Current Psychiatry Reviews, 2011, 7, 000-000 1

A Review on the Prevalence of Depression in Malaysia

Firdaus Mukhtar*,1 and Tian P. S. Oei

1
Department of Psychiatry, Universiti Putra Malaysia, Malaysia; 2School of Psychology & CBT Unit, Toowong Psy-
chiatry Hospital, University of Queensland, Brisbane, Australia

Abstract: Transforming western technology to Eastern populations, including Malaysia, presents important implications
in understanding the development, maintenance, and treatment of depression. The present paper aims to review the litera-
ture on the prevalence of depression studies in Malaysia. PsycINFO, Medline databases, local journals, and 13 published
articles, were included in the current review. Findings were presented in three categories i.e., ‘prevalence of depression in
primary care’, ‘general community’, and ‘among clinical population’. Major limitations of previous studies were noted,
and thus, problems associated with the implementation and future direction of clinical and research on depression in Ma-
laysia, was provided. In short, the contribution of empirical research on the prevalence of depression has remained incon-
sistent and fragmented and it is therefore, a time to venture modification.

Keywords: Prevalence, depression, Malaysia.

1. INTRODUCTION To date in Malaysia, literature is unclear on the following

important issues: no prevalence of depression, lack of valid
Depression affects all people - regardless of age, geo-
and reliable assessment tools, no appropriate theory, no good
graphic location, demographics, or social position. It is pro-
evidence of treatment efficacy data, and no clear long-term
jected that depression will be among the leading causes of
outcome data [5]. As a result, this scenario contributes to a
worldwide disability by the year 2020 [1]. Across the Asia
serious shortage of documented empirical research on de-
Pacific region, rates of current or 1-month major depression pression in Malaysia. Therefore, the aims of this paper are
range from 1.3 to 5.5%, and rates of major depression during
twofold; first, to review available articles related to the
the previous year ranged from 1.7 to 6.7% [2]. Epidemiol-
prevalence of depression, and second, to appraise the prob-
ogical studies indicate that the rates of depression in the Asia
lems of implementation, and thus, present future directions
Pacific, although dropping internally, are comparable to
for clinical application and research on depression.
other western countries [2].
2. METHOD
The lifetime occurrence of depression in any country is
between 8 and 10% [3]. Contrary to common belief, it is not 2.1. Selection of Studies
only an illness of developed countries. The case of Malaysia
A search of literature, using the electronic databases Psy-
is no exception; in fact, depression is the most common men-
cINFO (SilverPlatter, 1970-present) and MEDLINE (1970-
tal illness reported in Malaysia. It is by far the most impor-
present), was conducted (Fig. 1). Due to the scarcity of pa-
tant and the most treatable condition, and is projected to af-
pers found in these databases, this review also includes elec-
fect approximately 2.3 million people in Malaysia, at some
point in their lives [4]; yet, depression remains under de- tronic and manual searches of available local journals in Ma-
laysia, such as the Malaysian Journal of Psychiatry, the Ma-
tected and undertreated [5]. To date however, issues of de-
laysian Medical Journal, and the Malaysian Medical and
pression in Malaysia have not received the kind of attention
Health Science Journal, in order to meet the objectives of
that they deserve [5,6,7]; hence, the picture of depression in
this review.
Malaysia is fragmented and unclear.
Searches were refined to identify studies published in
Over the last two decades, considerable research has ad-
dressed the issue of cultural differences, in the manifestation English over the past 40 years that included at least a cross-
sectional and experimental study of depression using adult
of depression [8,9,10,11,12]. Among the problems noted, in
participants. Adult studies were targeted in order to eliminate
reviews of cross-cultural studies of depression, are the ubiq-
developmental differences that are present in child or adoles-
uitous lack of resources, too few trained providers, and the
cent groups.
social stigma associated with mental disorders, including
depression. These problems exist in most developing coun- Searches were conducted using the keywords: preva-
tries and occur for various reasons. lence, Malaysia, depression, depressive disorder, and mood
disorder. These keywords were selected due to their fre-
*Address correspondence to this author at the Department of Psychiatry, quency in the majority of papers collected early in the review
Faculty Medicine and Health Sciences, Universiti Putra Malaysia, 43400 process. The prevalence keywords were combined to yield
Serdang, Selangor, Malaysia; Tel: +60 3 8947 2543; Fax: +60 3 8941 4629; 125 citations in PsycINFO and 180 citations in Medline. The
E-mail: drfirdaus@medic.upm.edu.my

