Objective University students are at a developmental stage in which they may be more vulnerable to experiencing hikikomori (prolonged social withdrawal). Therefore, we focused on this population and examined the relationship between the tendencies toward and affinity for hikikomori in two studies.Methods Study 1 examined the relationship between the tendencies toward and affinity for hikikomori among 300 university students recruited online. Study 2 examined how stress coping, social support, and the affinity for hikikomori can explain hikikomori tendencies for a sample of 364 university students recruited offline. Both studies used the Adaptive Behaviors Scale for Hikikomori and Affinity for Hikikomori Scale, while Study 2 also used the Social Support Questionnaire and Coping Orientation to Problems Experienced Inventory.Results In both studies, hierarchical multiple regressions indicated that, among the affinity components for hikikomori, a stronger desire for hikikomori was associated with higher hikikomori tendencies. Conversely, higher empathy for others with hikikomori was associated with lower hikikomori tendencies, contrary to the implicit assumptions. Higher social support, active coping skills, and the use of instrumental support explained lower hikikomori tendencies.Conclusion These findings suggest that individuals at potential risk of developing hikikomori may be better identified by considering environmental (e.g., social support), behavioral (e.g., coping with stress), and cognitive and affective (e.g., desire for hikikomori) variables. Notably, empathy for others with hikikomori may reflect general empathic traits rather than being specifically related to hikikomori. Future longitudinal research should identify any causal relationships.

Hikikomori is increasingly recognized as heterogeneous; however, how behavioral functions relate to clinically important targets (e.g., functional impairment and social-evaluative anxiety) remains unclear. We identified latent hikikomori profiles by integrating behavioral topography and functions and characterized their clinical profiles. The study recruited Japanese adults aged 18-59 using an online panel, comprising 200 participants each in the hikikomori and control groups, respectively. Latent profile analysis was conducted using three functional indicators from the Hikikomori Functional Assessment Scale (social negative reinforcement, intrapersonal positive reinforcement, intrapersonal negative reinforcement) and an indicator of hikikomori behavior from the Adaptive Behaviors Scale for Hikikomori. Group differences were examined using Welch's ANOVA with Games-Howell post hoc tests. A three-profile solution was selected: Mild (11%), Moderate-withdrawal (52%), and Social-avoidance (37%). The Moderate-withdrawal profile showed clinically significant functional impairment without elevated social-evaluative anxiety compared to controls, indicating a paradoxical presentation of impairment without heightened fear of negative evaluation. The Social-avoidance profile showed the greatest withdrawal severity, elevated social-evaluative anxiety, lowest social support, and higher daily stressors. The Mild profile showed relatively lower impairment, reduced support quantity, and preserved support satisfaction. Hikikomori is thus not a unitary anxiety-avoidance condition. Profile-informed assessment may improve intervention selection, with anxiety-focused approaches being most relevant for the Social-avoidance profile, whereas reinforcement- and values-oriented behavioral strategies may be more appropriate for the Moderate-withdrawal profile. Longitudinal and multi-informant studies are needed to test profile stability and differential treatment responsiveness.

Background: Currently, paradoxical findings exist regarding the level of functioning in individuals with Hikikomori (prolonged social withdrawal). Aims: This systematic review aimed to clarify the functioning, disability, and health of individuals with Hikikomori and their families in comparison to those without Hikikomori. Method: Relevant studies were searched from April 22 to 25, 2022, using MEDLINE, PsycINFO, Scopus, and two Japanese databases. Functions were categorized into ‘body functions”; “structure”; and “activity and participation’, which were further classified into subcategories. Results: Of the 8,181 studies screened, 24 studies with 1,769 individuals with Hikikomori were included. Twelve, three, and four indicators from six studies on depression and anxiety, three on addiction, and two on thought problem symptoms, respectively, were higher in the Hikikomori group than in the comparison group, with at least moderate effect sizes. Three indicators from three studies on interpersonal relationships were worse in the Hikikomori group, with at least moderate effect sizes. The meta-analyses showed that internalizing symptoms, externalizing symptoms, and thought disorders were significantly higher in the Hikikomori group than those in the comparison group with moderate-to-high effect sizes. Contrastingly, communication/interpersonal interactions were significantly lower in the Hikikomori group than those in the comparison group. No significant differences were observed in daily life/social life and the families’ communication/interpersonal interactions and relationship. Conclusions: The study limitations include a high risk of bias and heterogeneity. Overall, individuals with Hikikomori often have impaired mental and interpersonal interaction functions; thus, comorbidities of this condition should be carefully assessed. PROSPERO: CRD42022320592.

