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Ambulance attendances: suicidal and self-harm behaviours

The ambulance attendance data includes 1-month per quarter snapshots from Victoria (Vic), Tasmania (Tas) and the Australian Capital Territory (ACT) from March 2018 to December 2021, New South Wales (NSW) from March 2018 to September 2021, and Queensland (Qld) from March 2020 to September 2021. AIHW began receiving monthly data for NSW, Vic, Qld, Tas and the ACT from January 2021.

See Data development activities to learn more about the ongoing developments relating to ambulance attendance data funded through this project.

Self-harm related ambulance attendances are included if self-harm occurred in the preceding (past 24 hours) or during the ambulance attendance, with 4 categories of self-harm related ambulance attendances defined and coded as:

  • self-injury (non-fatal intentional injury without suicidal intent)
  • suicidal ideation (thinking about killing oneself without acting on the thoughts)
  • suicide attempt (non-fatal intentional injury with suicidal intent, regardless of likelihood of lethality)
  • suicide (fatal intentional injury with suicidal intent).

Suicide, suicide attempt and suicidal ideation are considered mutually exclusive; however, self-injury could be simultaneously coded with any other self-harm case category.

The number of attendances related to suicide is under-represented as ambulances do not attend all deaths. Furthermore, when they do attend there may be insufficient information to determine suicidal intent at the scene. Rates of death by suicide have not been calculated because of small numbers, which may affect the reliability of the estimates.

For more information, see Data sources - National Ambulance Surveillance System (NASS).

How many ambulance attendances for suicidal and self-harm behaviours?

In 2020, ambulances attended a total of around 33,000 incidents involving suicidal thoughts and behaviours (suicidal ideation or suicide attempt) in the NSW, Vic, Qld, Tas and the ACT during the months of March, June, September and December. Over one third (36%) of these attendances occurred in NSW, in line with the population distribution between those jurisdictions.

Taking into consideration the population differences of the above 5 jurisdictions, the rate of ambulance attendances per 100,000 population for suicidal ideation in 2020 were:

  • 103.3 in NSW (around 8,400 attendances)
  • 90.9 in Vic (nearly 6,100 attendances)
  • 130.9 in Qld (around 6,800 attendances)
  • 52.0 in Tas (about 280 attendances)
  • 93.2 in the ACT (about 400 attendances).

Attendance rates for suicide attempts (by comparison, were lower than ideation in all 5 jurisdictions. Rates of attendances for suicide attempts per 100,000 population in 2020 were:

  • 41.3 in NSW (nearly 3,400 attendances)  
  • 50.2 in Vic (nearly 3,400 attendances)
  • 72.4 in Qld (over 3,700 attendances)
  • 46.1 in Tas (about 250 attendances)
  • 60.5 in the ACT (about 260 attendances).

Self-injury accounted for a relatively smaller number of attendances. These behaviours could be solely present in an attendance or present in conjunction with other suicidal and self-harm behaviours.

In 2020, ambulances in NSW, Vic, Qld, Tas and the ACT attended a total of around 6,400 incidents involving self-injury during the months of March, June, September and, December; 38% of which occurred in NSW.

In 2020, the rate of ambulance attendances per 100,000 population with self-injury present was:

  • 29.8 in NSW (over 2,400 attendances)
  • 25.3 in Vic (nearly 1,700 attendances)
  • 38.3 in Qld (nearly 2,000 attendances)
  • 17.0 in Tas (about 90 attendances)
  • 36.4 in the ACT (over 150 attendances).

(Supplementary table National Ambulance Surveillance System—self-harm behaviours S1).

Gender variations

There are distinct differences between genders when examining deaths by suicide and intentional self-harm hospitalisations; higher rates of deaths by suicide are seen in males compared with females (see Deaths by suicide over time) while females have higher rates of hospitalisations for intentional self-harm (see Intentional self-harm hospitalisations).

Ambulance attendances however, provide further context to these gender differences. Ambulance attendances capture if the intent of the self-harm was suicidal and therefore can provide information on the extent of these behaviours in the community.

In general, in 2020:

  • Rates of ambulance attendances for suicide attempt and self-injury were higher for females than males.
  • In the ACT, the rate of attendances for suicidal ideation was higher for females than males, while in NSW the rate for males was higher. The rates in Vic, QLD and Tas were not substantially different between males and females.