1573-4005/11 $58.00+.00 © 2011 Bentham Science Publishers

2 Current Psychiatry Reviews, 2011, Vol. 7, No. 3
Fig. (1). Flow-chart of the reviewing process.
assessment terms were combined to produce 22 citations in
PsycINFO and 24 in Medline. Studies were excluded for the
following reasons: review papers, biological/physiological
studies, treatment or assessment studies, depression was not
the focus of study; i.e., stress was misinterpreted as depres-
sion, and historical data paper, rather than an empirical
study.
This resulted in 7 studies that were suitable for the re-
view. An additional 6 studies from local journals, meeting
the selection criteria, were cited in these articles and added to
the review, resulting in a total of 13 studies.
2.2. Description of Studies to Review
The prevalence studies are presented in Table 1 and are
arranged in order of year of publication, according to three
categories of population.
The following study features are summarised in Table 1:
(a) population (b) study number and reference (c) target
group with sample size in brackets (d) representative of eth-
nic (e) gender (f) prevalence rate, and (g) measures used to
Mukhtar and Oei
screen for depression are conducted. The population and
target group were included to investigate whether assessment
for depression was targeting patient or non-patient samples.
Ethnicity is important, because Malaysia is a multi-ethnic
society. Gender information can be used for further recom-
mendations of research, especially for early intervention
programs. The measures used to screen for depression are
important, in order to conclude the trend in Malaysia.
3. RESULTS
3.1. Description of Studies Included in the Review
A total of 13 studies fulfilled the above criteria for inclu-
sion (see Table 1). A total of 9,463 participants were repre-
sented, with sample sizes ranging from 50 to 6,342. A diver-
sity of ethnicities was represented, with Malays as the domi-
nant ethnic group, having been involved in previous studies
(Studies 1 and 5 recruited Malays subjects only). The range
of subjects that participated in prevalence studies included
patients from primary care services, patients with specific
clinical problems (postnatal, post-stroke, breast cancer, and
headache), and samples from the general community (the
elderly and a group of women). Meanwhile, in terms of eth-
nicity, Malays (n=8333), followed by Chinese (n=402), In-
dian (n=405), and others (n=73) were involved in prevalence
studies in Malaysia. In terms of gender, female subjects
(n=6198) participated the most in research for depression.
However, Study 7 did not report gender as a study category.
3.2. Prevalence of Depression in Malaysia
As can be seen from Table 1, the prevalence of depres-
sion in the primary care population, ranged from 6.7 to
14.4%. Two studies (i.e., Studies 1 and 2) used a General
Health Questionnaire (GHQ) in screening for depressive
symptoms, while Study 3 used a Patient Health Question-
naire (PHQ-9). The gap between studies was quite large and
significant, from 1995 to 2009. No studies discussed or in-
vestigated the nature of prevalence, and it is therefore un-
clear whether it is lifetime, point, or past 12 months. Infor-
mation is also limited on depressive symptoms and the na-
ture of severity, as most studies only reported total question-
naires scores.
The second section of Table 1 is a clinical group consist-
ing of four studies on postnatal women, post-stroke depres-
sion, breast cancer, and headaches. The prevalence of de-
pression in clinical groups ranges from 3.9 to 46%. This re-
sult is important, as apart from of having a physical illness
patients may also suffer from depression before, after, or
during, the adjustment of their illness. This will importantly
assist clinicians and physicians to concentrate not only on
the biological or physical state of patients. The gap is large
because Study 8 considered positive cases as a prevalence of
depression among patients with headaches. However, the
study was further refined using SCID as a gold standard
measurement for depression, by having 17% lifetime MDD
and 8% current MDD. However, no other studies further
investigated depression as a disorder. Further refinement of
screening is good, so as to assist the patient in getting the
best treatment and rehabilitation that they deserve. This
could also help clinicians to lessen their burden, and in man-
aging their cases better.
Depression in Malaysia Current Psychiatry Reviews, 2011, Vol. 7, No. 3 3

Table 1. Studies on Prevalence of Depression in Malaysia

Population Study Target Group (n=) Ethnic (N) Gender (N) Prevalence Measure
Rate (%)

Primary Care 1. Varma et al. Primary care (n= Malays (N=6342) Male (N=2550) 13.2 GHQ-30
(1995) [13] 6342) Female (N=3792)

2. Taha et Primary care Malays (N=73) Male (N=96); Fe- 6.7 GHQ
al.(2005)[14] (n=196) Chinese (N=76) male (N=100)

Others (N=47)

3. Ruzanna et Primary care Malays (N=199); Chinese Male (75); Female 14.4 PHQ-9
al. (2009) [15] (n=263) (29); Indian (31); Others (4) (188)

Clinical 4. Kit et al. Postnatal women Malays (N=66); Chinese Female (N=154) 3.9 EPND
(1997)[16] (n=154) (N=41)
Indians (N=47)

