Publication, Part of Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England
Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4
Part 2 Release
The following chapters will be published in Autumn 2025:
5. Alcohol: hazardous, harmful and dependent patterns of drinking
6. Drug use and dependence
8. Personality disorder
10. Autism spectrum disorder
11. Bipolar disorder
12. Psychotic disorder
13. Eating disorders
26 June 2025 09:30 AM
Chapter 4: Suicidal thoughts, suicide attempts and non-suicidal self-harm
Overview
Suicidal thoughts, suicide attempts, and non-suicidal self-harm are associated with great distress for the people who experience them, as well as for the people around them. Although associated with poor mental health, they can be experienced by people with and without mental health conditions.
The Adult Psychiatric Morbidity Survey (APMS) included questions on suicidal thoughts and suicide attempts. It also asked participants about self-harm which they considered to be without suicidal intent, referred to here as self-harm or as non-suicidal self-harm. Some questions were asked in both the face-to-face and self-completion parts of the interview. For reasons of comparability, trends over time draw on face-to-face reports, which tend to be lower than those based on self-completion. A variable combining face-to-face and self-completion data was used for examining differences in prevalence between groups in 2023/4.
Key findings
- Prevalence of suicidal thoughts and suicide attempts has increased. The proportion of 16 to 74 year olds reporting suicidal thoughts in the past year has increased from 3.8% in 2000 to 6.7% in 2023/4. The proportion having made a past year suicide attempt also appears to have risen, from 0.5% in 2000 to 1.0% (95% CI 0.7, 1.4) in 2023/4.
- Prevalence of self-harm has increased. Lifetime self-harm was reported by 2.4% of 16 to 74 year olds in 2000, 3.8% in 2007, rising to 6.4% in 2014 and 10.3% in 2023/4. This increase was evident in men and women and across age-groups.
- Women were more likely than men to have ever made a suicide attempt (8.6% compared with 6.9%) or self-harmed (12.6% compared with 8.5%). Among 16 to 24 year olds, 31.7% of women and 15.4% of men reported having ever self-harmed.
- There were demographic and socioeconomic inequalities. Younger people, those of White British or ‘Mixed, multiple or other’ ethnicity, and those in problem debt or who were unemployed or economically inactive, were more likely to report lifetime suicidal thoughts, suicide attempts and self-harm.
- There were strong associations with physical and mental health. Over a third (35.8%) of people with a physical health condition that limited their activities had had suicidal thoughts in their life, 14.4% had made a suicide attempt, and 16.0% had self-harmed.
- Most people who self-harmed did so to relieve unpleasant feelings. 83.1% of those who had self-harmed reported doing so to relieve unpleasant feelings of anger, tension, anxiety or depression. Among people who had self-harmed, cutting was the most reported method.
4.1 Introduction
The suicide rate in England and Wales fell from the early 1980s through to the 2000s, reaching a low point in 2007 (9.0 deaths per 100,000 people). Since then, the downward trend has not been maintained and a change in 2018 to the definition of suicide at inquest increased subsequent reported rates. In 2023, the rate was the highest figure since 1999, with 6,069 suicides registered in England and Wales (11.4 deaths per 100,000 people) (ONS 2024).
A refreshed cross-sector strategy for suicide prevention in England was launched in 2023 (DHSC 2023). This highlighted progress made since the previous strategy was published over a decade before (Department of Health 2015). It raised the need for epidemiological evidence and data to underpin service planning and identified several priority groups for tailored, targeted support. These include children and young people, middle-aged men, and people in contact with mental health services. The strategy also highlighted people who have made a suicide attempt or who self-harm as priority groups at elevated risk of suicide.
The relationship between suicidal thoughts, self-harm and suicide is not straightforward. The age and gender/sex of people reporting suicidal thoughts, suicide attempts and self-harm differs from that of people who die by suicide, and the majority of people who engage in these thoughts and behaviours do not go on to die by suicide. Suicidal thoughts and self-harming behaviours, as well as indicating potential suicide risk (World Health Organization (WHO) 2014), warrant intervention on their own account. They are associated with high levels of distress, both for the people engaging in them and for those around them.
