Comment

Evidence of pathological social withdrawal in non-Asian countries: a global health problem?

Hikikomori refers to a state of pathological social withdrawal combined with avoidance of major social interactions or responsibilities. The present study examined the associations that aspects of hikikomori had with thwarted belongingness and perceived burdensomeness as well as whether culture moderated these associations in participants from the United States (n = 276) and Japan (n = 250). Results showed that avoidance of socialization and lack of emotional support were positively associated with both thwarted belongingness and perceived burdensomeness. Furthermore, the association between avoidance of socialization and perceived burdensomeness was stronger for Japanese participants than for those from the United States. These findings suggest that psychological mechanisms contributing to suicidal thoughts during limited physical contact and isolation may be linked to psychological and social withdrawal.

Over the last decade, the phenomenon of young people suffering from social withdrawal (hikikomori) has become a social emergency in many countries. The aim of this review is to analyse whether and how researchers have considered the relationship between the emergence and spread of hikikomori and the characteristics that educational contexts assume in neoliberal societies. The searches, which were conducted in the Web of Science, Scopus, Proquest and JStore databases, identified 73 articles published since 2000. The results confirm that in many cases authors have adopted a single-axis perspective as the key to interpreting the phenomenon, focusing on single factors (“psychiatrization” of the problem, diagnostic approach, proposals for recovery, etc.) or using traditional medical research tools. The review also identifies some studies that provide evidence in favour of how certain interventions in the school environment can contribute to re-socializing young hikikomori.

Hikikomori, a severe form of social withdrawal, has been observed in Japan amongst youth and adolescence since around the 1970s and has especially been highlighted since the late 1990s. Hikikomori-like cases have recently been reported in many other countries. Hikikomori negatively influences not only the individual’s mental health and social participation but also wider education and workforce stability and as such is a novel global issue. We propose that a variety of experiences during developmental periods may induce hikikomori-like conditions. Especially, we are proposing that family dynamic relationships (with a mother, a father, and brothers/sisters), school life with peers, and online communications using Internet are three major contributing factors for the occurrence of hikikomori.

In this review paper, we will introduce the developmental model of hikikomori and propose possible ways to prevent and treat social withdrawal.

Hikikomori, a severe form of social withdrawal, is increasingly a serious mental health issue worldwide. Hikikomori is comorbid with various psychiatric conditions including depression, social anxiety and suicidal behaviors. Family support is encouraged as a vital first step, however evidence-based programs have yet to be established. Mental Health First Aid (MHFA) is one of the most well-validated educational programs encouraging lay people such as family members, to support close persons suffering from various psychiatric conditions such as depression, anxiety and suicidal behaviors.

We newly developed an educational program for family members of hikikomori sufferers mainly based on MHFA and ‘Community Reinforcement and Family Training (CRAFT)’ with role-play and homework. As a single-arm trial, 21 parents (7 fathers and 14 mothers) living with hikikomori sufferers participated in our program with five once-a-week sessions (2 h per session) and six monthly follow-ups, and its effectiveness was evaluated using various self-rated questionnaires.

Perceived skills toward a depressed hikikomori case vignette, stigma held by participants, and subscales of two problematic and one adaptive behaviors of hikikomori sufferers were improved throughout the sessions and follow-ups. In addition, positive behavioral changes of hikikomori sufferers such as improved social participation were reported by participants.

Single-arm design and evaluation using self-rated questionnaires are the main limitations of the present study.

Our newly developed program has positive effects on family members in their contact and support of hikikomori sufferers. Future trials with control groups are required to validate the effectiveness of this program.

Hikikomori es un fenómeno complejo caracterizado por un aislamiento social severo. Durante años se ha considerado como un síndrome cultural limitado a Japón; sin embargo, la amplia descripción de casos fuera de Japón parece refutar esta teoría. Supone un importante problema de salud pública, por su elevado impacto social y el perjuicio que causa en la salud física y psíquica de las personas que lo sufren. El abordaje terapéutico debe ser multidisciplinar, con una buena coordinación entre los diferentes profesionales del sistema sanitario.

Hikikomori is a complex phenomenon characterized by a severe social withdrawal. Although it has been considered as a cultural-bound syndrome limited to Japan, the broad description of cases outside Japan seems to disprove this theory. It is an important public health problem, due to its high social impact and the damage it causes in the physical and mental health of the people who suffer from it. The therapeutic approach has to be multidisciplinary, requiring a proper coordination among different health professionals.

Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour.

To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students.

A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status.

Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22–3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45–3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses.

Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.