5. Kadir et al. Postnatal women Malay (N=421) Female (N=421) 20.7 EPND
(2005)[17] (n=421)

6. Ahmad et al Post-stroke depres- Malay (N=17); Male (N=31); 36% HADS & SCID
(2002)[18] sion (n=50) Chinese (19);Indians (12) Female (N=19)
Others (2)

7. Saniah et al. Breast Cancer Not available Not available 19.1% HADS
(2010)[19] (n=141)

8.Zuraida et al. Headache (n=106) Malay (N=134); Male (N=32); 46% ‘cases’; GHQ-28&
(2007)[20] Control (n=106) Chinese (N=16); Female (N=180) 17% Lifetime SCID
MDD; 8%
Indian (N=62)
Current MDD

General Commu- 9. Sidik et al. Elderly (n=208) Malays (N=99) Males (N=91); 18 GDS
nity (2003)[21] Non-Malays (109) Female (N=117)

10. Sherina et Elderly (n=223) Malays (N=120) Male (N=100); 7.6 GDS
al. (2004)[22] Chinese (N=52) Female (N=123)

Indians (N=45)
Other (N=6)

11. Sherina et Elderly (n=300) Malay (N=284); Male (N=144); 6.3% GDS
al. (2005)[23] Chinese (4); Female (N=156)
Indian (12)

12. Imran et al. Elderly (n=244) Malay (N=243) Male (N=80); 13.9% GDS
(2009)[24] Others (N=1) Female (N=164)

13. Sherina et Women (n=972) Malays (N=534) Female (N=972) 8.3% PHQ-9
al. (2008)[25] Chinese (N=194)
Indian (N=227)
Others (N=17)
Abbreviations: Edinburgh Postnatal Depression (EPND); Geriatric Depression Scale (GDS); General Health Questionnaire (GHQ); Hospital Anxiety and Depression Scale (HADS);
Patient Health Questionnaire-9 (PHQ-9); Structured Clinical Interview for DSM Disorders (SCID).

