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

The AIHW holds monthly ambulance attendance data for NSW, Vic, Qld, Tas, ACT and NT, dating from January 2021 to June 2023. Prior to 2021, the data comprises 1-month per quarter snapshots for the months of March, June, September and December for NSW, Vic, Tas, and ACT from March 2018 to December 2020, Qld from March 2020 to December 2020, and NT from March 2018 to December 2018.

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

In the NASS self-harm related ambulance attendances are defined as attendances where self-harm occurred in the preceding 24 hours or during the ambulance attendance. The NASS groups these attendances into 4 categories, which are 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 NASS data; however, self-injury could be simultaneously coded with any other self-harm case category (Lubman et al. 2020).

Instances of suicide, suicide attempt, suicidal ideation and self-injury in the community are 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).

Data considerations

The following factors should be considered when interpreting data and visualisations presented on this page:

  • Industrial action occurred in NSW in April 2022, with a minimal impact on ambulance services and demand. 
  • A small decrease in the number of NSW ambulance attendances was observed in July and August 2022 due to technical issues.
  • Industrial action in NSW during early February 2023, which could have resulted in lower numbers. 
  • A computer-aided dispatch outage in Qld on 10 March 2023 resulted in no cases being recorded for that date. 

How do rates of ambulance attendances for suicidal ideation, suicide attempt and self-injury differ across states and territories?

Comparing ambulance attendance rates across states and territories requires careful interpretation due to varying factors such as the availability of ambulance services, cost coverage differences, and access to 24-hour health centres. Additionally, inconsistencies in paramedic patient records across jurisdictions can affect the data, making it challenging to fully understand the reasons behind the differences in attendance rates. For further information on comparing state and territory data please refer to the Technical Notes.

The visualisation below displays the average monthly rate (per 100,000 population) of ambulance attendances for suicidal ideation, suicide attempt, and self-injury by state or territory for 2021, 2022 and January to June 2023. In the first half of 2023:

  • Qld had the highest average monthly rate of ambulance attendances for suicidal ideation (34), followed by NT (33), NSW (23), Tas (19), ACT (16) and Vic (13). 
  • Qld had the highest average monthly rate of ambulance attendances for suicide attempt (17), followed by Tas (16), NT (14), Vic (11), ACT (10) and NSW (8.3).
  • NT had highest average monthly rate of ambulance attendances for self-injury (17), notably higher than all other states and territories in the NASS, with rates of 10 in Qld, 9.1 in ACT, 8.6 in Tas, 7.6 in NSW and 4.8 in Vic.

Average monthly rate of ambulance attendances for suicidal ideation, suicide attempt and self-injury by state or territory, January 2021 to June 2023

The interactive data visualisation shows the average monthly rate of ambulance attendances for suicidal ideation, suicide attempt and self-injury categorised by state and territory. Year and attendance type can be selected.

Ambulance attendances for suicidal thoughts and behaviours, and self-harm 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 2023 for NSW, Vic, Qld, Tas, ACT, and NT. Data prior to 2021 are based on 1-month per quarter snapshots between March 2018 and December 2020 from NSW, Vic, Tas and ACT, between March 2020 and December 2020 for Qld, and between March 2018 and December 2018 for NT.  

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 the 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. 


The visualisation below shows the monthly crude rates (per 100,000 population) and number of ambulance attendances for suicidal ideation, suicide attempt and self-injury from March 2018 to June 2023.

  • Across the period for NSW, Vic and Qld, the highest rates of ambulance attendances were for suicidal ideation, followed by suicide attempt and then self-injury. 
    • In NSW, attendance rates at each time point were at least twice as high for suicidal ideation (range from 14 to 28) compared with suicide attempt (range from 6.2 to 12).
  • For Tas, ACT and NT while similar to the above states there are differences. For example:
    • For NT the rates of ambulance attendances for suicide attempt (range from 7.7 to 19) are similar to self-injury (range from 8.1 to 21). 

Ambulance attendances for suicidal ideation, suicide attempt and self-injury, March 2018 to June 2023

The interactive time series visualisation shows ambulance attendances for suicidal ideation, suicide attempt and self-injury to show patterns over time. Crude rate or number of attendances, state or territory, and an option to show or hide error bars can be chosen.

How do attendance rates differ by gender over time?

On this webpage, gender is reported as a binary variable with values ‘male’ and ‘female’. In the initial documentation of ambulance attendances, paramedics use a dropdown box to select male or female. While notes can be added to indicate if a patient is trans, transitioning or non-binary, this is likely to be underreported.  

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 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. 

The visualisation below shows the monthly crude rates (per 100,000 population) and number of ambulance attendances for suicidal ideation, suicide attempt, and self-injury by gender from March 2018 to June 2023.

  • For NSW, Vic and Qld, rates of ambulance attendances for suicide attempt and self-injury were higher among females than males across the period (with the exception of self-injury in Vic in December 2020, where there was no difference by gender). For instance, in June 2023, the rates of ambulance attendances (per 100,000 population) for suicide attempt were:
    • around 1.5 times as high in females compared with males in NSW (8.8 and 5.7, respectively)
    • nearly twice as high among females compared with males in Vic (13 and 6.5, respectively)
    • around 1.8 times as high in females compared with males in Qld (18 and 10, respectively).
  • Rates of ambulance attendances for suicidal ideation in NSW, Vic and Qld, however, were similar for males and females across the same period.
  • For Tas, ACT, and NT, due to small numbers and large margins of error, there were few differences observed by gender for rates of attendance for suicidal ideation, suicide attempt or self-injury.

