Welcome to a School of Medicine Faculty Research Theme (FReT)
Mental Health and Wellbeing
We aim to improve care for people with mental health problems by generating new insights and new evidence-based treatments. Our research covers a broad range of topics spanning common mental health problems (anxiety and depression) to severe mental illness across UK and global healthcare contexts.
Below you will find details about our team members, research studies, and networks.
BASIL (Behavioural Activation in Social IsoLation)
This programme of work was adapted at the start of the covid-19 pandemic building on an NIHR-funded programme MODS Managing multiple health conditions in Older aDultS.
The Chief Investigator is Professor Simon Gilbody, University of York, and Professor Carolyn Chew-Graham leads the qualitative work within BASIL and MODS as well as being part of the training team for the Support Workers in BASIL and MODS.
Find out more about BASIL
BALM (Behavioural Activation for Low mood and anxiety in Male NHS frontline workers: The BALM programme)
Read more about this programme: 'Male frontline NHS workers to be offered support from mental health programme designed by York researchers'.
CHOOSE study (Children and young people psychiatric diagnoses before and during the Covid-19 pandemic)
Funded by SPCR
Led by Dr Pearl Mok, Greater Manchester Safety Centre, University of Manchester
This research aims to:
- Look at how many children and young people in the UK have been diagnosed with a psychiatric disorder or have self-harm recorded in their GP records, comparing the periods before and during the Covid-19 pandemic. Specifically we will look at diagnoses of depression, anxiety disorders, eating disorders, attention-deficit/hyperactivity disorder, and autism spectrum disorder. We will also look at prescriptions offered in GP practices for medications used to treat mental health conditions, and how many children and young people have been referred to mental health services by their GPs.
- Work with children and young people, parents and other key partners to develop recommendations for GPs, other healthcare services, social services, schools and colleges, on how to help children and young people with their mental health difficulties.
We are working closely with the McPin Foundation, mental health charity, who are supporting the PPIE in this study.
We are working with:
- Young people who have had experience of mental health problems.
- Parents/family carers who have had experience of supporting a young person with mental health problems.
- Healthcare and educational professionals, including GPs, working with children and young people.
CLARENCE (CuLturally Adapting pRimary care mENtal health for the UK Central and eastern European community)
CASPER PLUS (Collaborative Care in Screen-Positive Elders)
CASPER PLUS was a study of a primary care-based psychological treatment, called 'collaborative care' for older people with depression. The study sought to establish clinical and cost effectiveness. Read our NIHR report. Article about CASPER PLUS.
Diabetes and Depression Study
This Diabetes and depression study focussed on the illness perceptions and explanatory models in patients with type 2 diabetes and co-morbid depression. The findings of this study will contribute to the development of patient-centred interventions using Cognitive Behavioural Therapy (CBT) principles.
The FIRESIDE study seeks to understand whether it is acceptable to utilise Fire and Rescue Service “Safe & Well” visits to support the detection of, and sign-posting for, mental health problems (anxiety and depression) among older adults.
Junior doctors and distress
An exploratory mixed method study to identify working conditions and work cultures associated with psychological distress and suicidality among junior doctors working in the NHS.
Research-informed film on junior doctors: @WellbeingNhs
MIR Study (Mirtazapine added to SSSRIs for treatment resistant depression in primary care)
This is a randomised controlled trial which aims to test whether the addition of the antidepressant 'Mirtazapine' is effective in reducing the symptoms of depression compared with a placebo in patients who have been treated with Serotonin Selective Reuptake Inhibitor (SSRI) or Serotonin Noradrenaline Reuptake Inhibitor (SNRI) for at least six weeks. >>link to MIR
NOTEPAD Study (NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression)
This NOTEPAD study was a collaboration with Age UK North Staffs, and tested the feasibility of training third sector workers to deliver and intervention to older people with anxiety and depression. Read our NIHR report. See other study outputs including published papers and training materials.
Information on this study can be found in our Comorbid physical and mental health problems section.
SPCR drugs and mental health workshop: Reducing antidepressants
Stress and burnout in General Practitioners
Stress and burnout in General Practitioners is a study which explores the barriers and facilitators for General Practitioners to access support when they are experiencing stress/burnout and/or reduced emotional or mental well-being. This study is funded by SPCR.
- Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study
- The experiences of general practitioner partners living with distress: An interpretative phenomenological analysis
- What are the sources of stress and distress for general practitioners working in England? A qualitative study
- 'Treading water but drowning slowly': what are GPs' experiences of living and working with mental illness and distress in England? A qualitative study
RIDDLE Study (Realist review of Interventions for Depression Delivered by ‘non-traditional’ providers to oLder pEople)
This study aims to solve the riddle of how, when and where interventions to detect mental health problems in older people, delivered by "non-traditional" providers (e.g. fire and rescue service, police, library services), work.
