p. 22.

of adolescents, with Selangor and Sabah recording the highest prevalence (12.5 per cent and 12.3 per cent respectively). Again, adolescents of Indian ethnicity reported the highest stress rates (at 15 per cent), and the rate for girls was slightly higher (at 10.3 per cent) than boys (at 8.9 per cent).

There are some limited data on the prevalence of depression among refugee adolescents. A cross

sectional study of 104 refugee adolescents aged 12- 19 years found mild levels of stress, moderate levels

of depression, and high levels of anxiety. The mean score for depression was 14.31 per cent, but 46.1 per cent of the refugee adolescents reported severe (19.2 per cent) to extremely severe (26.9 per cent) anxiety levels. Female refugee adolescents reported higher levels of stress, anxiety and depression than males. 244

Some of the main immediate risk factors for depression include loneliness and early relationship

cent of secondary school children felt lonely ‘most of the time or always’. The prevalence of loneliness was highest in Kuala Lumpur (13.4 per cent), in urban areas, among female students (10.8 per cent compared to 7.8 per cent of males) and those of Indian ethnicity. 245 The NHMS also found that 3.6 per cent of students had no close friends, the prevalence being significantly higher among males as compared to females (4.5 per cent compared to 2.7 per cent), and highest among those of Indian ethnicity. Pahang reported the highest prevalence of having no close friends (at 5.2 per cent) and Melaka the lowest (at 2.2 per cent). There was little difference between urban and rural areas. Other factors that are linked to mental health issues include stress from homework and exams that can contribute to anxiety and feelings of helplessness, excessive internet use and cyberbullying, and bullying more generally, along with drug and alcohol misuse, traumatic or otherwise problems with peers. The NHMS revealed that 9.3 per

detrimental life events (such as bullying and sexual abuse) and socio-economic inequities (poverty).

FIGURE 13: Prevalence of stress, anxiety and depression among 13-17-year-olds, 2017 (%)

Source: NHMS 2017: Key Findings from the Adolescent Health and Nutrition Surveys – Infographic Booklet, April 2018

244

245 Low, S. K., Tan, S. A., Kok, J. K., Nainee, S., & Viapude, G. N. (2018). ‘The Mental Health of Adolescent Refugees in Malaysia’, 4(2) People: International Journal of Social Sciences. Institute for Public Health, Ministry of Health, National Health and Morbidity Survey 2017, Adolescent Health Survey 2017, Malaysia, pp. 103 and 106.