The National Institute for Health and Care Excellence (NICE) guidelines define self-harm as self-injury or self-poisoning regardless of motivation or suicidal intent (NICE 2022). Establishing suicide intention can be difficult; people’s understandings of their behaviour can be ambiguous or change with hindsight (Kapur et al. 2013). However, the APMS series examines these behaviours (suicide attempts and non-suicidal self-harm) separately, based on participants’ own reported understanding of their intention (McManus et al. 2019). Administering these questions consistently in each survey does allow for meaningful assessment of change over time.
Among those who engaged in self-harm (with suicidal intent or not) many do not consult health services and, if they do, they may not be identified as needing or may not receive care. Health service records provide a unique understanding of patterns of service use but give a different understanding to community prevalence studies. Studies of people attending health services will be affected by the factors associated with clinic and hospital attendance (Geulayov et al. 2016). Some people attend health services but have poor experiences and so do not attend after subsequent self-harm (O’Keeffe et al. 2021).
Official statistics on recorded suicides (official suicides and undetermined deaths) provide a profile of people who have taken their own life, but not systematically coded detail about their life and socioeconomic circumstances. While this can be obtained from surveys, survey samples exclude those people, mostly male, who take their own life at the first attempt (Jordan and McNeil 2020). There is therefore a need to look across a range of data sources, and at suicidal thoughts, suicide attempts and non-suicidal self-harm.
This chapter provides nationally representative estimates of the prevalence of suicidal thoughts, suicide attempts, and non-suicidal self-harm (also referred to as self-harm), and trends in these using comparable measures since 2000. Their relationship to age, gender and other characteristics is described alongside findings on the methods and reasons reported for self-harming. Finally, results are presented on the help-seeking behaviours of people who have made a suicide attempt, and on the types of professional help received by those who have self-harmed.
4.2 Definitions and Assessments
Suicidal thoughts, suicide attempts and self-harm
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA 2013) includes two types of self-harming behaviour as conditions for further study: non-suicidal self-injury (NSSI) and suicidal behaviour disorder (SBD). While intentionality can be difficult to establish (Kapur et al. 2013), this is broadly the approach that has also been adopted in the APMS series, with a separate focus on thinking about suicide; making a suicide attempt with the intention of taking one’s own life; and harming oneself without the intent to die (referred to here as non-suicidal self-harm or self-harm). This approach has remained consistent across the APMS series to enable assessment of changes over time.
Measuring suicidal thoughts, suicide attempts and self-harm
Face-to-face questions
As in APMS 2000, 2007 and 2014, all participants in 2023/4 were asked in the face-to-face section of the interview several questions about suicidal thoughts, suicide attempts, and self-harm without suicidal intent. These questions form part of the revised Clinical Interview Schedule (CIS-R). For the purposes of the analysis in this chapter, suicidal thoughts, suicide attempts, and non-suicidal self-harm were assessed using the following questions:
- Have you ever thought of taking your life, even though you would not actually do it?
- Have you ever made an attempt to take your life, by taking an overdose of tablets or in some other way?
- Have you ever harmed yourself in any way on purpose but not with the intention of killing yourself?
Note that the question used for self-harm in 2023/4 was slightly different from that used in the earlier surveys. The previous version of the question - ‘Have you ever deliberately harmed yourself in any way but not with the intention of killing yourself?’' - included the word ‘deliberately’ which has been considered problematic in this context.
A positive response to each was followed up with a question on whether this last occurred in the past week, the past year, or longer ago.
Self-completion questions
While questions about suicidal thoughts, suicide attempts and self-harm were asked face-to-face to retain comparability with the previous APMS surveys, it was recognised that some participants might choose not to report them if asked face-to-face. For this reason, in the 2007, 2014 and 2023/4 surveys, some questions were also asked of all participants a second time, later in the interview, using laptop self-completion. In 2007 this consisted of the three lifetime prevalence questions listed above (a subset of the full section administered face-to-face). In 2014 and 2023/4, most of the questions on suicidal thoughts, attempts and self-harm were administered in the self-completion section, with some retained in the face-to-face section for trends and for use in scoring the CIS-R.
In 2023/4, the questions asked a second time in the self-completion part of the interview were not asked of the small number of participants who completed the interview by phone, for ethical and safeguarding reasons.
