Quantitative.

1. To generate descriptive statistics on older victims’ help-seeking behaviour.
2. To determine the predictors of help seeking in older crime victims’ of crime.

Qualitative.

To qualitatively explore what older victims consider the barriers and facilitators to help-seeking and their views on the signposting letter in a subset of older victims selected from the quantitative study.

Signposting older victims to their General Practitioner (GP).

Participants were recruited by Safer Neighbourhood Teams dealing with community-based offences during home visits within 2 months of the crime. In addition to their usual advice and support, Safer Neighbourhood Teams screened older victims for depressive and anxious symptoms using the GAD-2 and PHQ-2 [14, 15] after obtaining consent to share the university screening data with the research trial team. All victims were provided with information about the potential impact of crime. Screen-positive victims were given a letter signposting them to their GP, signed by the VIP trial chief investigator. The letter stated they had suffered a crime and screened as significantly distressed on the GAD-2 and PHQ-2 and suggested the GP should manage them as they deem appropriate. Participants who screened negative were also given a GP letter making them aware of potential symptoms that could present following a crime and suggested that if they experienced further distress, they should approach their GP. University researchers followed-up with consenting screen positive older victims within three months of crime through home visits or telephone and were re-screened for continued symptoms on the GAD-2 and PHQ-2, and also asked whether they had given the letter to their GP and what help they had received, if any.

Measures.

Depressive and anxious symptoms at one month (screening) and three months (re-screening) post-crime were assessed using a four question pro-forma consisting of the PHQ-2 [14] and GAD-2 [15], with participants asked to rate how much they felt bothered by depressive and anxious symptoms over the previous two weeks on a 4-point scale. Caseness was determined by a score of ≥ 3 on the PHQ-2 and ≥ 2 on the GAD-2, as recommended for use in older adults [16]. The PHQ-2 and GAD-2 have been used previously in older victims [2, 9] and their brevity and simplicity meant they could be reliably administered by Safer Neighbourhood Teams with a half day’s training.

Descriptive statistics.

Using a one-page questionnaire, data were collected on older victims’ sociodemographic characteristics, living arrangements, social networks, and crime characteristics. At re-screening, the questionnaire was extended to ask initially screen-positive older victims whether they remembered receiving the signposting letter (yes/ no), whether they gave the letter to the GP (yes/ no) and, if yes, what action the GP took (free response). For categorical data, the number of observations and percentages will be presented. For continuous data, means and SDs will be presented under the assumption that the data is normally distributed.

Help-seeking behaviour was measured by whether screen positive participants acted on their signposting letters. Among participants who remembered receiving the signposting letter, demographic and crime related characteristics were summarised using mean, standard deviation, count and percentage where applicable.

Analysis of predictors of acting on signposting in older victims.

Demographic data collected by Safer Neighbourhood Teams at initial screening were analysed using univariable logistic regression to determine predictors of acting on signposting. Given the dearth of research determining help-seeking in older victims of community crime, we used a predominantly data-driven approach, although we did consider variables known to be associated with access to health care and help-seeking in other victim groups [8, 12]. These included: age, gender, ethnicity, marital status, education, living arrangements, number of social contacts, previous depression, Crime Reporting Information System score (a measure of vulnerability), crime type, whether they were a previous victim, whether perpetrator arrested, daily life affected, sense of safety before and after crime, severity of depressive symptoms at step 1, severity of anxious symptoms at step 1, and screening outcome at Step 2.

Participants’ responses to whether they had given the letter to their GP were categorised into a binary outcome variable (yes/no). A small number reported seeing their GP for further help without the letter which we classified as ‘yes’ as it was still help-seeking. Any responses which could not be classified as yes/no were coded as missing. Logistic regression models were used to investigate the association between participants’ characteristics and help-seeking behaviours. Univariable logistic regression models based on P<0.2 were used to screen potential predictor variables on help-seeking behaviours as a method of variable selection. Multivariable logistic regression models and backward elimination method with P<0.05 were used to select a final set of variables as the predictors. No consensus exists about the best method for selecting the predictor variables, but backward elimination is generally the preferred method [17]. This analysis was conducted using Stata version 17.

Study of barriers and facilitators to help-seeking.

Twenty-seven semi-structured interviews were conducted with older crime victims to explore the barriers and facilitators to using the GP signposting letter and help-seeking in depth. Purposive sampling was used to achieve a sample that was diverse across gender, age, ethnicity, religion, crime type, positive and negative outcomes on the PHQ-2 and GAD-2 at both screening and re-screening, and use of the GP letter recorded at re-screening. Older victims were invited to participate during re-screening home visits or telephone calls and, if agreeable, a separate interview visit arranged, with the aim of establishing rapport in advance. The interviews were conducted pre-randomisation to the VIP trial.

