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Whereas sex ratios are likely to affect the likelihood of marriage, how sex ratios affect health and survival is underexplored. This study uses suicide as a measure of mental health and examines how suicides are affected by sex ratios. As women tend to marry men older than themselves, shrinking populations will lead to higher sex ratios (i.e., higher proportions of men) in the marriage market. Using data from Japan, I find that high sex ratios, both early-life and current, are correlated with higher male suicide rates, whereas female suicide rates are generally not affected. The results of this study have important implications for public health in countries where imbalanced sex ratios are a concern. Copyright © 2013 John Wiley & Sons, Ltd.