Mental Health Issues among Malaysian Adolescents: Prevalence, Trends, and Ecopharmacovigilance Considerations of Psychiatric Medication Use — A Qualitative Systematic Review

Abstract

Mental health issues among adolescents represent a significant and growing public health burden in Malaysia, with escalating rates of depression, anxiety, and stress recorded over the past decade. The widespread diagnosis and pharmacological management of these conditions has led to substantially increased consumption of psychotropic medications — including antidepressants, anxiolytics, and antipsychotics — with implications extending beyond clinical settings into the broader environment. This qualitative systematic review synthesises evidence on the prevalence, types, trends, and contributing factors of mental health disorders among Malaysian adolescents from 2014 to 2024, drawing on 19 peer-reviewed studies identified through Scopus, PubMed, and Google Scholar. Findings reveal a marked escalation in the prevalence of depression (8.85% to 34.84%), anxiety (10% to 57.68%), and stress across all reviewed intervals, peaking during the COVID-19 pandemic period (2020-2022). From an ecopharmacovigilance perspective, the rising psychotropic drug burden associated with this epidemiological trend raises important concerns regarding pharmaceutical residues in wastewater and aquatic ecosystems. This review highlights the need for integrated surveillance strategies that address both the clinical and environmental dimensions of adolescent psychiatric pharmacotherapy in Malaysia.