The interactive data visualisation shows ambulance attendances for males and females by each attendance type and for each of the five participating states and territories.

Ambulance attendances for self-harm behaviours, by gender, selected states and territories, 2020.

The vertical bar graph shows the crude rate and number of ambulance attendances for self-injury, suicidal ideation and suicide attempt for males and females in New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory for the combined quarterly snapshot months in 2020. Users can choose to view crude rates and numbers of attendances for New South Wales, Victoria, Queensland, Tasmania or the Australian Capital Territory for all or selected self-harm behaviours. Females generally had higher attendance rates and numbers for self-harm behaviours, with the exception of suicidal ideation in New South Wales and Tasmania. The highest crude rate of attendances for females and males was for suicidal ideation Queensland.

In 2020, rates of ambulance attendances for suicide attempt and self-injury were between 1.4 and 2.6 times higher for females than males. Ambulance attendance rates per 100,000 population for females involving a suicide attempt in 2020 were:

  • 48.1 compared to 33.9 for males, in NSW
  • 63.5 compared to 36.0 for males, in Vic
  • 90.0 compared to 53.6 for males, in Qld
  • 59.7 compared to 30.7 for males, in Tas
  • 77.4 compared to 41.3 for males, in the ACT.

Age and gender variation

The interactive data visualisation below illustrates the distribution of self-harm related ambulance attendances for both males and females by age. For this visualisation, ambulance attendance data from 2020 in NSW, Vic, Qld, Tas and the ACT have been combined.

In general, in 2020 there were higher numbers of attendances for self-harm behaviours in the younger age groups for both males and females. Attendance numbers generally decreased with increasing age. 

In 2020:

  • Attendances for self-injury and suicidal ideation were highest in the 15–19 age group for both males (around 470 and 1,400 attendances respectively) and females (around 1,100 and 2,100 attendances).

  • Attendances for suicide attempts were highest in the 20–24 age group for males (over 620 attendances) and the 15–19 age group for females (over 1,500).

Ambulance attendances for self-harm behaviours by age group and gender, selected states and territories, 2020.

The bar chart shows the distribution of the number of ambulance attendances for suicide attempts by age group for males and females, for combined quarterly snapshot data collected in New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory in March, June, September and December 2020. Users can choose to view ambulance attendance numbers by age group for self injury, suicidal ideation and suicide attempt. The number of attendances for suicide attempts generally decreased with increasing age group from 15–19 and 20-24 for both males and females. Self-harm behaviour attendances were generally higher in females than males, across all age groups. 

Ambulance attendances for suicidal and self-harm behaviours over time

Trends in suicidal and self-harm behaviours – especially recent trends – are a matter of public and policy interest. However, interpretation of trends and changes in rates is complicated by large variations due to small numbers in some instances and, thus, large confidence intervals.

The following time series visualisations are based on 1-month per quarter snapshots between March 2018 and December 2021 currently reported from Vic, Tas, and the ACT, between March 2018 and September 2021 from NSW, and between March 2020 and September 2021 for Qld. These data are thus not representative of total attendances in a quarter, year or total attendances in Australia.

Caution is advised when making month to month comparisons. To identify trends in 1-month per quarter snapshot data, it is advised to compare the same months over a number of years to allow for any seasonal effects and variations at different times of year. When comparing changes to estimates over time it is advised to ‘Show error bars’ on the visualisation. These show the 95% confidence interval for the crude rate which can vary widely in the case of small populations, such as for Tas and the ACT. As such, caution is advised when making trend comparisons for Tas and the ACT.

AIHW began receiving monthly data for NSW, Vic, Qld, Tas and the ACT from January 2021. The latest monthly data is for December 2021, except for NSW and Qld which is only reported until September 2021. These data are provided as additional visualisations in the below section. The visualisations will be updated over time and currently show no discernible trends.

Attendances for suicidal ideation

Across the snapshot months between March 2018 and December 2021 (March 2018 to September 2021 for NSW, March 2020 to September 2021 for Qld), the rate of ambulance attendances for suicidal ideation (per 100,000 population):

  • decreased in NSW from 21.0 in September 2018 to 20.6 in September 2021
  • increased in Vic from 17.8 in September 2018 to 25.6 in September 2020, followed by a decline to 15.5 in December in 2021
  • increased in Qld from 30.6 in March 2020 to 34.9 in March 2021, decreasing slightly to 31.6 in September 2021
  • increased in Tas from 11.5 in December 2020 to 20.3 in December 2021
  • increased in the ACT from 12.4 in March 2018 to 25.5 in March 2021.

