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Ambulance attendances: suicidal and self-harm behaviours

The ambulance attendance data includes 1-month per quarter snapshots from New South Wales (NSW), Victoria (Vic), Tasmania (Tas) and the Australian Capital Territory (ACT) from 2018 to 2020.

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

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

In 2020:

Ambulances attended a total of around 22,400 incidents involving suicidal behaviours (suicidal ideation or suicide attempt) in the NSW, Vic, Tas and the ACT during the months of March, June, September and December;

  • 53% of which occurred in NSW in line with the population distribution between those jurisdictions.

Taking into consideration the population differences of the 4 jurisdictions, the rate of ambulance attendances for suicidal ideation (thinking about killing oneself without acting on the thoughts (Klonsky et al. 2016)) ranged from:

  • 103.3 per 100,000 population in NSW (over 8,400 attendances) to 52.0 in Tas (about 280 attendances) with the ACT reporting a rate of 93.2 (about 400 attendances) and Vic reporting a rate of 90.9 (nearly 6,100 attendances) (Supplementary table National Ambulance Surveillance System—self-harm behaviours AMB S1).

Attendance rates for suicide attempts (non-fatal intentional injury with suicidal intent, regardless of likelihood of lethality (Klonsky et al. 2016)) by comparison, were lower than ideation in all 4 jurisdictions. Rates of attendances for suicide attempts ranged from:

  • 60.5 per 100,000 population in the ACT (about 260 attendances) down to 41.3 in NSW (nearly 3,400 attendances), with Vic reporting a rate of 50.2 (nearly 3,400 attendances) and Tas reporting a rate of 46.1 (about 250 attendances).

As ambulances do not attend all deaths, fatal suicide (fatal intentional injury with suicidal intent) is under-represented in these data (Klonsky et al. 2016). Rates of death by suicide have not been calculated because of small numbers, which may affect the reliability of the estimates (see Technical notes for details).

Self-injury (non-fatal intentional injury without suicidal intent) 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 (see Technical notes for definitions).

In 2020:

  • ambulances in NSW, Vic, Tas and the ACT attended a total of nearly 4,400 incidents involving self-injury during the months of March, June, September and, December; 56% of which occurred in NSW.

In 2020, the rate of ambulance attendances with self-injury present ranged from:

  • 36.4 per 100,000 population in the ACT (over 150 attendances) down to 17.0 in Tas (about 90 attendances), with NSW reporting a rate of 29.8 (over 2,400 attendances) and Vic reporting a rate of 25.3 (nearly 1,700 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 (see Technical notes on evidence) and therefore can provide information on the extent of these behaviours in the community.

In general:

  • 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 and Tas are 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 four 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, 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, 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 was for suicidal ideation in Australian Capital Territory, New South Wales for males.

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 for females involving a suicide attempt were:

  • 77.4 per 100,000 population in the ACT, 63.5 in Vic, 59.7 in Tas and 48.1 in NSW.

By contrast, the corresponding rates in males were:

  • 41.3 per 100,000 population, 36.0, 30.7 and 33.9 respectively.

Age and gender variation

The interactive data visualisation 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, Tas and the ACT have been combined.

In general, 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 increased age of the age groups. 

In 2020:

  • self-injury and suicidal ideation attendances were highest in the 15–19 age group for both males (around 330 and 970 attendances) and females (around 770 and 1,400 attendances)

  • attendances for suicide attempts were highest in the 20–24 age group for males (around 400 attendances) and the 15–19 age group for females (around 960).

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, 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 overall 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. Caution is advised when making month to month comparisons.

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

Attendances for suicidal ideation

Across the snapshot months between March 2018 and December 2020, the rate of ambulance attendances for suicidal ideation:

  • increased in NSW from 17.3 per 100,000 to 26.4, Vic from 18.4 to 22.9 and the ACT from 12.4 per 100,000 to 23.0
  • remained generally stable in Tas, peaking in September 2019 (16.8 per 100,000).

Attendances for suicide attempts

Comparing the same months across the years, the rate of ambulance attendances for suicide attempts:

  • rose in NSW from 2018 to 2019, with a smaller increase evident from 2019 to 2020
  • rose in Vic from 2018 to 2019 but fell from 2019 to 2020

  • fluctuated throughout the entire period in Tas and the ACT with no discernible trend due to large confidence internals. 

