Background Past studies in French Polynesia have identified suicide as a significant concern, with a measured annual incidence of 79.4 attempts per 100,000 population during 2008–2010. In response to the COVID-19 pandemic, a monitoring system was established to track and investigate suicide attempts (SA). Methods A prospective study was conducted between April 2020 and March 2023, including all patients referred to the French Polynesia Hospital Center for SA. Demographic factors as well as clinical parameters were analyzed. Findings During the study period, 895 SAs were registered and confirmed, with a crude annual rate of 106.7 events and the adjusted rate at 113.2 per 100,000 population. Substantial majority of SA happened in the island of Tahiti. Half of the subjects did not have psychiatric diagnosis. There was a significant increase in SA from year 1 to year 3, with young people (female more than male) particularly at risk, especially in Tahiti. The normalized incidence among females younger than 20-year-old was as high as 310.4 per 100,000 population. Interpretation Our data revealed an overall 34.4% increase in SA in French Polynesia, with a striking 54.9% increase during the third year of pandemic. The last year’s record high incidence, is confirmed by increased activity on suicide hotlines, notably in Tahiti. A correlation between COVID exposure and suicidal behaviors, both at the individual and social level, is suspected with young female in Tahiti being the most vulnerable. These findings highlight the need for reinforced prevention and an efficient suicide monitoring system even after the public health emergency was declared over.