The aim of this study was to examine the spouse effects on depressive symptom and suicidal thinking among the elderly aged 65 and over in Korea. The subjects selected from the database of the Fourth Korea National Health and Nutrition Examination Survey(KNHANES IV) conducted by Korea Centers for Disease Control and Prevention from 2007 to 2009. Those who were female, older, lower educated, or poorer were more likely to live alone than their counterparts respectively. The elderly living alone experienced depressive symptom as 2.0 times(OR=2.004, 95% CI=1.433, 2.803) as, and suicidal thinking as 1.6 times(OR=1.567, 95% CI=1.111, 2.211) as the elderly couples did, adjusting for socio-economic factor, health status factors, and health behaviors factors. As for the male subgroup, the elderly living alone experienced depressive symptom as 4.0 times(OR=3.997, 95% CI=2.066, 7.732) as, and suicidal thinking as 3.2 times(OR=3.181, 95% CI=1.535, 6.592) as the elderly couples did. On the other hands, there was no significant difference in depressive symptoms and suicidal thinking between the female elderly living alone and couples. The authors suggested policy interventions to promote the mental health of the male elderly living alone.