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Introduction Potentially owing to higher rates of psychiatric comorbidities associated with functional seizures (FS), suicidal behavior, suicidal thoughts, and deliberate self-harm are commonly reported in this patient group. Recent studies have also reported high mortality rates amongst people with FS, with or without comorbid epilepsy. The factors that may contribute to the risk of self-harm in people with FS are, though, still unclear and it is not well understood whether certain demographics might be at particular risk.Methods We performed a systematic review of the literature across 12 databases. We included 76 studies, of which 58 were eligible for meta-analysis. We disaggregated data by clinical features, age, and sex and also sought to understand if people from certain regions were at greater risk.Results Included studies captured data from 10928 patients with FS, of whom 6553 were included in the meta-analysis. The pooled prevalence of previous suicide attempts was 23% (95%CI=19- 27%), with lower suicide attempt rates in Latin America and Asia compared to Africa and Europe (p-value for subgroup differences < 0.001). The pooled prevalence of reported suicidal ideation was 25% (95%CI=14-38%), with African regions having significantly higher rates of suicidal ideation compared to North America (43% vs 16%, p<0.001). The pooled prevalence of deliberate self-harm was 22% (95%CI=16-30%). In people with only FS compared to those with only epileptic seizures, there was an increased risk of suicide attempts (OR 3.07) and suicidal ideation (OR 2.02).Conclusions Around one-quarter of people with FS report previous suicide attempts, current suicidal thoughts, and/or deliberate self-harmful behavior. This is additional to the known greater risk of suicide-related death in those with FS. Our work highlights the importance of appropriate screening strategies for at-risk behaviors in all people with FS. There is a clear need for targeted psychotherapeutic interventions in this vulnerable group, particularly in resource- underprivileged settings.