For postnatal depression, the main tool used by research-
ers was EPND, which needed to be taken carefully when
interpreting scores. This has been used worldwide, but at the
time that this review was prepared, no one had validated it
according to Malaysian norms. This is similar to cases using
HADS (Hospital Anxiety and Depression Scale) and GHQ.
Although it has been used for many studies and clinical
work, a good tool for screening (especially psychological
assessment), should be tested on psychometric properties and
its compatibility to be used among all backgrounds in Ma-
laysia. This may otherwise lead to misleading or an overgen-
eralization of the results, to compare with worldwide re-
search outcomes.
The last section in Table 1 consists of studies that were
carried out amongst the general community, such as the eld-
erly (Studies 9 to 12) and a large study on women in rural
and urban areas, in one State in Malaysia (Study 13). The
prevalence of depression was reported to be from 6.3 to
4 Current Psychiatry Reviews, 2011, Vol. 7, No. 3
13.9% amongst the general community in Malaysia. Again,
in all studies, no gold standard measures to pursue depres-
sion as a disorder were carried out. However, in terms of the
measurement used in studies (Geriatric Depression Scale and
PHQ-9) for the general community, all measures were vali-
dated for use with confidence in Malaysia.
Nevertheless, no studies were conducted at two-stages of
screening to confirm whether the depressive symptoms were
a disorder or otherwise. Study of the prevalence of depres-
sion among women is important, as recent statistics have
reported that women in Malaysia were placed at 16-rank to
suffer depression, compared to all other countries worldwide
[26].
4. DISCUSSION
This paper aims to review all studies on the prevalence of
depression in Malaysia. Results are summarised in Table 1,
with three categories of studies at primary care level, clinical
patients, and the general community. Overall, the prevalence
of depression in Malaysia ranges between 3.9 to 46%. How-
ever, careful interpretation of this result is important for each
study, as certain studies describe in terms of depressive
symptoms, or lifetime and current depression disorders.
Compared to Western countries, approximately 9.5% of
the US population aged 18 or older had a depressive disorder
in 2009 [3]. Women (12%), numbering nearly twice as men
(6.6%), are affected by a depressive disorder each year.
Women between the ages of 25 to 44 are the most affected
by depression [3].
In primary care in Italy, the prevalence of current depres-
sion ranges between 7.8 and 9.0% [27] whereas in Malaysia,
it ranges between 6.7 and 14.4%. Most of the epidemiologi-
cal studies on depression in primary care were conducted at
single site.
The comparable rates of depression, between the elderly
in Malaysia and the Western world, also suggests that a pre-
ventive program, earlier detection, and treatment consulta-
tion, is required. In America, 1 to 2% of people over 65 are
living in the community suffering from major depression,
and about 2% have dysthymia [3]. In addition, between ap-
proximately 1 to 27% of older adults have subclinical de-
pressions that do not meet the diagnostic criteria for major
depression, but are associated with an increased risk of major
depression, physical disability, medical illness, and high use
of health services [3]. Whereas in Malaysia, studies have
reported between 6.3 and 18% of the elderly with depressive
symptoms. Moreover, as stated in the above studies, vali-
dated instruments are important to give a reliable detection
of symptoms of depression amongst Malaysians. Therefore,
in order to understand depression, its management and cost-
effective intervention plans, valid, reliable, and accurate
measurements, are needed.
For postpartum, American studies reported rates from 5
to 25%, but the methodological difference between the stud-
ies makes the actual prevalence rate unclear [3]. Meanwhile,
in Malaysia, the pick-up rates are almost similar to Western
results, which are between 3.9 to 20.7%. It is now time that a
proper diagnosis on depression as a disorder to be high-
Mukhtar and Oei
lighted; so that patients can be managed properly in terms of
assessment, diagnosis, and treatment, especially in isolated
cases where it can also affect children’s development.
Limitations of study on the prevalence of depression in
Malaysia:-
1. Research studies vary in the methodology and designs
used, and thus, often present conflicting findings in all
areas, including epidemiological, assessment, and treat-
ment.
2. There is a lack of information on the use of gold standard
measures of depression, in order to have information on
lifetime or current diagnosis of depression, which can ac-
tually lead to confusion by society, especially when the
media releases inaccurate reports. The most commonly
alarming issue is when society is informed that depres-
sion occurs in certain populations, and it is misinterpreted
as general mental illness, or even worse, depression is
thought to be similar to psychotic cases.
3. Obviously, the lack of valid and reliable measurements
used in studies, such as HADS, EPND, and GHQ. Con-
sequently, study results may lack a cut-off score and cul-
tural norms to be considered depressive symptoms or
mood disorder. This is because most measures were de-
rived from a Western perspective of understanding and
investigation on depression, and thus, the conclusion can
be lacking diagnosis information or the need for extra
caution to be interpreted as it is.
4. In terms of sample size, many studies have represented
an inadequate sample size, for certain ethnicities, which
can bias the concluded prevalence rate of depression in
the general Malaysian population.
5. It is expected that depression appears earlier in life, with
an average age of just 14 in America. However, it is still
undetermined in Malaysia, as results from studies vary on
the reported age recruitment and studies on children are
not included in this review paper.
6. In addition, inadequate information on subjects’ recruit-
ment, unclear diagnoses, and a lack of validated instru-
ments, could lead to difficulty of accurate information
reporting on the prevalence of depression in Malaysia.
Future research could actually suggest several instru-
ments that have been validated using larger sample sizes,
good psychometric properties, and are able to differentiate
between clinical and non-clinical groups. There is evidence
of testing treatment outcome measures, such as the Beck
Depression Inventory-Malay [28], Depression Anxiety Stress
Scale [29], and the latest screening for mental health SSKM-
20 [30] which are culturally sensitive, compared to measures
that are derived from the West.
In the Ninth Malaysia Plan (2006-2010) published re-
cently, the government allocated RM900 million (USD225
million) for professionals to improve mental health problems
in Malaysia. Therefore, as Malaysian society grows more
complex and sophisticated, the accompanying problems,
such as social and mental health problems, should not be
accepted. Clearly, depression is common in the general
Depression in Malaysia
population, but patients’ symptoms often go unnoticed and
untreated, due to a lack of awareness for many reasons. Only
about half of the patients diagnosed with depression in pri-
mary care were recognised as having depression, and of
these, less than a half received adequate treatment, even
though effective treatments were available [4]. Although
psychiatric services in Malaysia are still in their infancy, and
services are not utilised at their optimum level, the rise in
cases of depression indicates that urgent attention to this area
of mental health care is required. It is time to make the rec-
ognition and treatment of depression in clinical practises
through a bold and effective paradigm shift that will trans-
form the management of depression to coexist with the di-
versity of religion and cultural context.
5. CONCLUSION
The impact of local factors and methodological differ-
ences may limit the comparability between studies, and may
partially account for variations in reported prevalence fig-
ures; ranging from 3.9 to 46%. In conclusion, the high preva-
lence rate of depression amongst patients in primary care,
clinical settings, and in the general community, indicates that
depressive symptoms need to be taken seriously, because
their severity may contribute to a decrease in the quality of
productivity and an increased morbidity and mortality of the
individual, as well as society and the nation.
ACKNOWLEDGEMENT
Prof. Sherina Mohd Sidik for her generosity in assisting
with this review, and Mr Philip Morgan, a professional
proofreader, for his final edit on the language used in this
paper.
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