Background: Suicide notes in China are rarely studied and seldom available. Aims: This study examines the characteristics of suicide note leavers and analyzes the contents of their suicide notes for the period of 2004-2016 in Pudong, Shanghai, which has more than 5.5 million inhabitants. Method: The characteristics of the note leavers (n = 458) and those who left no notes (n = 1949) were compared. Four major groupings of the suicide note content were identified, namely, addressees, mandates/requests, expressions, and difficulties. Results: Only 19.0% of the deceased left suicide notes and they were characterized by having no diagnosed psychiatric illnesses, being in debt, having a high education level, having made no previous suicide attempts, and having used suicide methods that required preparation. Wanting to hide their suicide information was not uncommon for these individuals (9.7%). Adolescents were likely to mention a negative interpersonal relationship with someone (27.4%). Illnesses/pain was frequently mentioned by adults (33.4%) and older people (61.5%). Limitations: Many features of suicide notes, e.g., interpersonal features of suicides, were not examined. Conclusion: Education level might be a key factor influencing the likelihood of leaving suicide notes. Most people who left suicide notes showed a negative attitude toward suicidal behavior. The myth of an afterlife should also be addressed.