The interview topic guide, enquired about the older victims’ background and details of the crime before asking about their understanding and experience of different support services, reasons why they did or did not seek help, and views about the signposting letter. Questions were open-ended. Interviews were conducted by the researchers through home visits or at the university as preferred by the participant and were mostly one-to-one except for three participants who chose to have a family member present. Interviews ranged from 34–132 minutes and lasted on average 73 minutes, of which an average of 30 minutes was spent discussing help-seeking. Interviews were audio recorded and transcribed verbatim.

Positionality statement.

Our research team is made up of qualified mental health professionals (MS, JS, JB), a GP (MB), and statisticians (VV and TL). Some of our team have been crime victims and reported to the police but have not sought mental health support for this. The authors recognise their previous experiences in mental health research may have influenced their expectations of what might appear in the data.

Qualitative sample characteristics.

Older victims (N = 27) from step 1 and 2 participated in qualitative interviews (Fig 1). Participants ranged from 65 to 94 years in age (M = 74; SD = 8.05) and 16 (59%) were female. As shown in Table 4, there was a mixture of sociodemographic characteristics, crime types, those who did and did not seek help, and screening outcomes at both step 1 and step 2 in the sample.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 4. Characteristics of older victims in the qualitative interviews.

https://doi.org/10.1371/journal.pmen.0000082.t004

Service use in the qualitative sample.

Of our 27 qualitative participants, only five had discussed the crime with their GP and two other interviewees took their letter to the GP but did not hear anything further: “The [doctor] said, ‘we’ll let you know,’ but I haven’t got it back… it’s like nearly two months now.” (P5). Of those that discussed with their GP, one was referred to counselling, one received practical help in the form of a supporting letter to their housing association, and the other three received no action but said talking to their GP was helpful. Of the remaining participants who did not act on their letter, 14 remembered receiving it, suggesting awareness is not enough for help-seeking. When asked for their views on the letter, all of them thought it was a good idea for other people. However, they often did not think it was needed for themselves: “It’s a good idea, you know, to try and help people and that… but for me, I suppose I thought it wasn’t necessary” (P22).

There were a few examples of participants who visited their GP because they were distressed: “I was feeling pain, I went to my doctor… you know because every day I cry” (P23). Some did not seek help simply because they considered it unnecessary: “If I waltzed in there, sat down and said, ‘I had an attempted burglary, but I feel okay,’ she’d go, ‘what the hell you doing here?’” (P3). However, others were distressed but still did not attend: “I don’t fancy running around on antidepressants…but I am a bit depressed” (P21).

Perception of themselves.

Some participants did not seek help because they felt personally responsible for the crime. One participant, who had Parkinson’s Disease, explained: “One consequence of the event was feeling I might be increasingly incompetent about things like locking the car… So when the boot was empty, £150 quid’s worth of stuff, the biggest effect was to say to myself what an idiot I’d been leaving the car door open” (P9). Feelings of shame and self-blame were also reported by victims of deceptive crimes such as fraud and distraction burglary: “You feel a bit ashamed that you let it happen without realising." (P6). Despite feeling distressed, these feelings were barriers to seeking informal support from their friends: “I felt stupid… I didn’t tell my friends I had been scammed” (P15).

Some older victims expressed views that they should ‘just get on with it’ (P16). Some felt they should be able to cope by themselves: “You’ve got to cope with things, you’re on your own and it’s up to you” (P22) even when family were encouraging them to seek help: “I have emailed her GP to tell her… and social services” (P22—daughter). Some seemed to interpret help-seeking as meaning they were less independent: “I’m what you’d call, really independent. I’ve had Victim Support before, and it’s not helped me, because it’s not relevant to me, because I’ve got my own mind” (P7) or that it was a sign of weakness: “The letter is good [for other people] because not everybody is strong emotionally and they might fall to pieces not knowing what to do” (P10).

Perception of the crime.

There was a common perception that some crimes should be given more professional help than others. Participants would often compare their experiences with other crimes they felt would have been worse. There was no consensus across the sample about which crimes required such help, instead the emphasis was on crimes they had not suffered themselves: “Having your laptop stolen, you get over it, buy a new laptop…. Maybe if they’d set fire or trashed the place” (P3). This was observed across different crimes, including those that many might consider severe, such as armed robbery: “I suppose for some a knife might be very traumatic. It wasn’t particularly, if they’d waved a gun around, I might have felt very differently about it” (P19). For some participants, this perspective helped them make peace with their experience. For others, it seemed they were downplaying the impact it had, perhaps because they felt they should not have been affected by it. For example, one older victim (P2) described how ongoing harassment from his neighbour had affected his mood: “I can’t be bothered, I’ve lost interest. I think it’s affected the wife as much as me, we come home, it’s a case of ‘oh well, we’ll go to bed now’” but when asked whether he had seen his GP, he responded: “As I said to you, it’s not theft, it’s not damage, it’s just verbal abuse”.