Attendances for suicide attempts

Comparing the same months across the years, the rate of ambulance attendances for suicide attempts (per 100,000 population):

  • decreased in NSW from 9.9 in September 2018 to 8.4 in September 2021
  • decreased in Vic from 14.9 in December 2019 to 9.6 in December 2021
  • decreased in Qld in from 19.7 in September 2020 to 17.4 in September 2021.

Attendances for self-injury

Comparing the same months across the years, the rate of ambulance attendances for self-injury (per 100,000 population):

  • increased in NSW from 5.4 in September 2018 to 6.9 in September 2021
  • increased in Vic from 4.9 in September 2018 to 6.8 September 2021
  • decreased slightly in Qld from 9.6 in June 2020 to 7.4 in June 2021, increasing to 9.7 in December 2021
  • increased in Tas from 1.9 in June 2019 to 6.7 in June 2021
  • increased in the ACT from 3.8 in June 2018 to 10.4 in June 2021.

Ambulance attendances for self-harm behaviours, selected states and territories, snapshot months, 2018–2021.

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours for quarterly snapshot data collected in Victoria, New South Wales, Tasmania and the Australian Capital Territory in March, June, September and December 2018, 2019, 2020 and 2021 (New South Wales data until September 2021. Note NSW data in not available for June 2021). It also includes quarterly snapshot data for Queensland from March 2020 to September 2021.

sers can choose to view ambulance attendance by self-injury, suicidal ideation and suicide attempt. The crude rate and number of attendances for all suicide behaviours increased over the time period for all selected states and territories, with notable dips in June in 2018 and2019 in New South Wales. Suicidal ideation had the highest number and rate of attendances over the time period. While self-injury had the lowest number and rate of attendances over the time period, it had the largest increase of the suicidal behaviours.

Monthly data for ambulance attendance rates by self-harm behaviour in 2021 shows:

  • a downward trend in NSW for self-injury, suicidal ideation and suicide attempt
  • a decline in Vic for suicidal ideation and suicide attempt
  • a slight decline in Qld for suicidal ideation

Ambulance attendances for self-harm behaviours, selected states and territories, January–December 2021.

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours for monthly snapshot data collected in Victoria, Tasmania and the Australian Capital Territory from January to December 2021It also shows these data for Queensland and New South Wales from January 2021 to September 2021. Data for New South Wales June 2021 is unavailable.

The graph shows ambulance attendance by self-injury, suicidal ideation and suicide attempt. Users can choose to show one jurisdiction at a time. Suicide ideation had the highest number and rate of attendances over the time period, while self-injury had the lowest. There are no discernible trends as of yet.

Patterns by gender over time

Across the snapshot months from March 2018 and December 2021 (March 2018 to September 2021 for NSW, March 2020 to September 2021 for Qld), the ambulance attendance rates for:

  • suicide attempt were higher in females than males in NSW, Vic, and Qld. There was no significant difference between attendances rates for suicide attempt in Tas and the ACT
  • suicide attempt decreased in both males and females for NSW between September 2019 and September 2021 and Vic between December 2019 and December 2021, and increased in the ACT between December 2018 and December 2021for females. There were no significant changes for Qld and Tas
  • self-injury were higher in females than males in Qld. There was no significant difference between females and males in NSW, Vic Tas, and the ACT
  • suicidal ideation across NSW, Vic, Qld and Tas tended to be similar for females and males.

Monthly data from 2021 for ambulance attendance rates for self-harm behaviour by gender shows:

  • a general decline in NSW for suicidal ideation and suicide attempt for females and males
  • a general decline in Vic for suicidal ideation and suicide attempt for females and males
  • no discernible trends in Qld

Ambulance attendances for self-harm behaviours by gender, selected states and territories, January–December 2021

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours by gender (males and female) for monthly data collected in Victoria, Tasmania and the Australian Capital Territory from January, to December 2021 New South Wales and Queensland from January to September 2021. Data for New South Wales June 2021 is unavailable. Users can choose to view ambulance attendances by self-injury, suicidal ideation and suicide attempt. There are no disenable trends as of yet.