CHEMIST (Community pHarmaciEs Mood Intervention STudy)
The study aims to find out whether brief psychological support provided via community pharmacies may help people living with long-term health problems to maintain a healthy mood. The study is being undertaken at various community pharmacies within the North-East of England.
- Article: A psychological intervention by community pharmacies to prevent depression in adults with subthreshold depression and long-term conditions: the CHEMIST pilot RCT
- Find out more at york.ac.uk
CRIISP (Consortium to Research Individual, Interpersonal and Social influences in Pain)
Researchers at Keele University are working with teams in 7 other institutions on the CRIISP programme:
Our research will focus on how people perceive pain and how others affect their pain, as well as consider wider social and environmental influences on pain.
Distress and cancer
- Taylor AK, Chang D, Chew-Graham CA et al. ‘It’s always in the back of my mind’: understanding the psychological impact of recovery following pancreaticoduodenectomy for cancer: a qualitative study. BMJ Open. 2021;11:e050016. doi:10.1136/ bmjopen-2021-050016
- Taylor AK, Kauser A, Chang D, Phelan A, Chew-Graham CA. ‘You know where we are if you need us.’ The role of primary care in supporting patients following pancreaticoduodenectomy for cancer: a qualitative study. BJGP Open. https://doi.org/10.3399/BJGPO.2021.0154
This ENHANCE study examines the feasibility and acceptability of a new integrated care approach. The intervention focuses on the under-diagnosis and management of osteoarthritis related pain and anxiety and/or depression in patients with LTCs (asthma / COPD / hypertension or ischemic heart disease / diabetes) in primary care.
INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs)
To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care.
- Hider SL, Bucknall M, Cooke K et al. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; Identifying multimorbidity: Protocol for a pilot randomised controlled trial. Journal of Comorbidity 2018. Aug 2; 8(1):2235042X18792373.
- Hider S, Bucknall M, Jinks C et al. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot and Feasibility Studies (Jan 2021) 7:9 https://doi.org/10.1186/s40814-020-00750-7
MODS (Multimorbidity in OlDer adultS)
This study seeks to evaluate the use of behavioural activation to support mental health needs of older people with multiple long-term conditions.
The DeTRESSpain study, funded by Versus Arthritis, is led by Professor Tamar Pincus at University of Southampton. The research team aim to develop an intervention to support people with pain-related distress.
Chew-Graham led phase 1 which was a qualiative study, with interviews with people with persistent pain and with GPs. The first paper from this work has just been published.
- Shivji NA, Geraghty A, Birkinshaw H, Pincus T, Johnson H, Little P, Moore M, Stuart B, Chew-Graham CA. Supporting people with pain-related distress in primary care consultations: a qualitative study. BJGP 2022. 0120. DOI: https://doi.org/10.3399/BJGP.2022.0120
The Stoma Support Study
Individuals with inflammatory bowel disease (IBD) and who have stoma surgery frequently experience distress, and are at increased risk of developing depression with a higher likelihood of being prescribed antidepressant medication compared to those without a stoma. Stoma-related distress may be particularly salient in young people (aged 16-35) who may also be undergoing major life transitions.
This SPCR-funded study aims to co-design the content and format of an evidence-based, theory-informed online intervention to provide support for stoma-related distress in young people. The intervention will comprise two components:
- a brief information and training package for healthcare professionals to enhance identification and management of stoma-related distress
- a resource to support young people to self-manage and reduce distress, through improving their confidence and self-efficacy in dealing with distress, and equipping them with coping skills and strategies
SYMPHONI (SYstems approach to Mental and Physical Health in people with lONg-term conditions)
- Funded by CRN Impact and Innovation call for implementation (12-month project) hosted at MPFT
- This project aims to explore the barriers and enablers of engaging with healthcare reviews for people with multimorbidity to address mood and lifestyle factors such as obesity, smoking and low physical activity.
- We are using individual patient interviews and focus groups with professional stakeholders, informed by Community of Practice approaches.
WAVE (Work And Vocational advicE)
This study seeks to find out whether a brief vocational advice intervention for patients that receive a fit note for time off is effective (and cost-effective) in reducing the number of days lost from work.
- Wynne-Jones G and Chew-Graham CA. Why GPs must not lose their role in supporting people back to work. Life and Times, BJGP. 2022 DOI: https://doi.org/10.3399/bjgp22X719141
IDEA Study (Indicators of DEmentiA outcomes)
IDEA is a qualitative study of patients with dementia, caregivers of those with dementia, and healthcare professionals on outcomes and markers of disease progression.
