To examine associations of suicidal ideation with somatic symptoms, 863 outpatients were studied in a psychosomatic clinic in Japan. All subjects were diagnosed according to the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R and DSM-IV). They completed the Cornell Medical Index Questionnaire to assess suicidal ideation and 15 major somatic symptoms. Mood states were rated using the Profile of Mood States (POMS). In the study, 266 patients (31%) reported suicidal ideation. The age- and sex-adjusted odds ratios (typically in the range of 1.5 to 2.5) of somatic symptoms for suicide ideation showed significant differences (all ps < .05) for 13 of 15 symptoms. The total number of somatic symptoms predicted suicidal ideation (p < .05), controlling for the significant effects of sex, education, marital status, and the POMS Depression scale scores through multiple regression analysis. Evaluation of somatic symptoms might be important to assess suicidal ideation in a psychosomatic medicine population.