About

Ivan W. Miller is a Professor of Psychiatry and Human Behavior at Brown University. His work focuses on various aspects of mental health, including bipolar disorder, depression, suicidality, and treatment adherence. He has contributed to research on reward and punishment sensitivity, emotion regulation processes, and the development of interventions for mental health conditions such as nonsuicidal self-injury, bipolar depression, and psychosis. His research also explores the implementation of evidence-based practices, barriers to treatment, and the use of innovative therapeutic approaches like acceptance-based behavior therapy and psychosocial interventions. Through his extensive publication record, he has advanced understanding of clinical features, treatment outcomes, and intervention strategies in psychiatric disorders.

Research topics

• Medicine
• Medical emergency
• Psychiatry
• Psychology

Selected publications

• Safety Planning vs Standard Care for Suicide Prevention After Pretrial Jail Detention

  JAMA Network Open · 2025-11-10 · 3 citations

  articleOpen access

  Importance: In the US, 1 in 5 adult suicide decedents has spent at least 1 night in jail in the year prior to death. Objective: To evaluate the effectiveness of the Safety Planning Intervention (SPI) with telephone follow-up as an adjunct to enhanced standard care (ESC) compared with ESC alone for reducing suicide events in the 12 months following release from pretrial jail detention. Design, Setting, and Participants: This randomized clinical trial included individuals with past 30-day suicide risk (suicide ideation with intent and/or suicide attempt) in pretrial jail detention who were recruited from 2 jails from May 11, 2016, to November 13, 2018, with a 12-month follow-up after release. Data analysis was completed from April 2023 to May 2025. Interventions: All participants received ESC. The SPI included a safety planning session in jail followed by 4 to 8 telephone calls 6 months after jail release. Main Outcomes and Measures: The primary outcome was the number of suicide events (a composite of suicide attempts and behaviors, suicide-related hospitalizations, and suicide deaths). Secondary outcomes included the number of suicide attempts, weeks and severity of active suicidal ideation, time to first suicide event, psychiatric symptoms, functioning, and hypothesized mediators. Suicidal ideation and behaviors were assessed using the Columbia-Suicide Severity Rating Scale, the Longitudinal Interval Follow-Up Evaluation, and record reviews from area hospitals. Deaths were identified through hospital, state, and national death records. Hospitalizations were measured with the Treatment History Interview and hospital records. Results: Of 800 participants randomized in jail, 655 (mean [SD] age, 33.0 [10.4] years; 473 males [72%]) were released to the community and included in analyses. Of those, 593 (91%) completed at least 1 follow-up interview. Medical records were available for all 655 participants (100%). Per person-year of follow-up over 12 months, those in the SPI group compared with those in the ESC group had 42% fewer suicide events (mean [SE], 1.82 [0.18] vs 3.11 [0.32]; mean [SE] difference, -1.30 [0.37]; P < .001), 55% fewer suicide attempts (mean [SE], 1.06 [0.14] vs 2.35 [0.33]; mean [SE] difference, -1.33 [0.38]; P < .001). Differences in weeks of suicidal ideation were not statistically significant (mean [SE], 10.39 [0.78] vs 12.86 [1.02]; mean [SE] difference, -2.47 [1.28]; P = .06). There were no other observed differences in outcomes. Conclusions and Relevance: In this randomized clinical trial of the SPI compared with ESC, those in the SPI group experienced reduced suicide risk by 42% in the year after jail release. These results suggest that SPI is effective for reducing suicide risk during this high-risk period. Trial Registration: ClinicalTrials.gov Identifier: NCT02759172.

  PublisherDOI

• Development and Pilot Testing of the Mobile Application to Prevent Suicide (MAPS)

  Cognitive Therapy and Research · 2025-01-09 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Patients Who Screen Positive for Suicide Risk Incidental to Their Chief Complaint in the Emergency Department: Characteristics and Post-Visit Suicide Outcomes

  Archives of Suicide Research · 2025-11-07 · 1 citations

  article

  OBJECTIVE: Universal screening improves suicide risk detection in individuals presenting to the emergency department (ED) who are not presenting with a psychiatric chief complaint, what we refer to as incidental risk. We sought to better understand characteristics of individuals who present with incidental risk and to evaluate their suicide-related outcomes after the ED visit. METHODS: Two samples (cross-sectional, longitudinal) from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study were used. Combined, the samples allowed for comparison of baseline characteristics and suicide-related outcomes for participants with incidental risk compared to those with negligible risk (any kind of chief complaint and negative suicide risk) and clinically congruent risk (psychiatric chief complaint and positive suicide risk). Univariable and multivariable logistic regression analyses were completed. RESULTS: Universal screening differentially improved the identification of suicide risk among non-white individuals, potentially reducing racial disparities in risk detection. Participants presenting with incidental risk were generally more similar to those with congruent risk than they were to those with negligible risk across demographics and clinical characteristics. Those with incidental suicide risk exhibited similar post-visit suicide-related outcomes compared to those with congruent risk, yet they were far less likely to receive clinical assessments and interventions during the ED visit. CONCLUSIONS: The results of this study highlight an opportunity to broaden evidence-based suicide prevention practices in the ED where logistically possible. EDs may need to consider redesigning their clinical approach to address suicide risk among those who present with medical complaints but screen positive for suicide risk.