Participants also appeared to think that professional services would share this view “I didn’t tell my GP because I wasn’t harmed was I? I was just emotionally…you know affected” (P10). Meanwhile, the participant who had been robbed at knifepoint felt that the police had given him more assistance than he needed: “A man and a woman came to see how I was coping, then there was the follow-up call, I think they would have given me a psychologist if I’d said, ‘I’m not doing very well’, I said ‘look I’m absolutely fine’” (P19). This participant thought the police’s perception of the severity of the crime may have influenced the amount of support he was offered: “It may have been magic word ‘knife,’ of course, because that’s the rage at the moment.”

Perception of services.

Accessibility. We asked participants what they thought would happen if they approached their GP. Many did not think that effective help would be provided. Some thought this was because doctors are not trained to deal with emotional problems: “I think a lot of doctors would say ‘this is not my job.’ They might pass you on to a counsellor, but I think most GPs feel that they’re not trained for such things.” (P16). Others felt that doctors would not see it as a priority compared to physical health: “I don’t think I would expect much help because the doctors are under enormous pressure just to do the medicine. And I doubt that very many would have much ability to help with the problem for those people who are upset.” (P15). Prioritising physical health was a particular concern for older victims, many of whom had complex health needs: “I go often for my serious health complaints, I have a lot of other things to deal with, if my life were different perhaps [I’d go to the GP about the crime] but no, not at this time for me” (P27). The need to prioritise physical health was attributed to demand on GP resources and difficulties obtaining appointments: “If you’re told when you phone the doctor that you’re 20th in the queue and that the doctor can see you in 3 weeks’ time or whatever. [The letter] is a lovely idea in principle. In practice, I don’t honestly think that most doctors would see it as a priority” (P1).

Some participants felt demands on GP time had changed their relationship with their doctor: “You just don’t get a chance to establish a rapport. Back in the 70s, it was the same doctor for about two decades, we were on first name terms” (P17). As a result, they did not believe that GPs would be receptive to discussing the crime with them: “GPs are so busy, I get the feeling you go in there like a conveyer belt, ‘what’s your problem?’ ‘This, this, this.’ They hardly look at you, just look at the computer. ‘Give you this, take that, next one please.’ So, you don’t get a lot of sympathy” (P16). However, an exception to this was a participant (P13) who felt his health condition was being exacerbated by continued harassment from his neighbour. As he was visiting his GP regularly about his physical health, and saw the crime as connected, he was able to raise this during his appointments. He provided positive examples of the practical support his GP had offered: “I did [give the letter to the GP]. My GP is very aware of all the problems I’ve had in this building because she’s written letters of support to the local authority to move me out of here” (P13). Help-seeking for psychological distress for this participant was therefore facilitated by frequent and positive contact with the same GP about the impact to his physical health.

Acceptability. Other participants were concerned about the type of help their GP may offer. Some expected they would be prescribed medication, which they felt was undesirable: “I don’t fancy running around on antidepressants, and thing is, if one goes to the doctor, invariably they will try to deal with the situation in that way.” (P21). Others felt that medication was for people who did not have social support: “Medication is when the person has not got a big family” (P2).

It was clear that many preferred to seek support informally instead of from professional services. For some, this was through friends or family: “Having relatives that you know you can go to for help if you need it, you know…That means a lot, that you’ve got somebody there." (P22). For others, it was faith communities: “If we need support, we talk to certain circles of our friends within the church community” (P4). Being able to talk was seen as beneficial: “The more you talk about it, and get it out your system, it goes away quicker” (P2). Of the participants who did seek professional support, having someone who was approachable was often the most helpful aspect: “[The GP] was pretty sympathetic. He’s the type of guy we can talk to” (P6). Likewise, a participant who approached Victim Support commented: “I could talk about it to get it off my system… cos certain people you can talk to about it, there are certain people you can’t… but with your kind of people, you understand how I feel” (P8). Yet despite many acknowledging the benefits of talking, some older people expressed doubts around accessing therapy: “I’m spooked by the idea of what therapy is… I know it’s being more public now talking about mental health” (P9).

Finally, we asked participants what support would be helpful for other older crime victims. Again, having someone to talk to was a consistent theme. Victim Support was suggested: “They’re concerned, and they help you” (P17). Others suggested support groups “with others who have been through something similar” (P21). The opportunity to discuss the experience with people who could personally relate to their experience appeared particularly helpful: “One of the most important things is to meet other people who have had the same experience… I think it’s helpful if you get people talking not with some expert, but with other people who’ve had a similar problem” (P15). Others felt that bringing support to older victims was important: “Go where older people go. I mean, the library, have a sign that you can come and talk” (P17). Another suggested support could be brought to people in their homes: “I think the best thing would be to go to someone’s house. ‘Cause that is where a person feels easiest” (P6). This suggests bringing services to older victims may be more effective in engaging them in support, rather than older victims seeking out help themselves.