Self-harm refers to deliberately hurting or injuring yourself without trying to end your life. Suicidal
behaviours refer to suicidal ideation (serious thoughts about taking one’s own life), making suicide
plans and suicide attempts where the self-injury is intended to end in death.
This chapter describes results obtained from the adolescent self-report questionnaire about the
prevalence of self-harm and suicidal behaviours and the association between these behaviours and
mental disorders. These questions were only asked of young people aged 12 years and over.
11.1 Self-harm
Around one in ten adolescents (10.9%) reported having ever self-harmed. This is equivalent to 186,000
young people aged 12-17 years who had deliberately injured themselves. About three quarters of
these adolescents (amounting to 8.0% of the full population or an estimated 137,000 young people)
harmed themselves in the previous 12 months (Table 11-1). In addition, 7.5% of 12-17 year-olds
answered “prefer not to say” to the first question on self-harm and were not asked subsequent
questions. As such the proportion of young people who have ever self-harmed may be higher than
indicated in these estimates.
Self-harm was more common among females than among males and more common in older
adolescents, with 16.8% of females aged 16-17 years having self-harmed in the previous 12 months
and 22.8% having ever self-harmed. The prevalence among 12-15 year-old females was lower, but still
higher than for males, with 9.8% of females aged 12-15 years having self-harmed in the previous 12
months and 11.1% having ever self-harmed. In comparison 9.1% of males aged 16-17 years and 5.7%
of males aged 12-15 years had ever self-harmed with 6.2% of 16-17 year-old males and 3.0% of 12-15
year-old males having self-harmed in the previous 12 months.
Over half of females who had ever self-harmed had self-harmed four or more times (amounting to
6.0% of females aged 12-15 years and 14.9% of females aged 16-17 years). The proportion of males
who had self-harmed four or more times were much lower (1.9% of males aged 12-15 years and 4.5%
of males aged 16-17 years). One in ten of the young people aged 12-17 years who had self-harmed in
the previous 12 months or 0.8% overall had received medical treatment as a direct result of injuries
incurred by an act of deliberate self-harm.
Of those adolescents that had self-harmed in the previous 12 months, 61.6% had self-harmed more
than four times at any time in the past.
Rates of self-harm by selected socio-demographic characteristics (family type, household income,
carer education, carer labour force status and area of residence) are shown in supplementary tables
S-52 through S-56. In young people who did not have major depressive disorder based on adolescent
self-report, self-harm rates were higher in young people from step families compared with original
families. Of young people without major depressive disorder, 14.7% had ever self-harmed and 7.8%
had self-harmed 4 or more times from step families compared with 6.4% and 2.5% respectively from
104 The Mental Health of Children and Adolescents
original families. There were no significant differences in self-harm rates by other socio-demographic
characteristics.
Table 11-1: Self-harm among 12-17 year-olds by sex and age group
Sex Age group Self-harm ever (%)
Self-harm 4 or
more times (%)
Self-harm in
previous 12
months (%)
Received medical
treatment for selfharm
in previous
12 months (%)
Males 12-15 years 5.7 1.9 3.0 np
16-17 years 9.1 4.5 6.2 np
12-17 years 6.8 2.8 4.0 np
Females 12-15 years 11.1 6.0 9.8 1.1
16-17 years 22.8 14.9 16.8 1.8
12-17 years 15.3 9.2 12.3 1.3
Persons 12-15 years 8.2 3.8 6.2 0.7
16-17 years 16.1 9.8 11.6 1.1
12-17 years 10.9 5.9 8.0 0.8
np Not available for publication because of small cell size, but included in totals where applicable.
11.1.1 Self-harm and mental disorder
The highest rate of self-harm was in adolescents with major depressive disorder. This was particularly
so for females with major depressive disorder, approximately half of whom had self-harmed (54.9%
and 49.2% of those with major depressive disorder based on adolescent and parent reports
respectively). While young people with other mental disorders had rates of self-harm more than twice
as high as those with no disorder, the rates for these young people were markedly lower than for
young people with major depressive disorder (32.5% for all 12-17 year-olds with major depressive
disorder, 10.6% for those with other disorders and 4.2% for those with no disorder based on parent
reports) (Table 11-2).
Receiving medical treatment as the direct result of injuries incurred in an act of deliberate self-harm
was also markedly higher for young people with major depressive disorder compared to those with no
disorder (6.6% when based on self-report or 9.9% when based on parent report compared with 0.8%
for all persons).
One in twelve (8.5%) females who had major depressive disorder based on their self-reports received
medical treatment in the previous 12 months. However, the rate for females with major depressive
disorder was double this (16.9%) when their disorder status was based on parent or carer reports.
