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Ambulance attendances: Suicidal ideation, and suicidal and self-harm behaviours

AIHW began receiving monthly ambulance attendance data for New South Wales (NSW), Victoria (Vic), Queensland (Qld), Tasmania (Tas) and the Australian Capital Territory (ACT) from January 2021. Monthly data have been received until December 2022 for Tas, Qld, and Vic, and until September 2022 for NSW and ACT. Prior to this, data included 1-month per quarter snapshots from Vic, Tas, ACT and NSW from March 2018 to December 2020, and Qld from March 2020 to December 2020.

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 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 taking one's own life 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 coded as mutually exclusive in these data; 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 attempts, injuries, or 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.

Note that minor industrial action occurred in NSW on 7th April 2022, with a minimal impact on ambulance services and demand. This should be considered in any interpretation of data presented for April 2022.

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

State and territory variations

It is important to interpret ambulance attendance rates carefully when comparing across states and territories, as there are several factors that can influence differences. For instance, the number of ambulance services available may vary by state and territory. Some states offer free ambulance services to their residents, while others are covered by private health insurance or out-of-pocket costs or are only free to vulnerable populations (Queensland Government 2020; Tasmanian Government Department of Health 2021; NSW Ambulance n.d.; ACT Emergency Services Agency n.d. & Victorian Government Department of Health 2022). Furthermore, paramedics record information that is relevant to patient care, rather than for research purposes. Data collected by paramedics may not be consistent between state and territories (Lubman et al. 2020). Although, Turning Point (the data custodian) obtains a degree of consistency between states and territories through their coding practices. Therefore, factors such as these are unmeasurable in these data and may influence some variation in the rate of attendances across states and territories.  

2021

Throughout 2021, across NSW, Vic, Qld, Tas and the ACT, ambulances attended around 90,100 incidents, or an average around 9,000 incidents each month, that involved suicidal thoughts and behaviours (suicidal ideation or suicide attempt). 

During 2021, the average monthly rates of ambulance attendances (per 100,000 population) for either suicidal ideation or suicide attempt were:

  • 34 in NSW (the lowest monthly rate was 29 and the highest was 40)
  • 31 in Vic (the lowest monthly rate was 26 and the highest 36)
  • 50 in Qld (the lowest monthly rate was 43 and the highest 55)
  • 28 in Tas (the lowest monthly rate was 24 and the highest 34)
  • 38 in the ACT (the lowest monthly rate was 31 and the highest 47)

2022

Ambulance attendance data for Qld, Tas and Vic are available up till December 2022 with data for NSW and ACT available up till September 2022. 

These data show that the average monthly rates of ambulance attendance per 100,000 population for suicidal ideation or suicide attempts combined were:

  • 27 in NSW (the lowest monthly rate was 23 and the highest 32)
  • 25 in Victoria (the lowest monthly rate was 22 and the highest 28)
  • 47 in Qld (the lowest monthly rate was 38 and the highest 54)
  • 36 in Tas (the lowest monthly rate was 31 and the highest 40)
  • 29 in ACT (the lowest monthly rate was 22 and the highest 37)

Generally, for the available states and territories across both 2021 and 2022, average monthly rates of ambulance attendances per 100,000 population is highest for suicidal ideation, followed by suicide attempts, and lowest for self-injury. However, for Tas and the ACT, there are individual months where the rate of suicide attempts is higher than the rate of suicidal ideation. 

The interactive data visualisation shows the average monthly rate of ambulance attendances (averaged across 12 months of a calendar year) for suicidal ideation and self-harm behaviours (self-injury and suicide attempt). These categories are subdivided by state and territory. Selection for years where monthly ambulance attendance data are also available (from 2021 onwards).  

Gender variations

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

While more males die by suicide compared to females in Australia, females tend to self-harm or attempt at higher rates than males. Overall, across the 5 available states and territories in 2021, the rate of ambulance attendance with self-injury and for suicide attempts is higher for females compared to males. Attendance rates for suicidal ideation are higher in females than males in ACT, Qld and Vic. However, in NSW and Tas, attendances for suicidal ideation for males and females are similar (this can be more clearly observed when viewing the visualisation with the error bars shown).

The interactive data visualisation shows ambulance attendances for suicidal ideation and self-harm behaviours (self-injury and suicide attempt) for 2021. These categories are subdivided by sex (male and female) to show gender variations. Crude rate (per 100,000) or number of attendances can be selected, with an option to show or hide error bars. Selection for different state or territories (ACT, NSW, QLD, TAS, Vic) are also available for viewing.

