For years, Malaysians have spoken softly, if at all, about mental health but the silence is getting harder to maintain.
National data shows mental health problems among adults skyrocketed from 10.7 per cent in 1996 to 29.2 per cent in 2015, according to the National Health Morbidity Survey.
And while anxiety remains the most commonly reported condition, depression is rapidly climbing the ranks.
Within just a decade, national depression figures rose from 1.8 per cent to 2.3 per cent, representing nearly half a million Malaysians aged 16 and above. Yet new research suggests this number may be only the tip of the iceberg especially when it comes to men.
A 2023 peer-reviewed study published in Heliyon titled "Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study" (Heliyon, 2023; 10(1): e23042) provides one of the clearest snapshots to date of depressive symptoms among Malaysian adults aged 35 to 70.
The community-based study found that 3.7 per cent of respondents showed depressive symptoms, a figure higher than the national depression rate at the time of study, but more importantly, one that reveals who is most likely to struggle silently.
And Malaysian men are central to that silence.
The Hidden Burden on Men
Although the research included both women and men, the findings highlight a crucial truth - Malaysian men are significantly less likely to report or acknowledge depressive symptoms, even when they experience them.
In other words, the numbers we see are likely suppressed - not because men suffer less but because they speak less.
This aligns with global evidence showing men often minimise or under-report emotional distress due to cultural conditioning, gender expectations and fear of stigma.
The study notes that social and cultural norms in communities especially in rural, lower-income or patriarchal settings may cause certain groups to understate mental health challenges.
Among men, expectations of "toughness," stoicism and being the family’s primary pillar often discourage honest disclosure.
In Malaysia, the masculine ideal still leans heavily towards the stereotypes of "men must be strong", "men must endure" and "men must not buckle."
Unfortunately, mental health does not follow cultural rules.
Depression is Rising - Quietly but Consistently
The study’s findings echo a worrying national trend: depression is quietly becoming one of Malaysia’s most pressing health conditions, highlighting depressive symptoms were present in 3.7 per cent of respondents - and this was more than a decade ago (2007–2008 baseline), when the data was collected.
If mental health problems almost tripled nationally between 1996 and 2015 and if depression rates have already climbed by the millions globally, Malaysia’s current numbers are likely much higher.
Yet despite this trend, depression remains a "silent crisis" among menparticularly working-age men juggling financial pressures, family responsibilities and cultural expectations.
The study identifies several factors that significantly raise the likelihood of depressive symptoms. While women, as consistently shown in global data, are more likely to meet diagnostic criteria, men emerge strongly in categories deeply tied to lifestyle, stress and health.
Key associated factors showed younger adults aged 35 to 40 had the highest odds of depressive symptoms, with smokers and alcohol consumers were more likely to show symptoms.
Data also showed stress at work or home doubled the odds of depression, while chronic disease, particularly hypertension, diabetes and asthma among others, significantly increased depressive symptoms.
These patterns mirror the struggles of many Malaysian men who often downplay stress, use smoking or alcohol as coping mechanisms, experience chronic illnesses earlier due to lifestyle patterns and internalise emotional burden due to pressure to "hold everything together."
The study states that these combination makes depression in men uniquely hard to detect. While women may express sadness or hopelessness, men often present as irritable, withdrawn, fatigue, overly focused on work and engaged in risk-taking behaviour.
In essence: men’s depression wears a disguise.
The Cost of Ignoring Men’s Mental Health
It's important to note that unchecked depression is never harmless. Research links depressive symptoms with increased suicide risk, worsened chronic illness outcome, lower productivity and poorer family relationships.
The study highlights the urgency of timely and well-targeted collaborative interventions are needed to prevent depressive symptoms from escalating into full-blown clinical depression.
For men, early intervention is especially crucial because the time many seek help, their symptoms may have persisted for years.
Malaysia cannot afford for men to stay silent. If one in 10 men show signs of depression and many more remain undiagnosed, the national impact is far greater than one can imagine.
The study proposes a few approaches to addresss the crisis which includes a workplace mental health frameworks, screening for depression among men with chronic illnesses, male-friendly mental health services and safe spaces, community outreach that encourages men to talk without judgement and the importance of reframing the idea 'vulnerability as strength'.
And until we create space for honest conversations, countless men will continue carrying burdens no one realises they’re holding.