The Mental Health of Children and Adolescents 105
Table 11-2: Self-harm and self-harm requiring medical treatment among 12-17 year-olds by sex and
mental health status
Sex Mental health status
Self-harm in
previous 12 months
(%)
Received medical
treatment for
self-harm in
previous 12 months
(%)
Males Major depressive disorder based on adolescent report 25.8 np
Major depressive disorder based on parent or carer
report 9.1 np
Other disorder based on parent or carer report 6.2 np
No disorder 2.7 np
All males 4.0 np
Females Major depressive disorder based on adolescent report 54.9 8.5
Major depressive disorder based on parent or carer
report 49.2 16.9
Other disorder based on parent or carer report 17.8 np
No disorder 5.9 np
All females 12.3 1.3
Persons Major depressive disorder based on adolescent report 46.6 6.6
Major depressive disorder based on parent or carer
report 32.5 9.9
Other disorder based on parent or carer report 10.6 np
No disorder 4.2 np
All persons 8.0 0.8
np Not available for publication because of small cell size, but included in totals where applicable.
11.1.2 Self-harm and service use
More than half (57.6%) of adolescents who had self harmed more than four times at any time in the
past had used services for emotional or behavioural problems in the previous 12 months (Table 11-3).
Most commonly these adolescents had used a health service (53.5%) or school service (48.8%) while
fewer had used telephone counselling (15.4%) or online personal support or counselling services such
as those provided by headspace, Reachout, and Youth beyondblue (7.4%).
Rates of service use among 13-17 year-olds who had self-harmed in the previous 12 months were
similar to rates of service use among those who had ever self-harmed more than four times. Service
use among those who had self-harmed in the previous 12 months was higher among females than
males (60.9% compared with 40.1%).
It is not possible to say from the survey whether the services were used before or after the time that
the person had harmed themselves.
106 The Mental Health of Children and Adolescents
Table 11-3: Service use in past 12 months among 13-17 year-olds who had self-harmed by type of
service
Type of service
Self-harm in the
previous 12 months (%)
Self-harm more than 4
times (%)
Health service 49.1 53.5
School service 45.0 48.8
Telephone counselling 15.7 15.4
Online personal support or counselling 7.7 7.4
Any service (a) 55.6 57.6
The proportion using school services is based on those who were attending school at the time of the survey.
(a) Any service is not equal to the sum of individual services because adolescents may have used more than one type of
service.
11.2 Suicidal behaviours
Around 128,000 or 7.5% of young people aged 12-17 years had seriously considered attempting
suicide in the previous 12 months. The proportion was over twice as high for females as for males
(10.7% and 4.5% respectively). In addition, 4.7% of males and 6.6% of females answered “prefer not to
say” to the question on suicidal ideation and were not asked subsequent questions about suicide
plans or suicide attempts. As such, the results presented here may underestimate the full extent of
suicidal behaviours in Australian young people.
Overall one third of young people who had seriously considered attempting suicide in the previous 12
months, or 2.4% of all 12-17 year-olds, reported having attempted suicide in the previous 12 months.
This is equivalent to 41,000 young people. One quarter or 0.6% of all 12-17 year-olds received medical
treatment as a direct result of their injuries (Table 11-4).
Suicide attempts were more common among females than among males and for 16-17 year-olds
compared with younger adolescents (4.7% for females and 2.9% for males aged 16-17 years
compared with 2.7% for females and 0.8% for males aged 12-15 years in the previous 12 months).
Rates of suicidal behaviours by selected socio-demographic characteristics (family type, household
income, carer education, carer labour force status and area of residence) are shown in supplementary
tables S-58 through S-62. There were no significant differences in rates of suicidal behaviours by
socio-demographic characteristics.
The Mental Health of Children and Adolescents 107
Table 11-4: Suicidal ideation, suicide plans and suicide attempts among 12-17 year-olds by sex and age
group
Sex Age group
Suicidal
ideation in
previous 12
months (%)
Suicide plan in
previous 12
months (%)
Suicide
attempt ever
(%)
Suicide
attempt in
previous 12
months (%)
Medical
treatment for
suicide
attempt in
previous 12
months (%)
Males 12-15 years 3.4 2.0 0.9 0.8 np
16-17 years 6.8 4.9 3.9 2.9 np
12-17 years 4.5 2.9 1.9 1.5 np
Females 12-15 years 8.1 5.9 3.3 2.7 np
16-17 years 15.4 10.6 6.7 4.7 1.6
12-17 years 10.7 7.6 4.5 3.4 1.1
Persons 12-15 years 5.6 3.8 2.0 1.7 np
16-17 years 11.2 7.8 5.3 3.8 1.0
12-17 years 7.5 5.2 3.2 2.4 0.6
np Not available for publication because of small cell size, but included in totals where applicable.
