Suicide is a significant and far-reaching public health issue in Queensland. Reducing the incidence and tragic impacts of suicide is a priority of the Queensland Government. Suicide is a multidimensional phenomenon, and its prevention is complex. Therefore, a cross-sectoral policy and service response with targeted interventions for high-risk groups and population-wide strategies to promote the health and wellbeing of all people is required.17 Reducing suicide risk depends on coordinated cross-sectoral policy and practice efforts across health, social care, and criminal justice agencies.18, 19 Surveillance is a central part of the public health model of suicide prevention.20 Effective suicide surveillance systems provide suicide data and statistics, as well as timely and fit for purpose information to inform responses to suicide. The Queensland Government has funded the monitoring of suicide deaths with a suicide register for over three decades. The Queensland Suicide Register (QSR) includes suicide data since 1990, and the interim Queensland Suicide Register (iQSR) was established in 2011 to provide real-time information on suicide deaths. The Australian Institute for Suicide Research and Prevention has managed the QSR since 1996. Existing and ongoing reform to suicide prevention policies by state and federal governments provide more opportunities to improve suicide prevention efforts in Queensland. However, reducing suicide is not the responsibility of governments alone – we each have a role to play by watching out for family, friends and colleagues when we think they might need help, which could make the difference.21 Suicide in Queensland: Annual Report 2022 gives a summary of the nature of suicides and characteristics of those who died by suicide in Queensland. In total, 813 people died by suicide in Queensland in 2021. Queensland’s age-standardised suicide rate, which considers population growth and changes in the population’s age structure, has risen by 2.3 suicides per 100,000 people from 2006 (13.2 per 100,000) to 2021 (15.5 per 100,000). In 2021, Queensland’s age-standardised suspected suicide rate (15.5) was slightly higher than the past five-year average (15.3). Since it emerged in late January 2020, the COVID-19 pandemic, has increased suicide risk factors involving uncertainty, unemployment, changes in access to physical and mental health services and financial problems. The data in this report reinforces the need for targeted action to intervene early with those who are at the highest risk of suicide. Section 1 describes the elements, methods, limitations and context of the suicide surveillance system in Queensland. Section 2 reports on population groups and areas with higher suicide rates in Queensland from 2019 to 2021. Section 3 presents the characteristics of those who died by suicide, and factors that contributed to suicides in Queensland in 2016 to 2018. Section 4 summarises the critical results of the report, highlighting policy and practice implications.