Questions used for results in this chapter
In 2014 and 2023/4, a question was included on when the participant had last self-harmed. In previous surveys in the series, participants were asked if they had ever self-harmed, but not when this had last happened. Trends in self-harm, therefore, are based only on reports of lifetime experience. Also to retain comparability of method with the 2000 and 2007 surveys, only data collected in the face-to-face interviews were used to assess change over time. The other analyses of suicidal thoughts, attempts and self-harm in this chapter draw on derived variables that combine positive responses in the face-to-face interview with positive responses in the self-completion section, as we believe this approach to be the most accurate (Bowling 2005; Tipping et al. 2010). Generally, reporting in the self-completion was higher than reporting face-to-face, but not all participants agreed to the self-completion.
Measuring methods of self-harming
In the self-completion section of the interview, participants who reported that they had self-harmed at some point, were asked which of a list of methods they had used. It was possible to give more than one response.
Did you… (You may give more than one response)
- Cut yourself
- Or burn yourself
- Or swallow anything
- Or harm yourself some other way.
Measuring reasons for self-harming
Participants who reported in the self-completion that they had self-harmed were also asked two questions about their motivation. It was possible to select neither, one, or both of these reasons:
- Did you do any of these things to raise awareness of your situation or to change your situation?
- Did you do any of these things because it relieved unpleasant feelings of anger, tension, anxiety or depression?
Note that the first of these questions differed from that used in the previous surveys. The revised version replaces the words ‘draw attention to’ with ‘raise awareness of’. This is because of the stigmatising associations with 'attention’. The issue of intent is very complex; these questions are therefore necessarily reductive, and the reasons given by participants for self-harming may reflect subsequent rationalisations (Kapur et al. 2013). The data presented on this should be treated as only indicative.
Measuring help-seeking after a suicide attempt
Participants reporting a suicide attempt were asked whether they had tried to get help following their most recent attempt, and if so which, from a list of formal and informal sources. They were also asked if they had ever received medical attention or seen a mental health professional following a suicide attempt.
Measuring help-seeking for self-harm
Participants reporting self-harm were asked whether they had received medical attention and whether they had seen a psychiatrist, psychologist or counsellor because of self-harming.
4.3 Results
Suicidal thoughts, attempts and self-harm, by age and gender
Prevalence of suicidal thoughts (ever)
A quarter of adults (25.2%) reported that they had thoughts of taking their own life at some point. If all adults in the population had been assessed, it is likely that this proportion would be between 23.7% and 26.7% (referred to as the 95% confidence interval or 95% CI). This equates to an estimated 11.7 million adults living in England. The prevalence was similar in men and women.
The proportion reporting lifetime suicidal thoughts decreased with age. It was highest in people aged 16 to 24 (31.5%, 95% CI 25.8, 37.8) and 25 to 34 (32.9%, CI 29.1, 36.9) and lowest in those aged 75 and over (11.0%, CI 9.0, 13.5). The survey questions related to suicidal thoughts across the participant’s lifetime. The higher reporting by younger participants might be explained by generational differences, with young people now being more likely to have suicidal thoughts than their counterparts in the past. However, age group variations in recall, perception, and willingness to report, together with healthy-survivor effects, may explain some of this association with age.
For more information: Table 4.1 and Table A1 for confidence intervals
Prevalence of suicide attempts (ever)
One in thirteen adults (7.8%) reported having made a suicide attempt at some point in their life, with the proportion of the wider population likely to respond in this way being between 7.0% and 8.7% (95% CI). This equates to an estimated 3.6 million adults.
Despite men being three times more likely than women to die by suicide (ONS 2024), women (8.6%, 95% CI 7.6, 9.7) were more likely to report an attempt than men (6.9%, CI 5.7, 8.3). Similar to suicidal thoughts, lifetime suicide attempts were more likely to be reported by people aged 16 to 24 (10.3%, CI 6.9, 15.2) and 25 to 34 (11.4%, CI 8.8, 14.6), and less likely to be reported by those aged 75 and over (2.3%, CI 1.4, 3.6).
For more information: Table 4.1 and Table A1 for confidence intervals
Prevalence of self-harm without suicidal intent (ever)
About one adult in nine (10.8%) reported having self-harmed without suicidal intent at some point in their life. Prevalence in the wider population is likely to be between 9.7% and 12.1% (95% CI). This equates to around 5 million adults living in England. Women (12.6%, 95% CI 11.1, 14.3) were more likely to report self-harm than men (8.5%, CI 7.0, 10.4).