11.2.1 Suicidal behaviours and mental disorder
Suicidal behaviours were strongly associated with mental disorder, in particular major depressive
disorder. Rates of suicidal ideation, suicide plans and suicide attempts were much lower in young
people whose parents or carers had identified any other mental illness apart from major depressive
disorder than in those young people where major depressive disorder was identified. In addition
these rates were higher when the major depressive disorder was based on information provided by
the young person themselves than when based on information provided by the parent or carer.
Among young males identified with major depressive disorder based on adolescent self-report
information, nearly one third (29.2%) had seriously considered suicide and 13.8% had attempted
suicide in the previous 12 months, compared with 3.1% and 0.4% of young males without a mental
disorder based on either the parent or adolescent report. Similarly for females, over half (56.4%) of
those who were identified with major depressive disorder based on adolescent self-report
information had seriously considered suicide, and over one fifth (22.1%) had attempted suicide while
3.5% of females with no identified mental disorder had seriously considered suicide and the number
of females with no identified mental disorder who had attempted suicide was too small to allow an
estimate to be produced (Table 11-5).
The highest rates of suicidal behaviours were in young people with major depressive disorder. This
was particularly so for adolescent females. Approximately half of females with major depressive
disorder based on self-report (56.4% or 47.7% based on parent or carer report) had seriously
considered attempting suicide in the previous 12 months compared with just under one third (29.2%)
of males with major depressive disorder based on self-report (or 17.0% based on parent or carer
report). These rates were four to five times higher than for young people with other disorders based
108 The Mental Health of Children and Adolescents
on their parents’ or carers’ reports and around ten times the rates for young people with no disorder
(Table 11-5).
Suicide plans followed a similar pattern, with 45.3% of young females and 26.0% of young males with
major depressive disorder based on self-report having made a suicide plan in the previous 12 months
compared with 15.1% of females and 3.5% of males with another disorder and 1.9% of females and
1.6% of males with no disorder.
Just over one in eight young males with major depressive disorder (13.8% when based on their selfreport
or 12.2% based on parent report) attempted suicide in the previous 12 months. One quarter of
these (3.4% of males with major depressive disorder based on self-report) received medical treatment
as a direct result of their injuries. The rate of suicide attempts was much higher for females with major
depressive disorder. Just over one in five (22.1% when major depressive disorder based on self-report
or 22.7% based on parent report) attempted suicide in the previous 12 months and around one third
of these (6.8% of females with major depressive disorder based on self-report) had received medical
treatment as a direct result of their injuries. By comparison just 0.4% of young people with no disorder
had attempted suicide in the previous year.
Table 11-5: Suicidal ideation, suicide plans and suicide attempts in the past 12 months among 12-17
year-olds by sex and mental health status
Sex Mental health status
Suicidal
ideation (%)
Suicide plan
(%)
Suicide
attempt (%)
Males Major depressive disorder based on adolescent report 29.2 26.0 13.8
Major depressive disorder based on parent or carer report 17.0 13.5 12.2
Other disorder based on parent or carer report 5.2 3.5 4.4
No disorder 3.1 1.6 0.4
All males 4.5 2.9 1.5
Females Major depressive disorder based on adolescent report 56.4 45.3 22.1
Major depressive disorder based on parent or carer report 47.7 36.0 22.7
Other disorder based on parent or carer report 17.5 15.1 7.5
No disorder 3.5 1.9 np
All females 10.7 7.6 3.4
Persons Major depressive disorder based on adolescent report 48.6 39.8 19.7
Major depressive disorder based on parent or carer report 34.9 26.7 18.4
Other disorder based on parent or carer report 9.8 7.9 5.5
No disorder 3.3 1.8 0.4
All persons 7.5 5.2 2.4
np Not available for publication because of small cell size, but included in totals where applicable.
The DSM-IV criteria for major depressive disorder require a minimum of five symptoms of depression
to be present in the same period. One of the symptoms is “recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for
The Mental Health of Children and Adolescents 109
committing suicide”. As such, suicidal behaviours contribute towards establishing the diagnosis of
major depressive disorder.
11.2.2 Suicidal behaviours and service use
Seven in ten (70.9%) 13-17 year-olds who reported a suicide attempt in the previous 12 months had
used services for emotional or behavioural problems in the previous 12 months (Table 11-6). Most of
these had used health services (69.8%). Over half of 13-17 year-olds who reported a suicide attempt in
the previous 12 months had used school services (57.9%), one fifth had used a telephone counselling
service (21.9%) and one tenth (10.9%) had used an online personal support or counselling service
such as those provided by headspace, Reachout, and Youth beyondblue. The proportion that had
used services was higher for females than males (77.9% and 50.6% respectively).
Around six in ten adolescents who had seriously considered attempting suicide or had made a suicide
plan in the previous 12 months had used services in the previous 12 months (56.6% and 59.2%
respectively).
It is not possible to say from the survey whether the services were used before or after the time of the
young person seriously considering suicide, making a plan or making a suicide attempt.
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