The contents of suicide letters provide insight into the reasons for suicide and the mental states of victims. Coroner court records of 1,721 Singaporean suicides occurring between 2000 and 2004 were reviewed, 398 (23%) of whom left suicide letters. Letter writers tended to be younger, single, and less likely to have mental or physical illness. A reason for suicide was evident in 58%. Major reasons included school and relationship problems in the young, financial and marital problems in adults and physical illnesses in the elderly. Positive sentiment (care/concern) was expressed in 59%. Negative emotions in 45% of which despondency/agony (60%) was the most common, followed by emptiness (25%), guilt/shame (15%), hopelessness (10%), and anger (3%). The study of these letters suggests that there are combinations of social, psychological and physical factors that influence a person to suicide, all of which are important in the prevention, assessment, and management of suicide.