Overall, the largest difference in ambulance attendance rates for males and females are for suicide attempts. During 2021, the annual ambulance attendance rates for suicide attempts per 100,000 population for females were:

  • 133 compared to 78 for males, in NSW
  • 194 compared to 97 for males, in Vic
  • 267 compared to 156 for males, in Qld
  • 195 compared to 107 for males, in Tas
  • 234 compared to 111 for males, in the ACT.

Age and gender variations

The interactive data visualisation below illustrates the distribution of self-harm related ambulance attendances separately for males and females by 5-year age groups. For this visualisation, ambulance attendance data for 2021 in NSW, Vic, Qld, 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 increasing age.

During 2021:

  • the number of attendances for self-injury were highest for the 15–19 years age group for both males and females (around 1,300 and 3,900 attendances and crude rates of 204 and 671 per 100,000 population, respectively), however attendances for females aged 15–19 years was approximately 3 times the number of attendances for males of the same age
  • attendances for suicidal ideation were highest for females in the 15–19 age group (with around 5,900 attendances and a crude rate of 1,010 per 100,000 population)
  • attendance for suicidal ideation were highest for males in the 15–19 age group and 20-24 age group, with almost equally high numbers of attendances (around 3,300 attendances each and crude rates 537 and 488 per 100,000 population, respectively)
  • attendances for suicide attempts were highest in the 15–19 years age group for females (around 4,800 attendances and a crude rate of 815 per 100,000 population) and in the 20–24 years age group for males (around 1,600 attendances and a crude rate of 229 per 100,000 population); the number of attendances for females aged 15–19 years was approximately three times the number for males of the same age. ­

The interactive data visualisation shows the distribution of ambulance attendances for suicidal ideation and self-harm behaviours (self-injury and suicide attempt) for 2021. The data is divided according to age (5-year age groups) and gender (male and female) to highlight variations. Crude rate (per 100,000) or number of attendances and attendance type can be selected, with an option to show or hide error bars. 

Ambulance attendances for suicidal ideation, and suicidal and self-harm behaviours over time

Trends in suicidal and self-harm behaviours are a matter of public and policy interest. However, interpretation of trends and changes in rates is complicated by large variations due, in part, to small numbers which produce large confidence intervals. 

The following time series visualisations contain monthly data from January 2021 until December 2022 for Vic, Qld and Tas and until September 2022 for NSW and ACT. Data prior to 2021 are based on 1-month per quarter snapshots between March 2018 and December 2020 from NSW, Vic, Tas and the ACT, and between March 2020 and December 2020 for Qld. 

Caution is advised when making month to month comparisons, particularly for the 1-month per quarter snapshot data (pre-2021 data). It is advised to compare the same months over a few 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. This means that we are 95% confident that the true number falls within the interval range. 

Over the time series in the selected state and territories (see above box for details), the general trend for the crude rate of ambulance attendances: 

  • increased in NSW for suicidal ideation and suicide attempts from March 2018 to Jan 2021, before decreasing over 2021 and until June 2022. Rates increased, particularly for suicidal ideation, from July to September 2022. However, the rates in September 2022 were similar to the rates in September 2018. Self-injury attendances in NSW followed similar trends to suicide attempt across the time series but with less variation in rates.
  • decreased overall in Vic for suicidal ideation from December 2020 until December 2022.
  • decreased for suicide attempts in Vic from December 2020 to April 2022, before increasing to just below December 2020 rates. Self-injury attendance rates slightly increased over the time series until August 2021 before steadily declining back to March 2018 levels.
  • showed no clear direction in Qld for suicidal ideation and suicide attempt, with rates remaining similar across the time series. Rates of suicidal ideation increased between July and November 2022 before decreasing again in December 2022 to a similar rate to December 2020 and 2021. 
  • increased, in Tas for self-injury, suicidal ideation and suicide attempts from September 2021 until September 2022, noting that rates vary greatly between months due to smaller numbers.
  • decreased overall in the ACT for self-injury and suicidal ideation. Suicide attempts slightly increased overall, noting that rates vary greatly between months due to smaller numbers.

