The clinical and cost-effectiveness of a Victim Improvement Package (VIP) for the reduction of chronic symptoms of depression or anxiety in older victims of community-crime: the VIP RCT Synopsis

Background: Little is known about the psychological impact of community crime in older victims, whether signposting to their general practitioner is helpful, or the barriers and facilitators to help-seeking. Previous pilot work suggested that a ‘cognitive–behavioural therapy’-informed Victim Improvement Package showed promise for treating psychological distress in older victims, but further evaluation was needed.

Methods: The study was undertaken between June 2017 and June 2023 in selected areas of a United Kingdom city using Safer Neighbourhood Teams. Safer Neighbourhood Teams consist of a group of police personnel, working across several local authority areas, who are dedicated to managing victims in the community. Within 2 months of the crime, police Safer Neighbourhood Teams screened 3192 victims, aged 65 or over who had reported a crime, for psychological distress using the Generalised Anxiety Disorder-2 and Patient Health Questionnaire-2 items. Those identified as distressed were advised (signposted) by the police to seek help from their general practitioner. The impact of signposting was evaluated using qualitative and quantitative methods. At 3 months post crime, 877 older victims were reassessed by our researchers and, if still distressed, invited to participate in a randomised controlled trial. This compared the addition of our Victim Improvement Package to treatment as usual against treatment as usual alone. The Victim Improvement Package used a manual to guide our talking therapy (cognitive–behavioural therapy), delivered individually and weekly, for up to an hour by a mental health charity. Up to 10 sessions were.

Outcomes: The Beck Depression Inventory, version 2, and the Beck Anxiety Inventory, combined in a composite score, were used to evaluate clinical effectiveness. Measures were collected at baseline (3 months post crime), post intervention (primary end point) and follow-up; 6 and 9 months post crime, respectively. Cost-effectiveness was evaluated using the EuroQol-5 Dimensions and a modified Client Service Receipt Inventory.

Results: The police screened 24% of older victims (n = 17,611) in our selected areas. A third of the police screened victims were significantly distressed, and for those we rescreened at 3 months post crime, almost half remained distressed. Few distressed older victims (13%) approached their general practitioner (barriers included wait times and personal beliefs they should cope), and only a third of those who did so received help. One hundred and thirty-one participants were randomised (65 = Victim Improvement Package; 66 = treatment as usual) at 3 months post crime. The primary outcome was completed in 87 (66.4%). The Victim Improvement Package was acceptable to participants, although it was not possible to recruit our target sample of 226, because of a number of hurdles, which included changes in police leadership, the coronavirus disease discovered in 2019 pandemic and possible reduced confidence in the police. We report on these, the lessons learnt and make recommendations for further research. No treatment effect was found for the Victim Improvement Package. Mean Victim Improvement Package −0.41 (standard deviation 0.89) versus mean treatment as usual −0.19 (standard deviation 1.11); adjusted difference in means −0.039, 95% confidence interval (−0.39 to 0.31) and the Victim Improvement Package was not cost-effective.

Limitations: Recruitment was challenging, with insufficient numbers recruited to meet the sample size calculation. While appearing representative of the population, only 0.7% (131/17,611) of older victims reporting a crime participated in the trial. Assessing the quality of delivery of cognitive–behavioural therapy was challenging.

Conclusions: Crime significantly psychologically impacts older victims, with chronicity of symptoms. Distress can be identified by incorporating screening into routine police visits. While Victim Improvement Package remains acceptable and promising, more research is needed, including the feasibility of using typical clinical services to assess clinical effectiveness.