The prevalence of psychological distress leading to mental health disorders among youths in Malaysia has increased over the years. This metasynthesis provides an examination of the risk factors contributing to vulnerability to mental distress among the youth as well as protective factors in Malaysia. Keyword searches were conducted using EBSCOHost, JSTOR, PsycARTICLES, PubMed, SAGE Journals, and Scopus databases. A total of 24 journal articles were reviewed. Findings revealed academic stress, relationship issues, socioeconomic and social change issues, and cultural aspects were the main stressors for youths' vulnerability. Protective factors include connectedness, social supports, and cultural richness. The double-edged sword effects of family support and cultural aspects will be discussed against the backdrop of the Malaysia multicultural context. We propose outreach efforts and intervention programs that are culturally and contextually responsive to the different ethnic groups. To help young people from falling into psychological distress affecting their mental health, a family- and school-based approach is vital in providing protective interventions to address the risk factors.