There was a steep decline with increasing age. One in four 16 to 24 year olds (24.6%, CI 19.0, 31.1) reported having self-harmed, compared with less than one in a hundred (0.6%, CI 0.3, 1.3) of those aged 75 and over. Among both men and women prevalence was highest in 16 to 24 year olds, with 15.4% (CI 9.2, 24.7) of men and 31.7% (CI 23.8, 40.8) of women of this age reporting having self-harmed.
For more information: Table 4.1 and Table A1 for confidence intervals
Suicidal thoughts and attempts in the past year and self-harm ever, 2000, 2007, 2014 and 2023/4
Note that the trend data in this chapter were based only on the face-to-face section of the interview among 16 to 74 year olds, to allow for comparison back to 2000, and analyses by sex (male and female) rather than gender (men and women). See How to interpret the findings for information on how changes over time were assessed. In 2007, 2014 and 2023/4 self-completion data on this topic was also collected, which tends to elicit higher reporting.
Suicidal thoughts in the past year, 2000, 2007, 2014 and 2023/4
The proportion of adults aged 16 to 74 who reported suicidal thoughts in the past year increased from 3.8% in 2000 (95% CI 3.4, 4.4) to 6.7% in 2023/4 (CI 5.9, 7.7). Prevalence increased over this period among both males (from 3.5% (CI 2.9, 4.3) to 7.1% (CI 5.9, 8.7)) and females (from 4.2% (CI 3.5, 4.9) to 6.3% (CI 5.3, 7.6)).
For more information: Table 4.2 and Table B1 for confidence intervals
Suicide attempts in the past year, 2000, 2007, 2014 and 2023/4
The proportion of adults aged 16 to 74 who had attempted suicide in the past year appears to have increased, from 0.5% in 2000 (95% CI 0.4, 0.7) to 1.0% in 2023/4 (CI 0.7, 1.4). The same upward trend can be observed for both males (0.5% CI 0.3, 0.8) in 2000; 1.0% (CI 0.6, 1.6) in 2023/4) and females (also 0.5% (CI 0.3, 0.9) in 2000; 1.0% (CI 0.6, 1.5) in 2023/4). Confidence intervals around these estimates overlap, so caution is warranted.
For more information: Table 4.2 and Table B1 for confidence intervals
Self-harm without suicidal intent (ever), 2000, 2007, 2014 and 2023/4
There has been a steady increase in the proportion of adults aged 16 to 74 who had ever self-harmed, from 2.4% in 2000 (95% CI 2.0, 2.8) to 10.3% in 2023/4 (CI 9.1, 11.6).
Prevalence of self-harm has increased in both females and males. 2.7% of females aged 16 to 74 said they had ever self-harmed in 2000 (CI 2.2, 3.4) compared with 11.7% in 2023/4 (CI 10.1, 13.4). The equivalent proportions for males aged 16 to 74 were 2.1% in 2000 (CI 1.6, 2.7) and 8.8% in 2023/4 (CI 7.2, 10.8).
Prevalence of self-harm has increased in every age group. While the absolute rise was greatest in 16 to 24 year olds (from 5.3% (CI 3.7, 7.6) in 2000 to 21.2% (CI 16.0, 27.9) in 2023/4), the relative increase was similar or even greater in other age groups. For example, among 45 to 54 year olds, reported self-harm rose from 1.0% (CI 0.6, 1.7) in 2000 to 7.2% (CI 5.6, 9.1) in 2023/4.
For more information: Table 4.2 and Table B1 for confidence intervals
Variation in suicidal thoughts, suicide attempts and self-harm by other characteristics
Ethnic group
Age-standardised prevalence of lifetime suicidal thoughts, attempted suicide and self-harm varied by ethnic group. It should be noted that the confidence intervals for some estimates were wide and overlapping, so apparent differences between ethnic groups should be treated with caution.
- Suicidal thoughts were more commonly reported among those in the Mixed/multiple/other ethnicity (30.8%, 95% CI 21.2, 42.3), White British (28.2%, CI 26.4, 30.1) and White Other (27.2%, CI 21.6, 33.8) groups, and less so among those in the Black/Black British (15.8%, CI 11.3, 21.6) and Asian/Asian British (8.9%, CI 6.4, 12.2) groups.