  PublisherDOI

• The association between recency of suicide attempt and reattempt in adult emergency department patients

  General Hospital Psychiatry · 2025-12-20 · 1 citations

  article
  PublisherDOI

• Characteristics differentiating near-term multiple, distal multiple, and single suicide attempters during the 12-months post-discharge from the emergency department

  Journal of Psychiatric Research · 2025-10-04

  articleOpen access

  A history of repeated suicide attempts increases risk for subsequent attempts. Further, individuals with multiple prior attempts exhibit higher suicidal intent and make more lethal recent attempts than those with single attempt histories. However, prior research has not studied whether individuals who make multiple suicide attempts within a short time frame, ≤30-day period (“near-term attempters”), differ clinically from those who make multiple suicide attempts occurring more than 30 days apart (“distal attempters”) or a single attempt in the period following an emergency department (ED) visit. Exploratory secondary analyses were conducted using data from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Clinical telephone interviews were administered at 6, 12, 24, 36, and 52 weeks after the index ED visit, supplemented by chart reviews at 6 and 12 months. Participants ( N = 283) who reported at least one suicide attempt during follow-up were included and grouped based upon frequency and timing of follow-up attempts. Near-term attempters were compared to distal and single attempters on socio-demographic and clinical characteristics. Results indicated that near-term attempters had more suicide attempts prior to baseline, a higher incidence of nonsuicidal self-injury in the week before baseline, a higher prevalence of lifetime depressive disorder, and were more likely to have a primary care provider. They were also less likely to think about reasons for living and made earlier, more frequent attempts after the index ED visit. These findings could inform predictive models and interventions aimed at identifying and treating those at high risk for suicide. • ∼27% made near-term suicide attempts 12 months after emergency department discharge • Near-term attempters made sooner, more frequent attempts during follow-up • Near-term attempters were less likely to think about reasons for living • Near-term attempters reported more depression and recent non-suicidal self-injury • Near-term attempters had more prior attempts and primary care visits

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• An Open-Phase Pilot Trial of an Integration of Prolonged Exposure Therapy and the Coping Long-Term With Active Suicide Program

  Cognitive and Behavioral Practice · 2025-06-11

  articleOpen access

  • Posttraumatic stress disorder increases risk for suicide. • Prolonged exposure therapy was integrated with a suicide prevention program, CLASP. • CLASP-PE reduced suicidal ideation, PTSD, and depression. • Improvements in PTSD and depression predicted improvements in suicidal ideation. Posttraumatic stress disorder (PTSD) is associated with an increased risk for suicidal ideation and behavior, yet clinical practice guidelines for addressing suicide risk in the context of PTSD are not yet available. This open trial evaluated the safety and preliminary efficacy of an integration of a trauma-focused treatment, prolonged exposure therapy (PE), with the coping long-term with an active suicide program (CLASP). CLASP-PE was delivered to patients with PTSD who reported suicidal ideation with intent, a plan, or a past month attempt. Veterans or active-duty military personnel with a confirmed PTSD diagnosis and suicide risk (N = 14; 86% male) began the CLASP-PE protocol, which was delivered via telemedicine in 10–16 sessions, including a session with a support person as feasible. Two participants only provided baseline data; of the remaining 12, 8 participants (n = 66.7%) completed their treatment sessions. Participants reported significant reductions in PTSD symptoms ( p <.05), suicidal ideation ( p <.05), and depression symptoms ( p <.001). The degree of reduction in PTSD symptoms and depression symptoms in treatment predicted the degree of reduction in suicidal ideation in treatment. No suicide attempts or serious adverse events occurred in treatment. A case vignette is shared. CLASP-PE was safe, with preliminary evidence supporting its efficacy. Additional randomized controlled trial research is needed to evaluate its impact compared to a control group. If replicated, the CLASP-PE protocol would be a useful and safe clinical tool for individuals with PTSD who are experiencing significant suicide risk.

