Background: Older people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety symptoms in older victims of crime. Methods/design: People aged 65 years or more who report being a victim of crime will be screened by Metropolitan Police Service Safer Neighbourhood Teams within a month of the crime for distress using the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2. Those who screen positive will be signposted to their GP for assistance, and re-screened at 3 months. Participants who screen positive for depression and/or anxiety at re-screening are randomised to a CBT informed VIP added to treatment as usual (TAU) compared to TAU alone. The intervention consists of 10 individual 1-h sessions, delivered weekly by therapists from the mental health charity Mind. The primary outcome measure is the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI), used as a composite measure, assessed at 6 months after the crime (post therapy) with a 9-month post-crime follow-up. Secondary outcome measures include the EQ-5D, and a modified Client Service Receipt Inventory. A total of 226 participants will be randomised VIP:TAU with a ratio 1:1, in order to detect a standardised difference of at least 0.5 between groups, using a mixed-effects linear-regression model with 90% power and a 5% significance level

We aimed to conduct the first systematic narrative review and quality appraisal of existing evidence on the psychological consequences of crime in older victims in the community and psychological interventions. We searched five databases to identify all peer-reviewed literature published in English on psychological impact and/or interventions for older crime victims and quality appraised these using the Mixed-Methods Appraisal Tool, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (Prospero: CRD42019140137). Evidence from included studies were narratively synthesized, along with their strengths and limitations. We found 20 studies on psychological distress in older victims, four of which included interventions. From these, we identified 30 different impacts including symptoms of anxiety, depression, post-traumatic stress disorder, emotions including humiliation and self-blame, and behavioral changes. Only feasibility interventions have been published, although promising results were reported for cognitive-behavioral informed treatments for depression and anxiety. Studies were wide-ranging in aims, crimes included, and outcomes used. Recommendations for improving the evidence-base and to raise the profile of this neglected population have been provided.

Objective: There is growing need to strengthen support for older crime victims. We aimed to explore spiritual and/or religious (S/R) beliefs in a sample of older victims and understand how this shapes psychological responding and coping with crime. Method: Qualitative study with supplementary descriptive statistics nested within a clinical trial. We explored psychological responding and coping in-depth through semistructured interviews with 27 older victims of police-reported crime, purposefully sampled to achieve maximum variation. We inductively analyzed data using a reflexive thematic analysis. We assessed the breadth of S/R beliefs in a large sample (N = 402) of initially distressed older victims using an abbreviated version of The Royal Free Interview for Spiritual Beliefs. We assessed continued psychological distress using the two-item Generalised Anxiety Disorder and Patient Health Questionnaire 3 months postcrime. Results: Over twothirds (67%) identified as S/R, but psychological distress scores were similar, irrespective of religiosity. Our qualitative analysis suggests that crime may impact religious identity or practice in some older victims (hate crime) but influences attitudes or coping in others. Positive coping included acceptance, forgiveness, and/or turning to prayer or faith communities. Negative coping included fixation on retribution, superstition, perceived abandonment by God, or an inability to accommodate the crime within their beliefs, amplifying psychological distress. Conclusions: Understanding the psychological impact on older crime victims is enhanced by clarifying the role of S/R. Further research, especially on non-Christian religious victims, is needed. Cultural awareness training for trauma counselors and trauma awareness training for faith leaders is recommended. Clinical Impact StatementCrime can be psychologically distressing in older people. Of 402 older victims, two-thirds were religious or spiritual. Psychological distress scores were similar regardless of faith. In-depth interviews with 27 older victims found that acceptance, forgiveness, praying and support from faith communities helped distress. Justice-seeking, superstition, feeling abandoned by God or being unable to explain the crime within religious beliefs appeared to make distress worse. It is important therapists understand coping styles in the context of a person's religious or spiritual beliefs when working with distressed older victims.