- Suicide attempts were more commonly reported in the Mixed/multiple/other (11.0%, CI 5.2, 21.7), White British (9.2%, CI 8.2, 10.4) and White Other (7.5%, CI 4.2, 12.8) groups, and less so in the Black/Black British (3.0%, CI 1.5, 6.0) and Asian/Asian British (2.1%, CI 1.1, 4.0) groups.
- Self-harm was more common in the White British (13.5%, CI 12.0, 15.2) and White Other (9.9%, CI 6.2, 15.4), and Mixed/multiple/other (9.1%, CI 5.4, 15.0) groups and less so in the Black/Black British (4.3%, CI 1.9, 9.4) and Asian/Asian British (1.8%, CI 1.1, 3.1) groups.
For more information: Table 4.3 and Table A2 for confidence intervals
Employment status
Among participants of working age (16 to 64), age-standardised prevalence of lifetime suicidal thoughts, attempted suicide and self-harm varied by employment status. Economically inactive and unemployed adults were more likely to report having ever had suicidal thoughts, attempted suicide or self-harmed, than adults who were in employment.
-
Unemployed (42.3%) and economically inactive (37.5%) adults were more likely to have experienced suicidal thoughts than adults in employment (26.3%).
-
Unemployed (20.3%) and economically inactive (19.1%) adults were more likely to have attempted suicide than adults in employment (6.6%).
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Unemployed (23.2%) and economically inactive (19.4%) adults were more likely to have self-harmed than adults in employment (12.8%).
The relationship between employment status and attempted suicide was stronger for men than for women.
For more information: Table 4.4
Problem debt
In age-standardised analyses, being seriously behind with debt repayments or having utilities cut off was associated with higher lifetime prevalence of suicidal thoughts, attempted suicide or self-harm.
See the APMS 2023/4 Methods documentation for more information on how problem debt was derived.
- Adults with problem debt (39.4%) were more likely to experience suicidal thoughts (ever) than those who were not experiencing problem debt (23.8%).
- Adults with problem debt (21.2%) were three times more likely to report having attempted suicide (ever) than those not experiencing problem debt (6.6%).
- Adults with problem debt (19.3%) were twice as likely to report having self-harmed (ever) compared with those not experiencing problem debt (10.0%).
The pattern of association between problem debt and suicidal thoughts, suicide attempts, and self-harm was similar for men and women.
For more information: Table 4.5
Area-level deprivation
In age-standardised analyses, the prevalence of attempted suicide varied by area-level deprivation. Having ever made a suicide attempt was more common among adults living in the most deprived areas (12.9%) and less common among those living in the least deprived areas (5.3%). The prevalence of lifetime suicidal thoughts and self-harm by area deprivation overall did not meet the required levels of significance.
For more information: Table 4.6
Region
The prevalence of having ever experienced suicidal thoughts, attempted suicide and self-harm were not significantly associated with region.
For more information: Table 4.7
Comorbidity
Physical health conditions
Adults with a limiting physical health condition were more likely to have ever experienced thoughts of suicide (35.8%), attempted suicide (14.4%), or self-harmed (16.0%) than adults without a limiting physical health condition (19.9%, 4.9% and 8.7% respectively).
For more information: Table 4.8
Common mental health conditions
Adults with a CMHC were more likely to report having ever had thoughts of suicide, attempted suicide, or self-harmed than adults without a CMHC.
- Adults with a CMHC were three times more likely to have ever experienced suicidal thoughts than adults without a CMHC (55.6% compared with 17.0%).
- Adults with a CMHC were five times more likely to have ever attempted suicide than adults without a CMHC (21.8% compared with 3.9%).
- Adults with a CMHC were four times more likely to have ever self-harmed than adults without a CMHC (27.2% compared with 6.0%).
The relationship between having ever had suicidal thoughts and CMHC was stronger for men than for women.
For more information: Table 4.8
Methods of self-harming
Questions about the methods used to self-harm and reasons for self-harming (covered in the next section) were asked only of participants who reported in the self-completion section of the interview that they had ever self-harmed. Most, but not all, participants completed the self-completion section. Participants could report more than one method and more than one reason.