  PublisherDOI

• Rumination as a within-person indirect pathway between daily negative life events and suicidal ideation in recently hospitalized adults

  Journal of Psychiatric Research · 2025-05-23

  articleOpen access

  Negative life events are often implicated as a near-term risk factor for suicidal ideation (SI); however ruminative processes may play a critical role in amplifying the distress following experiences of negative life events, ultimately leading to greater suicide risk. In the present work, we examined whether rumination indirectly impacted the association between negative events and SI intensity in a day-level ecological momentary assessment (EMA) study. Participants ( N =107; M age =35.9 years, 65% female, 81% white) completed an EMA protocol for 65 days following psychiatric hospitalization. We used dynamic structural equation modeling to test a day-level, within persons model of direct and indirect effects between negative events, rumination, and SI intensity. After fitting the model across all people, we derived person-specific estimates to examine heterogeneity in the model parameters (i.e., while the indirect effect may be significant in the full sample, effect sizes may vary across individuals). Results indicated that the indirect effect of rumination was significant in the full sample (unstandardized estimate=0.026) and represented 38.058% of the total effect. Moreover, results for the person-specific examination indicated that the indirect effect was present for nearly all participants who reported SI at any point in their EMA data. Thus, in addition to highlighting the critical role that rumination can play in SI, this study also highlights the value in conducting person-specific research to understand the complexity and heterogeneity of psychological processes involved in suicide risk.

  PublisherDOI

• Daily Levels and Dynamic Metrics of Affective–Cognitive Constructs Associate With Suicidal Thoughts and Behaviours in Adults After Psychiatric Hospitalization

  Clinical Psychology & Psychotherapy · 2024-03-01 · 5 citations

  articleOpen access

  The period after psychiatric hospitalization is an extraordinarily high-risk period for suicidal thoughts and behaviours (STBs). Affective-cognitive constructs (ACCs) are salient risk factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within-person daily levels and between-person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65-day ecological momentary assessment protocol after discharge as part of a 6-month follow-up period. Using dynamic structural equation models, we examined both within-person daily levels and between-person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within-person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next-day suicidal ideation (SI). Same-day within-person higher rumination and negative affect were also risk factors for same-day SI. At the between-person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6-month follow-up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.

  PublisherOA PDFDOI

• Comparing Experiences of Community Reintegration Following Hospitalization Versus Jail Detention During a Mental Health Crisis.

  PubMed · 2024-06-03

  article

  BACKGROUND: This comparative qualitative study explores the experiences of individuals transitioning back to the community after institutionalization following an episode of acute suicidality. METHODS: Semi-structured interviews were conducted with eight individuals who had either been hospitalized (n=4) or incarcerated (n=4) during a mental health crisis that involved acute suicidality. Thematic analysis was conducted first within groups and then between groups. RESULTS: The findings reveal possible disparities in social determinants of mental health, family dynamics, treatment seeking, and coping mechanisms between groups. Social isolation, barriers to socioeconomic stability, and lack of treatment access were all found to be risk factors for poor outcomes during the vulnerable transition period and were experienced by participants in this limited sample. CONCLUSIONS: Individuals transitioning from the hospital after a suicide crisis may benefit from increased family involvement, follow-up, and social support at discharge. After a suicide crisis and incarceration, there is a significant need for housing and employment support to allow for mental health treatment seeking. Future research should build on the proof of concept for comparing the experiences of individuals across institutional settings.

  Publisher

• Development of the Mobile Application to Prevent Suicide (MAPS), a Personalized Smartphone App for Suicide Prevention: Feedback from Individual Interviews

  Journal of Technology in Human Services · 2024-04-02 · 1 citations

  articleOpen access

  The goal of this study was to explore preferences regarding the Mobile Application to Prevent Suicide (MAPS), an ecological momentary intervention smartphone app. We conducted individual interviews with 10 adults hospitalized for suicidal ideation or behavior. In these interviews, we asked about participants' preferences associated with smartphone apps for suicide prevention in general and requested feedback on the specific features of the MAPS intervention. We used line-by-line inductive coding to create a codebook and identify where codes were most prominently displayed. Participants expressed interest in personalized, targeted approaches to suicide prevention, psychoeducation, access to coping strategies, and direct access to crisis services. Involving individuals with lived experience in the early stages is an essential step in the development of a smartphone app for suicide prevention.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01NS037840

  NIH · $2.3M · 2005

• NIH Grant R01MH044778

  NIH · $1.8M · 1996

• NIH Grant R01MH101129

  NIH · $3.1M · 2020

• NIH Grant U01MH088278

  NIH · $11.7M · 2016

• NIH Grant R01MH097741

  NIH · $1.7M · 2019

Frequent coauthors

• Brandon A. Gaudiano

  Providence College

  389 shared

• Lisa A. Uebelacker

  Butler Hospital

  258 shared

• Lauren M. Weinstock

  Providence College

  237 shared

• Gabor I. Keitner

  221 shared

• Carlos A. Camargo

  Harvard University

  197 shared

• Gary Epstein‐Lubow

  John Brown University

  173 shared

• Sarah A. Arias

  Brown University

  166 shared

• Edwin D. Boudreaux

  161 shared