Recreational spearfishing is a fishing method that occurs globally, yet receives considerably less attention in the scientific literature relative to other recreational fishing methods, such as angling. Lack of scientific information on spearfishing may negatively affect the development and management of marine recreational fisheries. We conducted a systematic review of 102 peer-reviewed papers published between 1967 and 2022 pertaining to marine recreational spearfishing. Based on this literature review, we provide an overview of key insights across social, economic, and ecological dimensions of marine recreational spearfishing. While spearfishers represent less than 5% of marine recreational fishers, the participants are younger and may differ from recreational anglers in their motivations, with suggestions of increased well-being generated from a close connection with the sea during underwater fishing. Recreational spearfishers mostly target species of moderate to high levels of vulnerability that are mid to high trophic level carnivores. Though spearfishers can deliberately target larger individuals of exploited populations, this is not a generalizable pattern. Despite a growing body of research on the ecological impacts of marine recreational spearfishing, there is limited knowledge of these effects and their mechanisms across biological levels of organization (e.g., individual, population, community and ecosystem) compared with those of other fishing methods. Recreational spearfishers can contribute to advances in marine ecological knowledge, and inclusive participatory management could represent a key step towards transformative sustainable development of marine recreational spearfishing. Throughout the review, we identify gaps in the research and areas where future research is needed to better inform the socio-economic importance, ecosystem impacts and future management of marine recreational spearfishing.