Anxiety has overtaken relationship issues as the leading reason women in Sydney seek counselling. Work stress in women has surpassed men for the first time. Burnout has grown nearly five-fold as a share of clients (0.6% to 2.8%). An analysis of 36,309 clients and 139,687 appointments across Sydney practices, 2011 to 2025, with national context from headspace and the ABS.
Fifteen years of anonymised intake data from a multi-location Sydney counselling and psychology practice show three major shifts in women's mental health, alongside broader patterns across time, gender, and suburb.
Anxiety has overtaken relationship issues as the leading reason women in Sydney seek counselling. Female rate of 25.8% is well ahead of men at 18.1%.
For the first time in 14 years of clinical data, women report work stress at a higher rate than men. A reversal of the pattern that held throughout the 2010s.
Burnout has grown roughly five-fold as a share of clients (6 of 982 in 2011, 69 of 2,427 in 2025; 11-fold in raw client count) once the practice's own growth is taken into account. Consistent with post-pandemic workforce exhaustion. Increase is most pronounced among female clients.
Anxiety rates jumped from a 2011–2019 average of 12.5% to a 2021 peak of 24.3%. The 2025 rate of 17.8% remains well above any pre-pandemic year.
COVID years (2020 onwards) shown in orange. Volume growth reflects both increasing mental health awareness and practice expansion.
Across 11,026 female clients seen between 2011 and 2025, the composition of presenting issues has shifted in three significant ways. Anxiety has overtaken relationship issues as the leading reason women seek help. Work stress in women has surpassed men for the first time. And burnout, almost absent from intake notes a decade ago, is now a substantial category in its own right.
Anxiety is now the #1 presenting issue for female clients at 25.8%, ahead of relationship issues at 24.9%. For male clients, relationship issues remain the leading category (27.4%), with anxiety second (18.1%). The gender gap on anxiety is 7.7 percentage points – the largest difference for any non-addiction presenting issue.
National context: 53% of young Australian women report high or very high psychological distress (headspace 2025), and women aged 18 to 29 recorded the steepest increase in mentally unhealthy days of any demographic between 2018 and 2025.
In 2025, 12.2% of female clients cited work stress as a primary presenting issue, against 8.6% of male clients – a reversal of the pattern that held through the 2010s, when men consistently presented with work stress at higher rates than women. Aggregate work stress has also risen every year since 2015 and reached an all-time high of 13.9% in 2025.
In 2011, 6 of 982 unique clients (0.6%) presented with burnout. By 2025, 69 of 2,427 (2.8%) did — a roughly five-fold rise once the practice's own growth (982 to 2,427 unique clients per year) is taken into account. The corresponding raw count rose 11-fold. While burnout still sits below work stress in raw volume, its growth trajectory is one of the steepest in the dataset and tracks closely with broader Australian workforce exhaustion trends, particularly among women aged 25 to 44.
In 2025, work stress presentations in female clients (12.2%) exceeded male clients (8.6%) for the first time in the dataset. Throughout the 2010s, men consistently outpaced women on this measure.
Burnout grew from 0.6% of unique clients in 2011 (6 of 982) to 2.8% in 2025 (69 of 2,427) — a roughly five-fold rise as a share of clients. Plotted as percentage to control for the practice's own growth over the period; the corresponding raw count rose 11-fold. Trend most pronounced among female clients.
Anxiety has moved to the top spot, ahead of relationship issues. Work stress is now the fourth most common presenting issue for women.
The composition of why Sydneysiders seek counselling has shifted substantially. COVID created a clear inflection point for anxiety, and work stress and burnout show a structural upward trend that has continued well beyond the pandemic years. Across the full 15-year window, relationship issues remain the largest single presenting issue, but for female clients in recent years, anxiety has overtaken it.
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 grew from 0.6% of unique clients in 2011 (6 of 982) to 2.8% in 2025 (69 of 2,427) — a roughly five-fold rise as a share of clients, or 11-fold in raw count. 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 |
|---|
% of female clients (n=11,026)
| # | Issue | % of clients |
|---|
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 | % |
|---|
% of lower-affluence clients (n=1,360)
| # | Issue | % |
|---|
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 |
|---|