The most reported method of self-harming was cutting, with 72.7% of those who had ever self-harmed saying that they had cut themselves. A smaller proportion said they had burned themselves (13.4%) or swallowed something (10.0%). A third (33.2%) reported that they had harmed themselves in 'some other way'.
Women (79.5%) were more likely than men (60.1%) to report cutting themselves. Men (45.0%) were more likely than women (27.2%) to report harming themselves in ‘some other way’, that is, in a way other than cutting, burning or swallowing something.
Younger age groups were more likely to report burning themselves than older age groups, with 17.0% of those aged 16 to 34 reporting having done so ever compared with 7.8% of those aged 35 to 54 and 6.0% of those aged 55 and over.
For more information: Table 4.9 and Table 4.10
Reported reasons for self-harming
When asked if they had self-harmed to relieve unpleasant feelings of anger, tension, anxiety or depression, 83.1% of adults who had self-harmed ever said that this was the case. A smaller proportion (25.4%) said they had self-harmed to raise awareness of or a change in their situation.
Women (88.5%) were more likely than men (72.5%) to say they had self-harmed ever to relieve unpleasant feelings. There was no significant difference in the proportion of women and men saying they had self-harmed to raise awareness of their situation. The proportion reporting each reason for self-harm did not vary significantly between age groups.
For more information: Table 4.9 and Table 4.10
Help-seeking behaviour
Participants who reported in the self-completion section of the questionnaire that they had ever attempted suicide or self-harmed were asked whether they had sought or received help afterwards, this is discussed below. Most (89%) participants completed the self-completion section.
Help-seeking following most recent suicide attempt
Around half (51.6%) of adults who reported a suicide attempt ever said that they had sought help after the last attempt. The question captured help-seeking, participants may not have received the help sought.
The most common sources people turned to for help were “friends, partner, family or neighbours” (27.3%); a GP practice or family doctor (25.6%); a counsellor, therapist or mental health professional (23.8%) and hospital, emergency services or A&E (20.9%). Women (59.1%) were more likely than men (41.0%) to have sought help from at least one source. In particular, women (31.0%) were more likely than men (17.5%) to have sought help from a GP practice or family doctor, a counsellor, therapist or mental health professional (28.5% and 16.8% respectively) or a telephone or crisis helpline (9.0% and 2.7% respectively). Among those who sought help, men and women sought help from similar sources.
The likelihood of seeking help also varied with age.
- Those aged 35 to 54 (61.2%) were the most likely to have sought help from at least one source, compared with 47.8% of 16 to 34 year olds and 43.8% of those aged 55 and over.
- While friends, partner, family or neighbours were the most common source of help sought by 16 to 34 year olds (33.3%) and 35 to 54 year olds (29.6%), 12.9% of those aged 55 and over sought help from this source.
- The most common source of help sought by those aged 55 and over was a GP practice or family doctor (22.1%).
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1.1% of those aged 55 and over had sought help from a telephone helpline compared with 6.6% of 35 to 54 year olds and 9.0% of 16 to 34 year olds.
For more information: Table 4.11 and Table 4.12
Medical and psychological help following any suicide attempt
Three-fifths of adults (60.6%) who had made a suicide attempt (ever) received medical and/or psychological help after an attempt: half (51.6%) had psychological help and about two-fifths (42.1%) received medical help.
The proportion receiving help was similar for men and women and for different age groups.
For more information: Table 4.13 and Table 4.14
Medical and psychological help ever received for self-harming
Among adults who had ever self-harmed, 37.9% had received medical and/or psychological help at some point as a result: 34.9% had received psychological help and 17.5% medical help.
Women (42.6%) were more likely than men (26.7%) to have received help. In particular, women (40.6%) were around twice as likely as men (21.6%) to have received psychological help.
Receipt of psychological help also varied by age. 16 to 34 year olds (39.2%) were twice as likely as those aged 55 and over (20.0%) to have received psychological help.
For more information: Table 4.15 and Table 4.16
Treatment
Treatment and service use
Participants were asked about different types of mental health treatment and service use. Two types of mental health treatment were asked about: current medication and psychological therapy for a mental or emotional problem. Participants were also asked about their use of a range of health, community and day care services over the past year. This treatment and service use could have been for any mental health condition, not necessarily related to suicidal thoughts, suicide attempts or self-harm.
