Suicide notes are considered very sensitive markers of suicide attempt severity providing a lot of information about the mental state of the victim. An interesting question is whether note writers differ from suicide victims who don’t leave suicide notes.

To present and discuss the differences between these two subgroups. We collected psychological autopsy data from one year's suicide deaths (November 2007 -October 2008), at the Athens’ Department of Forensic Medicine (covering 35% of the total Greek population).

Note writers represented 21.7% of our sample (30 out of 138), had no history of psychiatric disorders (p = 0.003) or recent (psychiatric) hospitalization (p = 0.026), were mostly men (p = 0.001), and died by hanging or shooting (p = 0.04). We believe that the powerful stigma associated with psychiatric disorders in our Country could provide a possible explanation for our results. A lot of people suffer in silence. For many of the deceased's relatives the suicide note provided, for the first time, an insight into their loved one's mental problems. It is also believed that psychiatric symptoms are indicating character weakness, incompatible with the sense of power that, particularly men, should display. Finally, it is well-known that men commit suicide more often than women, choosing more violent methods (hanging or shooting) compared to them.

More efforts against mental illness stigma and towards improving detection of psychiatric disorders are needed in our Country. Unfortunately, suicide notes seem to represent the first and only means of communication of mental suffering for a lot of people.