The interactive timeseries visualisation shows ambulance attendances for suicidal ideation and self-harm behaviours. Crude rate or frequency can be chosen, including which state or territory. Quarterly (2018-2020) and monthly data (2021 onwards) is provided, with an option to show error bars. The categories included are self-injury, suicidal ideation, and suicide attempt.

Patterns by gender over time

Over the time series in the selected state and territories, the general pattern for the rate of ambulance attendances for: 

  • self-injury tended to be higher for females compared to males, across NSW, Vic, Qld and ACT 
  • suicidal ideation were similar for females and males across NSW, Vic, Qld, Tas and ACT
  • suicide attempts were higher in females than males in NSW, Vic, and Qld.

From around March to April 2022 in Tas and ACT, suicide attempts attendance rates were distinctly higher in females than males. Prior to this period, no clear difference in attendance rates were observed (which can be more clearly seen when viewing the visualisation with the error bars shown).

The interactive timeseries visualisation shows ambulance attendances for suicidal ideation and self-harm behaviours categorised by gender (females and males) to show patterns over time. Crude rate or frequency can be chosen, with an option to show or hide error bars. Selection for different state or territories and type of suicide behaviour are also available to view.

Patterns by age and gender over time

There is a distinct variation in ambulance attendances for suicidal and self-harm behaviours between age groups. From June 2018 to September 2022, in NSW, Vic, Tas and ACT combined, attendance rates for: 

  • female self-injury, suicidal ideation, and suicide attempts generally decreased as age increased 
  • male suicide attempts were highest for the 25–44 years age group 
  • female self-injury in those aged under 25 years increased between March 2018 and August 2021, followed by an overall decline from November 2021 to September 2022
  • female suicide attempts attendances in those aged under 25 years increased between March 2018 and March 2021 before steadily declining until September 2022
  • male suicidal ideation decreased from January 2021 onwards for all age groups, particularly those under 65 years of age.  
  • self-injury were higher in females aged under 24 years compared to males of the same age
  • self-injury for those aged 45 years and older were similar across females and males 
  • suicidal ideation were higher for females compared to males for those aged under 24 years, but generally higher in males compared to females for the 25–44 years age group
  • suicide attempts were higher for females compared to males for the under 24 years age group.

Qld data were received from March 2020 onwards. Therefore, to retain the fullest timeseries possible (June 2018–September 2022), Qld data have been excluded from this analysis of patterns by age and gender over time.

The interactive timeseries visualisation shows ambulance attendances for suicidal ideation and self-harm behaviours categorised by age (0 to over 65) and gender (females and males) to show patterns over time. Crude rate or frequency can be chosen, with an option to show or hide error bars. Selection for different state or territories (NSW, Vic, TAS and ACT) and type of suicide behaviour are also available to view.

Ambulance attendances for suicide death and suicide attempts, by modality

Monitoring the modality used in a person's death by suicide or suicide attempts can play an important role in prevention of similar events in the future. These data are provided to inform discussion around restriction of access to means of self-injury 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. 

For each month between January 2021 and September 2022 in NSW, Vic, Qld, Tas and ACT combined, the percentage of ambulance attendances for:

  • suicide attempts were highest for attempts by alcohol and other drug (AOD) and lowest for hanging presentations  
  • suicide deaths were highest for deaths by hanging and lowest for deaths by AOD
  • suicide attempts by AOD, hanging, and other modalities showed no particular variation over time
  • suicide death by hanging, AOD, and other modalities show some month-to-month fluctuations due to small numbers, but no clear change in trend.

The timeseries visualisation shows the proportion of ambulance attendances for suicide attempt and suicide death from 2021, categorised by modality (AOD, hanging and other).

References

Queensland Government (2020) Interstate Ambulance Treatment and Transport Information for Queensland Residents, Queensland Government website, accessed 25 May 2023.

Tasmanian Government Department of Health (2021) Ambulance costs, Tasmanian Government Department of Health website, accessed 25 May 2023.

NSW Ambulance (n.d.) Accounts & Fees, NSW Ambulance website, accessed 25 May 2023.

ACT Emergency Services Agency (n.d.) Fees and charges, ACT Emergency Services Agency website, accessed 25 May 2023.

Victorian Government Department of Health (2022) Ambulance fees Victorian Government Department of Health website, accessed 25 May 2023.

Lubman DI, Heilbronn C, Ogeil RP, Killian JJ, Matthews S, Smith K, Bosley E, Carney RMcLaughlin 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:e0236344, doi:org/10.1371/journal.pone.0236344.

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