Half (50.6%) of adults who had attempted suicide at some point in their life were currently receiving treatment for some form of mental or emotional problem. This was the case for almost half (47.7%) of those who had ever self-harmed. It was less common for adults who reported ever having suicidal thoughts to currently be receiving treatment, although over a third were (36.9%). In comparison, 15.7% of adults overall were currently receiving treatment for a mental or emotional problem.
In all three cases, the most common form of treatment was psychotropic medication. The proportion of adults in receipt of medication ranged from about two fifths of those who had attempted suicide (43.9%) or self-harmed (38.6%) to about a third of those who had experienced suicidal thoughts (30.9%). The proportions receiving psychological therapy – either alone or in combination with medication – were 15.3% (both suicide attempts and self-harm) and 11.4% (suicidal thoughts).
About four in ten adults who had ever attempted suicide (41.1%) or self-harmed (40.5%) had used healthcare services in the past year for a mental or emotional problem. This was also the case for three in ten of those who had suicidal thoughts (30.8%). In comparison, 13.5% of adults overall had used healthcare services for a mental or emotional problem in the past year.
For more information: Table 4.17
Psychotropic medication
Participants were asked which (if any) psychotropic medications they currently take. These included any medications taken for a mental or emotional reason and not necessarily relating to suicidal thoughts, suicide attempts or self-harm.
Overall, 12.5% of all adults were taking some form of psychotropic medication, with the most common medication types those primarily used to treat depression (11.7%) and anxiety (10.7%). See Chapter 2 Mental health treatment and service use for more details.
Among adults who had attempted suicide, more than four in ten (43.9%) were currently taking psychotropic medication. The equivalent figures for those who had ever self-harmed or had suicidal thoughts were 38.6% and 30.9% respectively.
In all three cases, the most common types of psychotropic medication being taken were those used to treat anxiety or depression.
- 41.6% of those who had ever attempted suicide were taking drugs used to treat depression as were 36.3% of those who had self-harmed and 29.2% of those who had had suicidal thoughts.
- Similar proportions were taking drugs used to treat anxiety, with these being taken by 38.3% of those who had ever attempted suicide, 34.0% of those who had self-harmed and 26.3% of those who had had suicidal thoughts.
- A minority were taking drugs used to treat bipolar disorder (7.3% of those who had attempted suicide) or psychosis (7.2% of those who had attempted suicide).
For more information: Table 4.18
4.4 Discussion
APMS data provides unique insights into trends and patterns in suicidal thoughts, attempted suicide and non-suicidal self-harming behaviours in England. Information has been collected from samples of the general population in comparable ways since 2000, enabling an understanding of changes in the population over time.
A number of key findings emerge from the results presented in this chapter.
Suicidal thoughts, suicide attempts and non-suicidal self-harm have increased. This century has seen a sustained rise in the proportion of the adult England population reporting having thought about suicide or having made a suicide attempt, and a steeper increase in having self-harmed without suicidal intent. This is a continuation of trends observed in previous surveys in the APMS series (McManus et al. 2019), and is consistent with more recent studies of trends in numbers of people attending health service settings (Cybulski et al. 2021; Trafford et al. 2023). These increases have followed different patterns to the suicide rate in timing (which reached the lowest recorded rate in 2007) and in age-sex profile. Suicidal ideation, suicide attempts, non-suicidal self-harm and suicide are related, but they are distinct and should not be treated as proxies (ONS 2024). It is possible that some of the increased survey reporting may be attributable to changes in reporting behaviour, that some forms of self-injury which people had not included as self-harm in previous surveys have started to be labelled as such. It is also likely that people now feel more able to disclose suicidal thoughts, suicide attempts and self-harm, which might happen if these have become less stigmatised in wider public discourse (Ronaldson and Henderson 2024). However, it is likely that the survey trends also reflect a real increase in such thoughts and behaviours.