Patterns by age and gender over time

There is a distinct variation in ambulance attendances for suicidal and self-harm behaviours between age groups 0–24, 25–44, 45–64 and 65+ years.

Across the snapshot months from March 2018 to September 2021, in NSW, Vic, the ACT and Tas combined, attendance rates for:

  • self-injury were higher in females than males in the 0-24 age group, with marked increases in females since June 2018
  • suicidal ideation were higher in females compared to males in the 0–24 age group, but higher in males in the 25–44 age group for most snapshot months
  • suicide attempt were higher for females than males in the 0–24 age group.

Ambulance attendances for self-harm behaviours by age and gender, selected states and territories, snapshot months, 2018–2021.

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours by age group (0–24, 25–44, 45–64 and 65+ years) for quarterly snapshot data collected in New South Wales, Victoria, Tasmania and the Australian Capital Territory from 2018  March to September 2021 (Note June 2021 data are not available).

Users can choose to view ambulance attendances by self-injury, suicidal ideation and suicide attempt. Attendance rates and numbers for self-harm behaviours were much higher over the time period in females aged 0-24 years, compared to males in the same age group. This gap narrowed as the age group increased. The exception is the 25-44 and the 45-64 year age groups for suicidal ideation, where the attendance rates and numbers are higher for males than females.

Ambulance attendances for deaths by suicide and suicide attempts, by method

Understanding the methods used in a person's death by suicide or suicide attempt can play an important role in its prevention. These data are provided to inform discussion around restriction of access to means as a policy intervention for the prevention of suicide and self-harm.

Please consider your need to read the following information. If this material raises concerns for you or if you need immediate assistance, please contact a crisis support service, available free of charge, 24 hours a day, 7 days a week.

Please consider the Mindframe guidelines if reporting on these statistics.

Across the selected months from March 2018 to December 2020:

  • Most ambulance attendances for suicide attempts were due to alcohol and other drugs
  • The proportion of attendances for suicide attempts by alcohol and other drugs declined (64.0% to 59.9%) while the use of ‘other’ methods increased (41.2% to 43.8%) (note the proportion of attendances for suicide attempts due to other methods is combined due to small numbers)
  • Attendances for suicide attempts due to hanging were stable (3.8% to 4.3%)
  • Most ambulance attendances for death by suicide were due to hanging
  • The proportion of attendances for death by suicide due to hanging decreased (53.8% to 50.5%) while attendances due to ‘other’ methods increased (34.6% to 36.4%)
  • Attendances for death by suicide due to alcohol and other drugs increased from 10.3% to 15.0%.

Ambulance attendances for suicides and suicide attempts by modality, selected states and territories, snapshot months, 2018–2020

The line graph separates the number and crude rate of ambulance attendances into the two groups: suicide attempt and death by suicide. Within these groups, attendance by the three modality (method) categories is shown. The modality categories are ‘alcohol and other drugs’, ‘hanging’ and ‘other’ (includes wound/laceration/penetrating injury, inhalation, firearm, drowning, jumping from height, vehicular impact, poison, burning, asphyxia, other and unknown). This is shown for grouped quarterly snapshot data collected in New South Wales, Victoria, Tasmania and the Australian Capital Territory in March, June, September and December in 2018, 2019 and 2020, and in March and June 2021. For suicide attempts, all modality methods remained relatively stable over the time period, with a small increase in ‘other’, and a small decrease in alcohol and other drugs and hanging. For deaths by suicide, alcohol and other drugs and ‘other’ decreased, while hanging increased. Hanging had the highest proportion of attendance for deaths by suicide over the time period, while the proportion of attendances for alcohol and other drugs was highest for suicide attempts.

References

Klonsky ED, May AM and Saffer BY (2016) ‘Suicide, suicide attempts, and suicidal ideation’, Annual Review of Clinical Psycholology,12:307–330, doi:10.1146/annurev-clinpsy-021815-093204.

Lubman DI, Heilbronn C, Ogeil RP, Killian JJ, Matthews S, Smith K, Bosley E, Carney R, McLaughlin K, Wilson A, Eastham M, Shipp C, Witt K, Lloyd B and Scott D (2020) ‘National ambulance surveillance system: a novel method using coded Australian ambulance clinical records to monitor self-harm and mental health-related morbidity’, PLoS ONE, 15(7):e0236344, doi:org/10.1371/journal.pone.0236344.

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