MEDDIP Study (MEasurement of Dementia Disease progression in Primary care)
MEDDIP is an epidemiological study seeks to identify markers of dementia progress using primary care data.
While grief is a universal human response to loss, understanding the psychological dynamics which might contribute to complex reactions and coping difficulties, fit within a wider frame of concern for mental health. The Range of Response to Loss Model (RRL) is a theory of grief which articulates these dynamics and the Adult Grief Scale (AAG) is an associated measure used to map/profile individual grief. It is used especially with people who seek help in bereavement and is a model and measure used across a wide range of health and social care settings.
Find out more about mapping grief.
Grief and loss
Linda Machin (PhD) was formerly a lecturer in social work and counselling at Keele, and is now an Honorary Research Fellow of the University. Linda developed a theory of grief, the Range of Response to Loss model and a number of practice measures associated with that e.g., the Adult Attitude to Grief scale, which are being widely adopted in bereavement and hospice services in the UK and beyond. She continues her specialist focus on grief, pre and post bereavement: engaging in further research with the International Observatory on End-of-Life Care at Lancaster university; training psychosocial practitioners; and advising national services e.g., Cruse - Bereavement Care, Sue Ryder Care, in their strategic adoption of her grief measures and the development of a new triage tool.
Grief is often thought of as singularly linked to an experience of bereavement, but it is a reaction triggered by any significant life loss – a broken relationship, important changes in physical or mental health, financial concerns, social isolation – as well as the death of someone close.
The initial impact of a significant life loss will activate instinctive feelings and thoughts that have been shaped by family and wider cultural influences and assimilated into our personality. The consequent variation in the individual way grief is first experienced and expressed can be seen on a spectrum from those who are overwhelmed by loss to those who avoid engaging with it by appearing in control or people who range across the two extremes. Distressed emotions and disturbing thoughts often feature as immediate reactions to bereavement/loss.
A second dimension of grief is characterised by the conscious attempt to cope with the consequences of the bereavement/loss:
- accepting the reality/finality of the loss,
- its personal impact on feelings and thoughts,
- the social and relationship changes which need to be made/accommodated,
- making sense of what has happened.
Support for people who grieve is important. The challenges of loss are best met within our own social network – friends, family, and colleagues. While for some people counselling may be necessary for most people it should not be the first option of support. What is most important is:
- someone who understands not everyone grieves in the same way, and that some of the early theories e.g., 5 stages of grief, have been unhelpful in recognising the range of differences in grief response,
- someone who can listen without giving advice or using it as a platform for their own experience,
- someone who is patient with the ups and downs of grief and the time it takes,
- someone who knows when to encourage ‘resting’ from grief and offers support in diversionary activity,
- someone who knows when to ask for help for themselves as a supporter.
Bonanno, G. A., & Lilienfeld, S. O. (2008). Let's be realistic: When grief counselling is effective and when it's not. Professional Psychology: Research and Practice, 39(3), 377–378. https://doi.org/10.1037/0735-7028.39.3.377
Stroebe M, Schut H, Boerner K. Cautioning health-care professionals: bereaved persons are misguided through the stages of grief. Omega (Westport) 2017; 75: 455–473. DOI: 10.1177/0030222817691870
Services which might be of use:
The Metaphors Study
This study explored whether Metaphors usefully represent the underlying cognitive behavioural therapy (CBT) principles for medically unexplained symptoms (MUS), and how acceptable such generic and MUS specific Metaphors are to patients and practitioners.
Perinatal Anxiety (Study 1)
A qualitative study to explore perspectives of Health Care Professionals in primary and specialist care about perinatal anxiety.
Perinatal Anxiety (Study 2)
This study explores the perspectives of women with lived experience of perinatal anxiety.
A multi-centre randomised clinical trial which studies a group of psychological interventions for post-natal depression in British mothers of South Asian origin. >>link to ROSHNI-2.
CLAssification, outcomeS and interventions for Perinatal anxiety
This two-year study is funded by the School for Primary Care Research (SPCR). The aim of the study is to improve identification, management and quality of care for women with perinatal anxiety (PNA).
The term “perinatal anxiety” refers to anxiety (excessive worrying, restlessness, nervousness) that occurs during pregnancy and/or up to 12 months after birth. During this period, women are at greater risk of experiencing common mental health disorders such as depression and anxiety. Our research will help raise awareness about this and support healthcare decisions, which is of further importance given that COVID-19 pandemic has resulted in higher number of pregnant women experiencing mental health problems.
