The objectives of this study were to carry out a comprehensive review of the worldwide literature on suicidal behaviour by drowning. Systematic electronic searches of databases using various search terms were carried out. Recent trends in suicide and undetermined deaths due to drowning in England and Wales are described. The characteristics of patients presenting to the general hospital in Oxford, UK following attempted drowning are compared with self-poisoning patients. A total of 20 studies containing empirical data about suicide by drowning were identified, mainly concerning Western countries. Drowning suicides have declined in most countries in recent years. The proportion of undetermined deaths remains high. Drowning suicides and self-harm patients tend to be older, with only a small excess of males compared to those using other methods. This is an under-researched area that deserves good quality studies focusing upon prevention.