Attendances for self-injury

Comparing the same months across the years, the rate of ambulance attendances for self-injury:

  • increased in NSW from both 2018 to 2019 and 2019 to 2020, for example from June 2018 to June 2020 the rate rose from 3.8 per 100,000 to 7.4 per 100,000

  • decreased from 2018 to 2019 in Vic but rose from 2019 to 2020, for example the rate rose from 4.7 per 100,000 in December 2019 to 6.5 per 100,000 in December 2020

  • fluctuated in Tas and the ACT with no discernible trend. 

Ambulance attendances for self-harm behaviours, selected states and territories, snapshot months, 2018–2020.

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 and 2020. Users 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, with notable dips in June 2018 and June 2019. Suicide 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.

Patterns by gender over time

Across the snapshot months from March 2018 to December 2020:

  • the rate of ambulance attendances for self-injury and suicide attempts were higher in females than males in the ACT, NSW and Vic

  • attendances for suicidal ideation across the 4 jurisdictions were similar for females and males

  • similar trends in attendance rates across both males and females were reported for all self-harm behaviours in NSW and Vic

  • attendance rates for suicide attempts in Tas and the ACT for both males and females fluctuated over the period with no discernible patern due to large confidence intervals
  • attendance rates for suicidal ideation in the ACT increased for females in 2019 compared with 2018, and remained stable in 2020.

Ambulance attendances for self-harm behaviours by gender, selected states and territories, snapshot months, 2018–2020.

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours by gender (males and female) for quarterly snapshot data collected in Victoria, New South Wales, and the Australian Capital Territory in March, June, September and December 2018, 2019 and 2020. For Tasmania, attendances are grouped to ‘persons’ due to small numbers. Users can choose to view ambulance attendances by self-injury, suicidal ideation and suicide attempt. Across all jurisdictions, the number and rate of attendances for self-harm behaviours fluctuated between snapshot months. Most self-harm behaviours increased across the jurisdictions in the time period for both genders. There were some exceptions however. Suicidal ideation attendances for females and suicide attempts for males in Tasmania decreased over the time period. Suicide attempts attendances in both males and females in Victoria also decreased. In ACT, the crude attendance rate for suicide attempts in females decreased. 

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, 25-49 and 50+ years. Note that due to small attendance numbers, data for the ACT and Tas have been combined.

Across the snapshot months from March and June 2018 to September and December 2020:

  • attendance rates for suicidal ideation in NSW and Vic were higher in females compared to males in the 0-24 age group, but higher in males in the 25-49 and 50+ age groups
  • attendance rates for self-injury in NSW and Vic were higher for females than males in the 0-24 age group
  • attendance rates for suicide attempts in all 4 selected jurisdictions were higher for females than males aged 0-24
  • in the 25-49 age group, attendance rates for suicide attempts were higher for females than males in Vic, Tas and the ACT.

Ambulance attendances for self-harm behaviours by age and gender, selected states and territories, snapshot months, 2018–2020.

The line graph is split into the three age groups 0-24, 25-49 and 50+ year age groups. It shows the crude rate and number of ambulance attendances for self-harm behaviours by gender (males and female) for grouped quarterly snapshot data collected in Victoria, New South Wales, Tasmania and the Australian Capital Territory in March and June, and September and December over 2018, 2019 and 2020. 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 25-49 year age group 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 was 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 Victoria, New South Wales, Tasmania and the Australian Capital Territory in March and June, and September and December over 2018, 2019 and 2020.  For suicide attempts, all modality methods remained relatively stable over the time period, with a small increase in hanging and ‘other’, and a small decrease in alcohol and other drugs. For deaths by suicide, alcohol and other drugs and ‘other’ increased, while hanging decreased. Hanging had the highest attendance rates and numbers for deaths by suicide over the time period, while attendances for alcohol and other drugs were highest for suicide attempts.

References

Lubman DI, Heilbronn C, Ogeil RP, Killian JJ, Matthews S, Smith K, et al. 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.

Klonsky ED, May AM, Saffer BY 2016. Suicide, Suicide Attempts, and Suicidal Ideation. Ann Rev Clin Psychol. 12:307–30.

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