Previous research has focused on depression during the perinatal period, but we know much less about anxiety. What we do know is that anxiety may be comorbid with depression, poor quality of life and may impact child development. Previous research conducted by Keele MH&WB FReT members examined the experiences of diagnosis and treatment of perinatal anxiety from health care professionals’ and women’s perspectives. Knowledge about perinatal anxiety amongst health care professionals is limited and women describe barriers of access to acceptable treatment.
The CLASP study includes two studies. The first is the database study, which will use information from a large national database of anonymised patient records (CPRD) to identify different groups of women to compare: women who are pregnant and those who are not, women with children and those without and women with perinatal anxiety and those without. We will assess the following:
- the role of pregnancy and anxiety in terms of health and healthcare use.
- whether the children of these women experience different patterns of healthcare use.
- whether women with perinatal anxiety can be grouped according to background factors (age, deprivation), pregnancy details (gender of the baby, delivery method and outcome), lifestyle choices, and other medical conditions.
- groups at greatest risk of increased healthcare use and those more likely to go on to experience severe mental health problems.
The second study uses qualitative methods – we will use semi-structured interviews with women who have had perinatal anxiety (PNA) and a range of different healthcare providers (such as GPs and midwives). These interviews will help us to understand views on labelling women by risk, healthcare management, and training needs for staff. The recruitment of participants for this study will mostly be done using social media platform (e.g., Twitter) and using professional networks. We will also recruit from NHS sites.
The qualitative data generated during this study also complements Dr Victoria Silverwood’s PhD, which is closely aligned to CLASP and would like to understand how Optimal Interventions for Perinatal Anxiety are defined and aims to define a framework for an intervention for PNA.
The research findings from CLASP will be used to improve the awareness of PNA and to better inform decisions about treatment. Findings will be shared with members of the public and healthcare professionals. In the future, the team will look into how the findings from this study may lead to the development of new treatments for women at risk of PNA.
There has been extensive PPIE input to the PhD study as well as towards CLASP and patient advisory groups (PAGs) have supported the development of the grant application. These groups are providing support and advice during the research. The research team has also established a clinical advisory group (CAG), particularly for CLASP study, which will oversee the progress of the study and contribute to the end-of-study workshop.
C-MAP (Culturally adapted Manual Assisted Problem solving training)
This study conducted a multi-centre trial to evaluate the clinical and cost-effectiveness of C-MAP in patients with a history of self-harm in Pakistan.
- Kiran T, Chaudry N, Bee P, Tofique S, Farooqe S, Quershi A, Taylor AK, Husain N, Chew-Graham CA. Clinicians’ perspectives of self-harm in Pakistan: a qualitative study. Frontiers in Psychiatry. May 2021. https://doi.org/10.3389/fpsyt.2021.607549
Self-harm in older adults
As part of World Suicide Prevention Day, The Royal College of General Practitioners published a podcast that features mental health clinical champion, Dr Elizabeth England, and Chair of RCGP scientific foundation board, Carolyn Chew-Graham, discussing self-harm and suicide prevention.
Self-harm in younger people
The COPING study will work in partnership with young people aged 16-25 with lived experience of self-harm and GPs to develop a treatment guide (called COPING) for GPs to use with young people to reduce repeat self-harm.
Self-harm in people with musculoskeletal problems
- Prior J, Crawford-Manning F, Whittle R et al. Vertebral fracture as a risk factor for self-harm: A retrospective cohort study. BMC Musculoskeletal Disorders. 22 article 757 (2021) DOI: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04631-9
Closing The Gap (CTG) network
- Keele University is a member of the CTG network. The network seeks to understand why people with severe mental illness have some of the worst physical health issues of any section of the population. The network is led by colleagues at the University of York. >>link.
- Physical health inequalities in imprisoned women with serious mental illness: Following the award of funding from the ‘Closing the Gap’ Network (CTG), this project aims to develop a new, multidisciplinary (and cross-institution) collaboration of clinicians, researchers, individuals with lived experience, charities to address the physical health inequalities of women in prison. Read more about this project in our blog.
- Chew-Graham CA, Gilbody S, Curtis J, Holt R, Taylor AK, Shiers DS. Still ‘Being Bothered about Billy’ – managing the physical health of people with severe mental illness. BJGP August 2021 DOI: https://doi.org/10.3399/bjgp21X716741
Developing and user testing iSWITCHED (implementing SWITCHing EDucational intervention) to support switching antipsychotics to improve physical health outcomes in people with severe mental illness. Please visit the iSWITCHED webpage for further information about this study.
