Media release: 16 February 2023

An improved system for reporting on cases of self-harm and suicide-related behaviours in NSW hospital emergency departments (EDs) has more than doubled the estimated annual number of cases identified, according to research published today.

Published online early in Public Health Research & Practice, a peer-reviewed journal of the Sax Institute, the paper found that the standard diagnostic codes used in many Australian EDs to record cases of self-harm and suicidal thoughts greatly underestimated the number of cases.

Lead author Associate Professor Grant Sara, a director in the System Information and Analytics Branch at NSW Ministry of Health and Clinical Associate Professor in Psychiatry at the University of Sydney, said the findings are an important step forward in supporting suicide prevention in Australia.

“Emergency departments are often the first point of health care for people with self-harm and suicidal thoughts. We need accurate data so that we can understand trends, plan services, and improve the care that people receive. However, ED data systems are complex. In many health systems around the world, routinely collected data underestimate this important issue,” Associate Professor Sara said.

“Self-harm is one of the strongest risk factors for suicide. Our enhanced method for detecting self-harm in ED data allows us to monitor this more accurately and provide important information to support efforts to reduce the toll of suicide in Australia.”

The researchers examined all NSW ED presentations from 2005 to 2020. They expanded the number of diagnosis codes used to identify self-harm and suicide related behaviours, including additional codes for poisoning with medications such as paracetamol, where many poisonings in adults are likely to be due to self-harm. They also searched “presenting problem” text fields entered by clinical staff in the ED, using keyword searches to identify words and phrases indicating self-harm or suicidal thoughts.

The enhanced method more than doubled the number of self-harm related ED presentations detected across the state. For the five years to 2020, it detected an estimated 51,822 suicide and self-harm-related presentations per year, compared with 21,797 using the standard method.

The new figures were validated against hospital diagnoses for presentations that resulted in hospital admission, as well as ambulance data and recent ED self-harm estimates from the US, Northern Ireland and Victoria.

The authors are continuing to work to improve methods for monitoring this issue. With the current data, it isn’t possible to distinguish the reason or intent behind each episode of self-harm. However, regardless of an individual’s intent, all people presenting to EDs following self-harm need careful assessment and suitable follow-up.

The authors note that the consistent underestimation of self-harm presentations in Australian ED data has previously prevented routine reporting on this issue, requiring reliance on important but incomplete measures such as hospital admissions to monitor trends in self-harm.

The new method has been adopted across NSW public hospitals and in regular reporting of NSW emergency department self-harm data over the past two years. NSW continues to share methods with other States and Territories to work towards building consistent national data.

The study authors note that self-harm presentations to EDs have grown steadily over the last decade and may have accelerated during the COVID-19 pandemic, particularly in teens.

Please acknowledge Public Health Research & Practice as the source for any stories.

The link to the paper on self-harm presentations in emergency departments is: https://doi. org/10.17061/phrp33012303. This link can be included in news stories

Hugo Wilcken, Media Manager, Sax Institute
M: 0451 122 146   
E: hugo.wilcken@saxinstitute.org.au

Megan Howe, Editor, PHRP
M: 0404 466 526
E: megan.howe@saxinstitute.org.au