An analysis of 36,309 clients and 139,687 appointments across Sydney practices – examining presenting issues over time, gender differences, socioeconomic patterns, the COVID anxiety spike, addiction, and suicidal ideation.
Fifteen years of anonymised intake data from a multi-location Sydney counselling and psychology practice reveal clear patterns across time, gender, and suburb.
Relationship issues dominate across every year, gender, and suburb – 13,555 presentations across 15 years.
Anxiety rate jumped from ~12% pre-COVID to 21.1% in 2020, peaking at 24.3% in 2021. Still elevated above 17% in 2025.
Work stress in 2025 reached its highest-ever rate – more than double the 2011 rate of 6.0%. A structural shift, not a blip.
Combining all addiction types, men present at 18.5% vs 5.1% for women – the largest sustained gender gap across the entire dataset.
COVID years (2020 onwards) shown in orange. Volume growth reflects both increasing mental health awareness and practice expansion.
The composition of why Sydneysiders seek counselling has shifted substantially. COVID created a clear inflection point for anxiety, while work stress and burnout show a structural upward trend that has continued well beyond the pandemic years.
Average rate 2011–19: 12.5%. Jumped to 21.1% in 2020, peaked at 24.3% in 2021. The 2025 rate of 17.8% remains well above any pre-pandemic year.
Work stress has risen every year since 2015. 2025 is the highest ever. Now affects women at a higher rate than men – a reversal from earlier years.
Burnout presentations grew from 6 in 2011 to 69 in 2025 – an 11-fold increase – consistent with a broad workforce exhaustion trend post-pandemic.
16 presentations in 2011 → 99 in 2025 (6× increase). Trend is sharply accelerating from 2022 onwards. 97%+ of presentations are male clients.
Unlike porn addiction, suicidal ideation presentations are split near-equally between male and female clients. Peak in 2018 (35 presentations).
Gender was inferred from client first names. Of 36,309 clients: 11,608 male (32%), 11,026 female (30%), 10,944 couples (30%). The differences in presenting issues are clinically significant.
16.6% of male clients present with anger management vs 5.5% female. Third-largest gender gap after combined addiction and gambling.
Anxiety is the #1 presenting issue for women (25.8%) vs #2 for men (18.1%). Relationship issues rank #1 for men.
Women present with work stress at 12.2% vs 8.6% for men – a reversal from earlier in the dataset when men dominated this category.
Combining all addiction types, nearly 1 in 5 male clients presents with some form of addiction vs 1 in 20 for female clients – a 3.6× gap.
% of male clients (n=11,608)
| # | Issue | % of clients |
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% of female clients (n=11,026)
| # | Issue | % of clients |
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Addiction-related presentations show the most pronounced gender and socioeconomic disparities of any category. Alcohol, substances, porn, gambling, and general addiction, when grouped together, affect men at 3.6 times the rate of women and are significantly more prevalent in lower-affluence suburbs.
Each client counted once if they present with any addiction type. The figures below represent the share of clients with at least one addiction presentation.
Individual addiction types below. A client may present with more than one type; the combined figure above counts each client once.
Rising sharply: 16 cases in 2011, 99 in 2025 (6× increase)
Most equal addiction type by suburb. Female alcohol presentations rising since 2019.
Strongest socioeconomic gradient of any individual addiction type.
Includes behavioural addictions not classified elsewhere (gaming, sex, etc.)
Second-largest gender gap after porn addiction. High socioeconomic gradient.
Not all issues require the same depth of treatment. Trauma-related presentations lead to significantly more appointments on average than interpersonal or situational issues – a useful indicator of both clinical complexity and likely treatment duration.
Colour indicates depth tier: red = 5+ avg appointments (complex trauma), orange = 4.4–4.9 (significant), teal = 3.8–4.3 (moderate), grey = under 3.8 (shorter term).
PTSD and self-harm average the most appointments of any issue. Trauma-related presentations dominate the top of this list – abuse (5.2), childhood trauma (5.1), trauma (4.9).
Work stress (4.2) and burnout (4.2) sit well above the average – reflecting that occupational mental health issues often have complex contributing factors requiring longer work.
The most common presenting issue averages only 3.5 appointments – shorter-term, goal-focused couples or relationship work. Communication (3.2) and conflict resolution (3.2) similarly short.
Despite its severity, gambling averages the fewest appointments – possibly reflecting early dropout or referral to specialist gambling services after initial assessment.
Practice locations were classified into affluence tiers using ABS SEIFA data. Practitioner location serves as a proxy for client socioeconomic background. 7,674 clients were seen in high-affluence suburbs; 1,360 in lower-affluence areas.
HIGH AFFLUENCE (7,674 clients): Double Bay · Mosman · Lane Cove · North Sydney · CBD · Chatswood · Northbridge · Potts Point · St Leonards · Cremorne
MIDDLE AFFLUENCE (21,266 clients): Surry Hills · Bondi Junction · Glebe · Miranda · Caringbah · Castle Hill · Earlwood · Hornsby · Norwest · Ryde · Dulwich Hill · Narraweena/Dee Why
LOWER AFFLUENCE (1,360 clients): Parramatta · Blacktown · Campbelltown · Cabramatta · Stanhope Gardens · Wattle Grove
% of high-affluence clients (n=7,674)
| # | Issue | % |
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% of lower-affluence clients (n=1,360)
| # | Issue | % |
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Anxiety (High: 16.1% / Low: 17.4%) and depression (High: 11.3% / Low: 12.8%) are strikingly consistent across income tiers. Mental distress is not a problem of poverty.
Substance abuse presents in 1.7% of high-affluence clients vs 3.7% lower-affluence – the strongest socioeconomic gradient of any issue type.
Life transitions appear more often in high-affluence sessions – career change, identity, relocation. Lower-affluence clients more often present with financial stress and family conflict.
The most striking finding in this dataset is the mismatch between who presents for help with suicidal ideation and who actually dies by suicide nationally. Men and women seek help at near-equal rates in private practice – yet men die by suicide at 3.2 times the rate of women.
Suicidal ideation presentations are near-equal (male 90, female 84 over 15 years). Self-harm skews female. Note: these figures likely under-capture ideation – many clients present primarily with depression and disclose ideation during session.
Source: ABS Causes of Death, Australia 2024 (preliminary). Men die by suicide at 3.2× the rate of women. Suicide is the leading cause of death for Australians aged 15–44.
An average of 9 deaths per day. The 2024 rate of 12.2 per 100,000 is 6.5% higher than 2023 – after years of relative stability.
The highest suicide rate of any demographic group in Australia. Yet substantially under-represented in counselling data relative to their population size and risk level.
The national rate rose in 2024. Preliminary 2025 indicators suggest a continued increase. Help-seeking as captured in this dataset has not correspondingly increased.
Top 25 presenting issues across all 36,309 clients. A client may have more than one presenting issue recorded at intake.
| # | Issue | Total Clients | % of All Clients |
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