Enhancing the skills of hikikomori supporters inherently contributes to improving the quality of support provided. However, a comprehensive skills assessment tool for these supporters has not yet been developed. This study aimed to develop a self-rated questionnaire, the Hikikomori Supporter’s Skills Checklist (HSSC). Based on a preliminary survey involving 43 supporters, the HSSC draft was revised. The revised version comprises 39 items addressing various aspects of consultation support. In the main survey, questionnaires were posted to 118 hikikomori community support centers. To assess convergent and discriminant validity and derive clinical insights, respondents completed the HSSC along with measures of stigmatic attitudes toward hikikomori and psychiatric patients, workplace psychological flexibility, burnout, and demographics, including prior experience in hikikomori-related learning and support. Analysis of 238 valid responses revealed a single-factor structure; however, 12 items were removed due to lower item factor loadings. The refined 27-item HSSC demonstrated acceptable internal consistency (Cronbach’s α = 0.74). HSSC scores showed a significant correlation with the number of training sessions undertaken (ρ = 0.24), along with other theoretically consistent but statistically non-significant correlations, supporting the checklist’s validity. Furthermore, in the comparison involving specific questions with relatively low correct response rate, a linear increase in the total HSSC score was observed across the low-, middle-, and high correct response rate groups. However, score distribution deviated from normality due to limited data from lower-scoring participants, restricting parametric analysis. Although further validation is necessary, the HSSC appears valuable for promoting self-reflection among hikikomori supporters and evaluating training outcomes.

BackgroundsHikikomori, pathological social withdrawal, is becoming a crucial mental health issue in Japan and worldwide. We have developed a 3-day family intervention program for hikikomori sufferers based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). This study aims to confirm the effectiveness of the 3-day program by a randomized controlled trial.MethodsThis study was registered on the UMIN Clinical Trials Registry (UMIN000037289). Fifteen parents were assigned to the treat as usual (TAU) group (TAU only; Age Mean, 65.6; SD, 7.8), and 14 to the Program group (program + TAU; Age Mean, 67.9; SD, 8.6). This study was discontinued due to the COVID-19 pandemic; the recruitment rate was 36.3% of our target sample size of 80.ResultsPerceived skills improved temporally and stigma temporally worsened in the TAU group. Confidence decreased and attitude showed no change in both groups. Aggressive behaviors of hikikomori sufferers were significantly worsened in the Program group; however, no serious domestic violence was reported. In the TAU group, Avoidance and irregular life patterns were improved. Activity levels were worsened in both groups. Two participants (16.7%) in the Program group and one participant (7.7%) in the TAU group reported actual behavioral changes (e.g., utilizing support).ConclusionWe could not draw general conclusions on the effectiveness of the program due to the study discontinuation. Nevertheless, this study indicates the necessity for revision of the program to improve family members’ confidence in engaging with hikikomori sufferers, with safer approaching by families.

Hikikomori (a severe form of social withdrawal) is a serious mental health issue. A family approach is the initial step to support hikikomori; thus effective family intervention programs are warranted. We recently developed a 5-day family intervention program (120 min weekly) based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). In the present study, we modified the 5-day program to a 3-day program (180 min fortnightly), and examined the effectiveness of the 3-day program using a single-arm procedure. Data of 23 parents (four fathers and 19 mothers; age = 62.0 +/- 9.1 years) were analyzed. Mental health conditions among participants themselves improved at the 4-month follow-up, but the confidence in hikikomori support declined and stigma toward mental health problems did not change. However, short-term improvements in perceived skills in approaching hikikomori sufferers were detected. Hikikomori sufferers' actual behavioral changes, such as social participation or utilization of support, were also observed (six out of 20 hikikomori sufferers). Preliminary effectiveness was confirmed for the 3-day program. Further revision of the program and a validation study with controls are required.

A pilot study examined the efficacy of the Gatekeeper Training Program designed for suicide prevention in Yogo teachers. The author explored the program’s effectiveness on Yogo teachers with over 20 and under 20 years of experience. Self-administered questionnaires were administered before and after the program to assess the teachers’ confidence in managing students, their willingness to act as gatekeepers, and their self-efficacy. Yogo teachers (N=51) participated in the study. The results indicated improvements in confidence, the willingness to act as gatekeepers, and self-efficacy, regardless of experience, suggesting the Gatekeeper Training Program’s efficacy. The results also showed that the program was more effective for teachers with over 20 years than under 20 years of experience, especially for early intervention items.

