Associate Professor of Health Policy and Management
Specific areas of interest Dr. Miller, a physician with training in internal medicine, medical oncology, medical ethics, injury prevention, epidemiology and health policy has been the Associate Director of the Harvard Injury Control Research Center since the year 2000. Dr Miller has conducted extensive empirical research in injury and violence prevention and is the author of more than 50 articles and book chapters on fatal and non-fatal violent injuries (with special emphasis on suicide and homicide), unintentional injuries (including falls, fractures, overdoses, and motor vehicle crashes), and other topics including bioethics and ethical dilemmas in clinical cancer drug development. Recent projects include analysis of the relationship between physical illness and suicide among elderly Americans, the connection between recent changes in rates of homicide and suicide among African American youth, the relative risk of suicide and suicidal behavior among users of different classes of antidepressants, intentional and unintentional injury among users of prescription opioids, the effects of firearm legislation on rates of suicide and homicide, factors influencing public opinion about the inevitability of suicide, physician attitudes about the inevitability of suicide and the efficacy of restricting access to lethal methods as a suicide prevention strategy, Body-Mass-Index and the risk of suicide, the risk of suicide among veterans, immigration and suicide among Mexican and American cohorts, and the association between rates of household firearm ownership and rates of violent death.Current and incipient projects include:
- The relationship between physical illness and suicide. The chief aim of this study is to explore the impact of chronic disease on the likelihood of suicide among elderly individuals. This endeavor also evaluates whether individuals who complete suicide differ from others with similar medical conditions in their patterns of prescription drug use (such as the type of analgesic used for painful medical conditions).
- Ecologic determinants of suicide patterns in the U.S. over the past three decades. A series of studies that examine how changes in the availability of the most common mental health treatment for Americans (i.e., antidepressant therapy), the most common method of American suicide (i.e., firearms), and other ecologic factors (e.g., divorce, unemployment) help explain secular patterns of suicide in the U.S. over the past two decades. A related series of studies assess the relative contribution of these and other ecologic factors to secular changes in the incidence of non-fatal suicidal behavior (suicide attempts and ideation).
- Pharmacoepidemiological studies of the risk of suicide and unintentional injury associated with psychotropic medications. A series of studies that will examine the relation between antidepressants,other centrally acting agents, opioid and non-opioid analgesics and and the risk of suicide and unintentional injuries by quantifying the relative risk of completed suicide and non-fatal suicidal behavior associated with different antidepressant preparations across age groups
- The Rise and Fall of African American Suicide in the 1990s
An evaluation of factors that contributed to the unprecedented rise and fall of African American suicide rates in the 1990s. The variation in suicide rates appears to be driven by variation in rates of firearm (as opposed to non-firearm) suicide – and closely parallels the rise and fall in firearm homicides.
- Assessing the risk of fall-related injury and motor vehicle collisions among older adults initiating opioid analgesics. A cohort study that uses health care utilization data and pharmacoepidemiologic methods to assess the relative and absolute risk of unintentional injury among older Americans using opioid analgesics.
- Developing more accurate coding algorithms for identifying attempted suicide in heath care utilization data. A series of studies that attempt to create algorithms that increase the predictive power of identifying suicidal intent among administrative hospital data sets that currently do not parse suicide attempts from non-suicidal self-harm. These studies will also provide more accurate estimates of the rate of suicidal attempts and the mortality associated with suicidal acts that are sufficiently severe to result in a visit to an emergency department or admission to a hospital.
- Reassessing the risk of suicide among veterans. In collaboration with the Department of Veterans Affairs Healthcare System I am involved in a cohort study examining the risk of suicide among middle-aged and older veterans. In addition, a related cohort study using data from the Cancer Prevention Study II examines whether veterans are at increased risk of suicide when assessed years after they have separated from active military service.
- Evaluation of firearm legislation
An analysis of the effect of state level-legislation aimed at reducing unauthorized access to firearms on the rate of violent death among Americans.
- The relation between BMI and Suicidal behavior
- Attitudes about the inevitability of suicide among staff and physicians in an academic emergency department. A survey of psychiatrists and medical physicians that assesses beliefs about whether restricting access to lethal methods of suicide will save lives.
- Suicidal and Non-suicidal self harm among Boston high school students. A survey that examines the relationship between violence victimization and perpetration and deliberate self harm among Boston high school students. This study also attempts to identify other factors that distinguish deliberate self harm and that entails suicidal intent from deliberate self harm that does not.
- Ethical dilemmas in early stage cancer trials
- The relation between cancer drug development and organizational structure of biopharmaceutical firms.
Sc.D Harvard School of Public Health
M.P.H. Harvard School of Public Health
M.D. Yale University School of Medicine
B.S. Yale University