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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 June 2022 for ACT, Qld, and Vic, and until March 2022 for Tas and NSW. Prior to this, data included 1-month per quarter snapshots from Victoria (Vic), Tasmania (Tas), the 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 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 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.

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

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

2021

Throughout 2021, across NSW, Vic, Qld, Tas and the ACT, ambulances attended around 92,000, or an average around 7,700 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 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)

Generally, for all 5 jurisdictions across 2021, 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.

Across jurisdictions in 2021, the highest rate of ambulance attendances for suicidal ideation occurred in Qld while the lowest rate occurred in Tas. There were fewer clear differences, between the jurisdictions, for rates of self-injury and suicide attempts attendances during 2021.

During 2021, the average monthly rates (per 100,000 population) of ambulance attendances with self-injury present were:

  • 7.7 in NSW (range 6.4 to 9.3)
  • 6.5 in Vic (range 5.5 to 7.6)
  • 9.6 in Qld (range 7.4 to 11)
  • 5.9 in Tas (range 2.8 to 7.7)
  • 9.6 in the ACT (range 7.9 to 11)

During 2021, the average monthly rates (per 100,000 population) of ambulance attendances for suicide attempts were:

  • 9.7 in NSW (range 8.4 to 12)
  • 12 in Vic (range 9.8 to 14)
  • 18 in Qld (range 15 to 20)
  • 13 in Tas (range 9.5 to 17)
  • 15 in the ACT (range 12 to 20).

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

  • 24 in NSW (range 21 to 28)
  • 19 in Vic (range 16 to 23)
  • 32 in Qld (range 28 to 35)
  • 15 in Tas (range 13 to 19)
  • 23 in the ACT (range 19 to 27).

2022

Data from January until June 2022 is currently available for ACT, Qld, and Vic only.

From January until June 2022, the average monthly rates (per 100,000 population) of ambulance attendances with self-injury present were:

  • 5.9 in Vic (range 5.1 to 6.7)
  • 8.5 in Qld (range 6.7 to 9.9)
  • 6.9 in ACT (range 3.1 to 9.9).

From January until June 2022, the average monthly rates (per 100,000 population) of ambulance attendances for suicide attempts were:

  • 10 in Vic (range 9.0 to 11)
  • 17 in Qld (range 14 to 19)
  • 12 in ACT (range 10 to 14).

From January until June 2022, the average monthly rates (per 100,000 population) of ambulance attendances for suicidal ideation were:

  • 15 in Vic (range 13 to 17)
  • 28 in Qld (range 24 to 31)
  • 16 in ACT (range 9.9 to 23).

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 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 all 5 jurisdictions 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
  • 266 compared to 156 for males, in Qld
  • 195 compared to 107 for males, in Tas
  • 234 compared to 110 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 (1,300 and 3,900 attendances 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 5,900 attendances)
  • 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 (3,300 attendances respectively)
  • attendances for suicide attempts were highest in the 15–19 years age group for females (4,800 attendances) and in the 20–24 years age group for males (1,600 attendances); 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 June 2022 for ACT, Vic, Qld, and until March 2022 for Tas and NSW. Data prior to 2021 are based on 1-month per quarter snapshots between March 2018 and December 2020 from Vic, Tas, the ACT, and NSW, 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.

From March 2018 until June 2022 (March 2018 until March 2022 for Tas and NSW, March 2020 until June 2022 for Qld), the rate of ambulance attendances:

  • decreased, overall, in Vic for suicidal ideation from December 2020 until June 2022
  • generally increased, in Tas for self-injury and suicidal ideation from May 2021 until February 2022, followed by a decline in attendances for suicidal ideation in March 2022 while attendances for self-injuries continued to increase
  • decreased, overall, in the ACT for self-injury and suicidal ideation.

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

From March 2018–June 2022 (March 2018–April 2022 for Tas and NSW, March 2020–June 2022 for Qld), the rate of ambulance attendances for:

  • self-injury tended to be higher for females compared to males, across the ACT, NSW, Qld, and Vic
  • suicidal ideation were similar for females and males across NSW, VIC, Qld and Tas
  • suicidal ideation in Qld generally decreased from September 2020–June 2022 for both females and males.
  • suicide attempts were higher in females than males in NSW, Vic, and Qld. No clear differences in attendances rates were observed for suicide attempt in Tas and the ACT, (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–March 2022, in NSW, Vic, the ACT and Tas combined, attendance rates for:

  • female self-injury, suicidal ideation, and suicide attempts generally decreased as age increased 
  • male suicide attempts was highest for the 25–44 years age group 
  • female self-injury, in those aged 24 years and under, increased between March 2018 and August 2021, followed by an overall decline from November 2021 to March 2022
  • female suicide attempts attendances in those aged under 25 years increased between March 2018 and March 2021 before steadily declining until March 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 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 time series possible (June 2018–March 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 until March 2022 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

Klonsky ED, May AM and Saffer BY (2016) ‘Suicide, suicide attempts, and suicidal ideation’, Annual Review of Clinical Psychology,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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