Increases evident in both men and women and across all age groups. The absolute rise, particularly for self-harm, is greatest among young people: 6.5% of 16 to 24 year old women reported in the face-to-face section of the APMS 2000 interview, having self-harmed, in APMS 2023/4 this was 25.7%. When participant disclosures made in the self-completion section of the interview are also included in the estimate: one in three 16 to 24 year old women and one in six 16 to 24 year old men reported self-harm in the most recent survey. However, in terms of relative rises, increases are just as pronounced (or even more so) in older age groups. Those aged 45 to 54 in 2023/4 – were seven times more likely to report having ever self-harmed (7.2%) than those who were 45 to 54 in 2000 (1.0%). Among men, the prevalence of suicidal thoughts and suicide attempts was highest in those aged 25 to 34.
Self-harming takes many forms. Around three-quarters of adults who self-harm reported cutting. However, nearly half (45.0%) of the men in the 2023/4 survey sample who reported having self-harmed, said that this included a form other than cutting, burning, or swallowing something like pills. The comparable figure among men in 2014 was 32.2%, indicating that use of ‘other’ methods may be increasing (McManus et al. 2016). The options presented on the APMS questionnaire did not capture the behaviours participants included in their own understanding of self-harm. It is possible these included risky or self-destructive behaviours such as reckless driving (Witt et al. 2019). Tofthagen and colleagues (2022) found that acts such as head banging or punching a wall may be forms of self-injury particularly experienced by men. In future, the questions asked in surveys (Cook et al. 2022) and the probes used in clinical and other settings may need to be reviewed to be more open-ended, to ensure that they capture the range of behaviours that people engage in and consider to be self-harm (McCabe et al. 2017).
Self-harm as a coping mechanism. A minority of people who self-harmed reported doing so in order to change their situation, while the great majority (83.1%) reported having done so to manage and relieve feelings of anger and distress. It appears this proportion may have increased (McManus et al. 2019). Interventions to reduce self-harming need to consider ways of supporting healthy strategies for coping and managing distress (Witt et al. 2021), as this appears to be a key driver.
Prevention efforts need to address poverty and debt. The results in this chapter show that those struggling with financial debt or who were unemployed or economically inactive at the time of the interview were more likely to report lifetime suicidal thoughts, suicide attempts and self-harm (Meltzer et al. 2011; Richardson et al. 2013). These associations were especially pronounced for men. The risks posed by individual economic hardship is well established (Barnes et al. 2016), especially during periods of wider recession, indicating that people attending health services may benefit from signposting to local debt and advice services (Hawton et al. 2016). The resourcing and targeting of services and support should reflect how those living in the most deprived neighbourhoods (12.9%) were more than twice as likely to have attempted suicide compared to those in the least deprived areas (5.3%) (Cairns et al. 2017).
People presenting to services in poor physical health may be experiencing suicidal thoughts, suicide attempts and self-harm. The strong link between mental health and these thoughts and behaviours is well established, consistent with recent work by Nafilyan and colleagues (2023); the results in this chapter reinforce how these associations extend to physical health. Over a third (35.8%) of adults with a limiting physical health condition reported that they have had suicidal thoughts and 14.4% had made a suicide attempt. The interaction of physical and mental illness emphasises the importance of collaborative physical and mental health care, with health service contact for physical health reasons providing an opportunity for intervention.
There are gaps in help-seeking. Half of adults who attempted suicide (48.4%) did not seek help after their most recent attempt. The gaps in accessing health service support were especially pronounced for men and older people.
Addressing variations by ethnicity. Understanding of ethnic disparities in suicide in England is hampered by ethnicity not being recorded on death certificates (Knipe et al. 2024). The elevated prevalence found for those in the ‘Mixed/ multiple/ other’ group is consistent with Knipe and colleagues analyses using linked census and mortality data. In APMS 2014, there had been little variation by ethnic group in the proportion reporting suicidal thoughts, suicide attempts or self-harm, so emergence of variation in the APMS 2023/4 survey may be new. However, the small number of participants from ethnic minority backgrounds in survey samples means there is some uncertainty in the estimates by ethnicity and highlights the need for improved data collection, especially important given evidence of reduced service access for many groups (Ahmad et al. 2022). There is an urgent need to better understand the reasons for and best ways to respond to these variations by ethnic group.
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4.6 Citation
Please cite this chapter as:
Butt, S., Randall, E., Morris, S., Appleby, L., Hassiotis, A., John, A., McCabe, R., & McManus, S. (2025). Suicidal thoughts, suicide attempts and non-suicidal self-harm. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.), Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.
Last edited: 26 June 2025 9:31 am