Ambulance attendances for suicidal ideation, suicide attempt, and self-injury by gender, March 2018 to June 2023

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

How do attendance rates differ by age and gender over time?

The visualisation below shows the monthly crude rates (per 100,000 population) and number of ambulance attendances for suicidal ideation, suicide attempt, and self-injury by age and gender from January 2021 to June 2023.

For females, there was a clear gradient in the attendance rates for suicidal ideation, suicide attempt and self-injury by age-group. Across the period, the highest female rates for suicidal ideation, suicide attempt and self-injury were seen in those aged under 25 years. Rates decreased with increasing age-group, except for suicidal ideation, where rates were similar over time for females aged under 25 and 25 to 44 years.

  • For suicidal ideation attendances the highest rates were among females aged under 25 years and those aged 25 to 44 years (ranges from 23 to 39 and 22 to 35 per 100,000 population, respectively), followed by females aged 45 to 54 years (range from 14 to 23). The lowest rates were among females aged 65 years and over (range from 4.4 to 6.8).
  • For suicide attempt attendances, the rates decreased by age with the highest rates among those aged under 25 years (range from 19 to 30), followed by those aged 25 to 44 years (range from 13 to 19), 45 to 64 years (range from 9.0 to 13) and 65 years and older (range from 2.8 to 4.5). 
  • Rates of attendances for self-injury were also highest among those aged under 25 years (range from 14 to 25), followed by 25 to 44 years (range from 6.9 to 12), and those aged 45 years and older (2.9 to 4.8).

 For males, different patterns were observed by age group over the period.

  • For suicidal ideation, the highest male rates were seen in those aged 25 to 44 years, with the rate for this age group in January 2021 (40 per 100,000 population) being the highest among any age-gender group over the period, including females under 25 years (maximum rate 39).
  • For suicide attempt attendances:
    • The highest rates were among males aged 25 to 44 (range from 9.7 to 16 per 100,000 population). 
    • Males aged under 25 and between 45 and 64 years had the same or similar rates over the period (ranges from 6.1 to 11 and 6.4 to 9.9, respectively).
    • Males aged 65 years and over had the lowest rates (range from 2.7 to 4.6).
  • Attendance rates for self-injury were the same or similar among males aged under 25 and 25 to 44 years. Attendance rates for self-injury among males aged 45 years and over were generally lower across the period. 

Ambulance attendances for suicidal ideation, suicide attempt, and self-injury by age and gender, January 2021 to June 2023

The interactive timeseries visualisation shows ambulance attendances for suicidal ideation, suicide attempt and self-injury categorised by age (0 to over 65 for suicidal ideation and suicide attempt attendances and 0 to over 45 for self-injury attendances) and gender (females and males) to show patterns over time. Crude rate or number of attendances can be chosen, with an option to show or hide error bars. Selection for the type of attendance is also available to view.

Age and gender variations

The visualisation below explores ambulance attendances by age groups in greater detail with annual crude rates for 5-year age intervals from 10 to 85 years and over for the most recent full-year data (2022). Full-year data for 2022 for NSW, Vic, Qld, Tas, ACT and NT were combined to produce annual crude rates (per 100,000 population) and numbers of ambulance attendances for suicidal ideation, suicide attempt, and self-injury. Consistent with the findings over time, young females appear to be particularly at risk for suicidal ideation, suicide attempt and self-injury. 

In 2022:

  • Females aged 15 to 19 years had the highest rates of ambulance attendances for suicide attempt among all age and gender groups (700 per 100,000 population). Followed by females aged 20 to 24 years (420). Similar patterns were observed for suicidal ideation and self-injury.
  • Females aged 10 to 29 years exhibited higher rates of ambulance attendances for suicide attempt, compared with males in the same age range. For example, the rate for females aged 15 to 19 (700 per 100,000 population) was more than 3 times that of males in the same age group (214) and the rate for females aged 20 to 24 years (420) was more than twice that of males in the same age group (200). Similar patterns were observed for suicidal ideation and self-injury, although the magnitude of difference between females and males for suicidal ideation was less.

Ambulance attendances for suicidal ideation, suicide attempt, and self-injury by age and gender, 2022

The interactive data visualisation shows the distribution of ambulance attendances for suicidal ideation, suicide attempt and self-injury for 2022. The data are 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 suicide death and suicide attempts, by modality

Monitoring the modality used in a person's suicide attempts or death by suicide 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. 

The visualisation presented below illustrates the proportion of ambulance attendances related to suicide attempts and suicide deaths categorised by modality, spanning from January 2021 to June 2023 in the combined jurisdictions of NSW, Vic, Qld, Tas, ACT, and NT. The modality types include alcohol and other drugs, hanging, and other. The category of 'other' encompasses wound/laceration/penetrating injury, inhalation, firearm, drowning, jumping from height, vehicular impact, poison, burning, asphyxia, as well as instances classified as other or unknown. Differences between modality types are highlighted below:

  • Ambulance attendances for suicide attempts are predominantly associated with alcohol and other drugs, followed by other, then hanging (61%, 42% and 4.6% respectively for June 2023).
  • Ambulance attendances for suicide deaths are most frequently attributed to hanging, followed by other, and then alcohol and other drugs (57%, 31%, and 13% respectively for June 2023).

The proportion of ambulance attendances for suicide attempt exhibits minimal variation over time. In contrast, the proportion for suicide death shows larger fluctuations due to the smaller number of ambulance attendances, leading to month-to-month variations.

Ambulance attendances for suicide attempt and suicide death by modality, January 2021 to June 2023

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

References

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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