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 March 2018 to March 2021, and Queensland (Qld) from March 2020 to March 2021. AIHW began receiving monthly snapshot 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 behaviours (suicidal ideation or suicide attempt) in 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 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)

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

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.

In general:

  • rates of ambulance attendances for suicide attempt and self-injury were higher for females than males
  • in Qld and 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, 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.

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 for females involving a suicide attempt 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 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, 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:

  • 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, 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 March 2021, currently reported from NSW, Vic, Tas, and the ACT, and between March 2020 and March 2021 for Qld. These data are thus not representative of total attendances in a quarter, year or total attendances in Australia.

AIHW began receiving monthly snapshot data for NSW, Vic, Qld, Tas and the ACT from January 2021. The latest monthly data is for March 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 March 2021 (March 2020 to March 2021 for Qld), the rate of ambulance attendances for suicidal ideation:

  • increased in NSW from 17.3 per 100,000 to 27.0

  • increased in Vic from 18.4 to 19.7

  • increased in Qld from 30.6 to 35.2

  • increased in the ACT from 12.4 per 100,000 to 25.5

  • 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 increases evident from both 2019 to 2020 and from 2020 to 2021
  • rose in Vic from 2018 to 2019 then fell from 2019 to 2020 and showed little change from 2020 to 2021
  • remained stable in Qld from March 2020 to March 2021
  • 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 and from 2020 to 2021. From March 2018 to March 2021 the rate rose from 4.3 per 100,000 to 8.3 per 100,000

  • decreased from 2018 to 2019 in Vic but rose from 2019 to 2020 and from 2020 to 2021. The rate rose from 4.5 per 100,000 in March 2019 to 6.4 per 100,000 in March 2021

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

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 March 2021. It also includes quarterly snapshot data for Queensland in March, June, September and December 2020 and March 2021. 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.

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

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours for monthly snapshot data collected in Victoria, New South Wales, Queensland, Tasmania and the Australian Capital Territory in January, February and March 2021. Users can choose to view ambulance attendance by self-injury, suicidal ideation and suicide attempt. Suicidal ideation had the highest number and rate of attendances over the time period, while self-injury had the lowest. As data are for only 3 months, there are no disenable trends as of yet.

Patterns by gender over time

Across the snapshot months from March 2018 to March 2021:

  • the rate of ambulance attendances for self-injury and suicide attempts were higher in females than males in NSW, Vic, Qld and the ACT
  • attendances for suicidal ideation across the 5 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 pattern 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 and 2021
  • both males and females had similar rates for suicidal ideation in Qld, although the rate increase more in females (from 29.7 per 100,000 population to 35.8) than males (from 31.4 to 33.6) between March 2020 and March 2021.

Ambulance attendances for self-harm behaviours by 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 gender (males and female) 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, and March 2021.  It also includes quarterly snapshot data for Queensland in March, June, September and December 2020 and March 2021. 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 slightly decreased over the time period.  

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

The line graph shows the crude rate and number of ambulance attendances for self-harm behaviours by gender (males and female) for monthly snapshot data collected in Victoria, New South Wales, Queensland, Tasmania and the Australian Capital Territory in January, February and March 2021. Users can choose to view ambulance attendances by self-injury, suicidal ideation and suicide attempt. As data are for only 3 months, 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 and March 2021, in NSW, Vic, the ACT and Tas:

  • attendance rates for suicidal ideation were higher in females compared to males in the 0–24 age group, but higher in males in the 25–44, 45–64 and 65+ age groups
  • attendance rates for self-injury were higher for females than males in the 0–24 age group
  • attendance rates for suicide attempts were higher for females than males aged 0–24 and 25–44.

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 Victoria, New South Wales, Tasmania and the Australian Capital Territory in March and June, and September and December over 2018, 2019 and 2020, and March 2021. 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 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 snapshot months from March 2018 to December 2020:

  • most ambulance attendances for suicide attempts involved 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.