Objective <p>Suicide is among the top 10 leading causes of death. Epilepsy is associated with increased diagnoses of psychiatric conditions. Approximately 5% of deaths in people with epilepsy (PwE) are caused by suicide. We aim to compare the suicide incidence in PwE vs. people without epilepsy.</p> Methods <p>A systematic review was performed looking at suicide incidence among PwE compared to persons without epilepsy. The reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed in this study. The search included records until February 2024 in Ovid® MEDLINE, Embase®, and PsycINFO. Abstracts were screened in duplicate and extracted using standard proforma. Data were recorded on the incidence of suicide ideation, attempt, or completed suicide in PwE compared to persons without epilepsy. Meta-analyses were performed along with descriptive analyses.</p> Results <p>Out of a total of 7,371 records identified from the systematic search, 13 met the eligibility criteria. Meta-analysis showed a significantly higher incidence proportion of suicide ideation in PwE than those without epilepsy (risk ratio [RR]: 2.06, 95% CI 1.47–2.89). For suicide attempts, incidence proportion (RR: 3.62, 95% CI 2.88–4.55), incidence rate (incidence rate ratio [IRR]: 4.94, 95% CI 4.44–5.50) and hazard (adjusted hazard ratio [HR]: 2.32, 95% CI 2.17–2.48) were all significantly higher in PwE vs. people without epilepsy. Lastly, incidence proportion (RR: 2.39, 95% CI 1.28–4.47), incidence rate (IRR: 2.26, 95% CI 2.13–2.40), and hazard (adjusted HR: 2.50, 95% CI 1.99–3.16) of completed suicide were all significantly higher in PwE than those without epilepsy.</p> Significance <p>The incidence of suicide ideation, suicide attempt, and completed suicide were significantly higher in PwE compared to people without epilepsy. Comprehensive support systems to educate, diagnose, and manage epilepsy and concurrent psychiatric conditions in PwE are highly suggested.</p>