Personalised care for early psychosis: the EXTEND study
Keele University is a research partner in the NIHR-funded EXTEND programme, which is investigating the impact of duration of Early Intervention in Psychosis services (EIPs) on health outcomes. EXTEND is a collaborative programme, bringing together research institutions, NHS Trusts, and embedded public and patient involvement and engagement. Prof. Carolyn Chew-Graham is Lead Investigator for the qualitative studies embedded within EXTEND.
For Work Package 1, we will conduct interviews with service users, carers, health care professionals, commissioners, and managers, exploring experiences and views of EIP services and decision-making about, and preparation for, discharge from EIP service; and arrangements for ongoing care. We will develop a framework for understanding how decisions are made about duration of care within EIP services.
For Work Package 2, we will conduct detailed case studies with individuals previously under the care of EIP, their carers and health care professionals, to understand the benefits and limitations of the current time-limited EIP model.
SPCR drugs and mental health workshop: Antipsychotics
SPCR drugs and mental health workshop: Bipolar disorder
Development and early testing of SPIRIT (Schizophrenia Prediction of Resistance to Treatment), a clinical tool to predict treatment resistance to anti-psychotics in First Episode Schizophrenia
Qualitative study to explore views of healthcare professionals and people with schizophrenia on switching of anti-psychotic medication, barriers, facilitators and current practices.
- Nash A, Kingstone T, Farooq S, Tunmore J, Chew-Graham CA. Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals perspectives. BMJ Open Feb 2021. http://dx.doi.org/10.1136/bmjopen-2020-042497
Whilst this work was done by members of the MH&WB FReT, we are not suggesting that Long COVID is a mental health condition.
We have two Long COVID studies at Keele:
Hi-COVE - led by the University of Westminster
Hearing from the unheard: impact of long-COVID in minority ethnic groups in the UK
SPLAT-19 - led by Victoria Welsh at Keele
SPLaT-19 (Symptom Patterns and Lived experience of Long- COVID in children and adolescenTs).
Previous work on Long COVID:
- Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID: https://doi.org/10.3399/bjgpopen20X101143
- 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID: DOI: 10.1111/hex.13223
- Long COVID in children and young people: uncertainty and contradictions: https://doi.org/10.3399/bjgp22X719501
- Long COVID RCGP learning module
- Long COVID - what every employer needs to know
- Why every school needs to worry about Long COVID
Keele Mental Health Research Group
The School of Primary, Community and Social Care (then Research Institute for Primary Care and Health Sciences) established a research partnership with Midlands Partnership NHS Foundation Trust in 2014. The group comprises clinicians, academics and other mental health professionals and aims to improve care for people with mental health problems in primary and specialist care.
CARE 75+ (The Community Ageing Research Study 75+)
We are working with West Midlands Clinical Research Network to recruit to the CARE 75+ study which aims to understand how to better identify and manage frailty within primary care. This is done by collating an extensive range of health, social and economic outcome data from community dwelling people from the age of 75 and over.
Closing The Gap: Health and Wellbeing (CTG:HWB) cohort
The CTG:HWB Cohort is an important resource that underpins the Closing the Gap network and allows the team to approach people with severe mental ill health (SMI) to participate in the Closing the Gap network research programme. Keele University and Midlands Partnership NHS Foundation Trust are supporting this cohort.
Closing The Gap Primary Care Special Interest Group
This group provides a forum to discuss current evidence and develop new research ideas to support CTG objectives within the context of primary care. The group is co-led by Carolyn Chew-Graham (Keele) and Caroline Mitchell (University of Sheffield)
FRRESH (Forum for Rural RESearch on Health and well-being)
The FRRESH initiative aims to address the current rural gap in research through community engagement to drive research development. The forum has been established to provide a fresh perspective on rural health and wellbeing and is funded by Keele Innovation Fund.
Ethnic inequalities in mental health and primary care
Dr Paul Campbell
Research Fellow: Symptom Epidemiology
- DJW 1.51
- +44 (0)1782 734828
Professor Carolyn Chew-Graham
Professor of General Practice Research
- DJW 1.109
Dr Gill Cooke
Honorary Senior Lecturer
Dr Jason McDonald
Honorary Senior Lecturer
Dr Aaron Poppleton
Wellcome Trust funded PhD student in Primary Care
- Keele University
Dr Noureen Asif Shivji
Research Associate: Applied Qualitative Health Research
- DJW 0.110
- +44 (0) 1782 732923
Dr Victoria Silverwood
Clinical PhD Fellow
- Keele University
We also have a team of Honorary Senior Clinical Lecturers:
- Dr Rashi Negi
- Dr Manoj Kumar
- Dr Nwe Thein
- Dr Mohammed Gul