He said the victim showed more dominant suicide risk factors than protective factors at the time of the incident, Berita Harian reported.
Chua, the 67th witness in the inquest, said he prepared, signed and certified an 84-page psychiatric report dated Feb 2 for the court, focussing on the likelihood of self-harm and the 13-year-old’s circumstances.
Materials reviewed and risk factors
Reading his witness statement before coroner Amir Shah Amir Hassan, Chua said the materials he reviewed included Zara’s diary, the scene of the incident, and the post-mortem report by forensic pathologist Dr Jessie Hiu.
He also examined counselling reports, visited the hostel and dormitory, and conducted interviews with family members as well as staff of SMKA Tun Datu Mustapha and Zara’s primary school.
“There is information indicating emotional disturbance, intense anger, self-harming behaviour, unstable interpersonal relationships and fear of abandonment. However, this is insufficient to support a retrospective diagnosis of a personality disorder.
“Although there were indications of depressive symptoms, I do not believe the victim suffered from a diagnosable severe mental illness prior to the incident.
“The convergence of predisposing and triggering factors suggests that the final act was most likely an attempt to end suffering, occurring under acute stress, impaired judgment, and reduced access to normal protective mechanisms, rather than a carefully planned act.
“In this case, risk factors include stressful life events, negative self-perception, perceived bullying, unsatisfactory academic performance, history of substance use, anger or verbal aggression, non-suicidal self-injury, parental separation, conflict with parents, social sensitivity, depressive symptoms, behavioural issues and a desire to die.
“Triggering factors included stressful events such as interrogations and feelings of isolation. Other contributing conditions included chronic sleep deprivation and distress linked to reprimands by student wardens,” he said.
Chua added that several risk factors were present even before the victim entered the school.
Self-harm a leading factor for older adolescent death
Chua said self-harm was among the leading causes of death among older adolescents, and nearly three out of five youth cases had no prior documented mental health diagnosis.
He said studies showed that Malaysian adolescents aged 13 to 15 faced a higher risk of attempting self-harm than other age groups, with those from separated families also more likely to be affected.
On Sept 17, the Sabah Attorney-General’s Chambers asked the health ministry to conduct a psychiatric evaluation to assist the inquest.
Chua, child and adolescent psychiatrist Nurulwafa Hussain, and clinical psychologist Norhameza Ahmad Badruddin were appointed by the health director-general on Sept 19 to conduct the assessment using a psychological autopsy approach.
Zara was confirmed dead at Queen Elizabeth Hospital on July 17, 2025, a day after she was found unconscious in a drain near her school dormitory.