Background: The COVID-19 pandemic has forced people to change their lifestyles, especially with respect to restrictions on going out. Forced quarantine (i.e., lockdown) and self-restraint behavior (SRB), including self-quarantine, are suggested to induce potential negative impacts on public mental health. SRB seems to be related to governmental policies, each individual’s social background and mental condition; however, no empirical studies have been conducted. Methods: 1053 participants (mainly office workers) from epidemic areas and non-epidemic areas in Japan voluntarily conducted an online survey in June 2020. We assessed COVID-19-related aspects such as the degree of SRB, motivation for SRB, stigma, anxiety and depressive feelings due to COVID-19 by original questionnaires) and general mental health status (social anxiety by MINI-SPIN, depressive tendency by PHQ-9, depression-related personality traits by TACS-22 and resilience by TRS). Results: Regional comparison showed significant differences in SRB and social anxiety. People in epidemic areas tend to refrain from going out. Conversely, people in non-epidemic areas tend to shun the public eye. Regardless of epidemic status, proactive SRB was associated with higher motivation for SRB, higher social anxiety, higher depressive tendency, stronger COVID-19-related psychological factors and lower resilience. Moreover, people with proactive SRB in non-epidemic areas had the highest depressive tendency. Discussion: The present cross-sectional survey among office workers in Japan showed that people with proactive SRB have stronger COVID-19-related anxiety and depressive feelings, regardless of where they live. Our key finding is that people with proactive SRB in non-epidemic areas have the highest depressive tendency. Based on the present finding, we herein propose the following hypothesis: Higher levels of depressive tendency may enhance proactive SRB, which may be partly associated with higher levels of stigma, anxiety and depressive feelings related to COVID-19. Limitations: The general tendencies to avoid danger and stigma were not evaluated. Conclusions: Depressive tendency is suggested to be associated with proactive SRB against COVID-19. Intervention for depressive tendency in non-clinical settings (e.g., workplaces) may help citizens understand the infectious situation appropriately and to behave effectively during the pandemic. Further investigations should be conducted to clarify the present findings.

Hikikomori, a severe form of social withdrawal, is a condition characterized by the avoidance of social participation and staying at home for more than 6 months. Hikikomori was initially reported in Japan in the 1990s and is now observed worldwide. Here, we introduce specialized psychodynamic group psychotherapy for persons with hikikomori, and illustrate the case of an adult male with schizoaffective disorder. In the present report, the patient initiated an unreasonably difficult job-hunting process, became unwell, and was hospitalized. He began to participate in group psychotherapy as a place of belonging and gradually increased his social interactions. We also consider the specific difficulties exhibited by people with hikikomori, especially focusing on the avoidance around assuming responsibility for decisions and extreme dichotomous thinking. Additionally, we discuss the benefits of dealing with these difficulties in a group structure and propose the applicability of group psychotherapy in therapeutic interventions for persons with hikikomori.

Interpersonal difficulties are often observed in major depressive disorder (MDD), while the underlying psychological and biological mechanisms have not yet been elucidated. In the present case–control study, a PC-based trust game was conducted for 38 drug-free MDD patients and 38 healthy controls (HC). In the trust game, participants invested money in a partner (trusting behaviors), and also rated each partner’s attractiveness (preference for others). In addition, blood biomarkers including metabolites were measured. Both MDD and HC males exhibited more trusting behaviors compared to females. MDD males’ preference for ordinary-attractive partners (lay-person photographs) was lower than HC males, whereas their preference for high-attractive females (fashion-model photographs) was similar levels to HC males. This tendency in MDD males could reflect a “focused (narrowed) preference for females”. As for blood biomarker analysis, the levels of 37 metabolites including acetylcholine, AMP, GMP, nicotinic acid and tryptophan were significantly different between two groups. Interestingly, among male participants, acetylcholine and nicotinic acid were negatively correlated with the level of focused preference for photographed females. In sum, we have revealed some behavioral, psychological and biological traits of trusting behaviors and preference for others especially in MDD males. Larger studies should be conducted to validate our preliminary findings.

AbstractHikikomori (a severe form of social withdrawal) is a serious mental health issue. A family approach is the initial step to support hikikomori; thus effective family intervention programs are warranted. We recently developed a 5‐day family intervention program (120 min weekly) based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). In the present study, we modified the 5‐day program to a 3‐day program (180 min fortnightly), and examined the effectiveness of the 3‐day program using a single‐arm procedure. Data of 23 parents (four fathers and 19 mothers; age = 62.0 ± 9.1 years) were analyzed. Mental health conditions among participants themselves improved at the 4‐month follow‐up, but the confidence in hikikomori support declined and stigma toward mental health problems did not change. However, short‐term improvements in perceived skills in approaching hikikomori sufferers were detected. Hikikomori sufferers’ actual behavioral changes, such as social participation or utilization of support, were also observed (six out of 20 hikikomori sufferers). Preliminary effectiveness was confirmed for the 3‐day program. Further revision of the program and a validation study with controls are required.

Backgrounds: 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. Methods: 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. Results: 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. Limitations: Single-arm design and evaluation using self-rated questionnaires are the main limitations of the present study. Conclusions: 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.

Background: Social withdrawal is a feature of a number of psychiatric disorders including major depressive disorder (MDD), yet research examining social withdrawal as a feature of MDD is rare. Methods: This was a retrospective case-control study. Participants (N = 67) were recruited through an outpatient clinic at an academic medical center in Japan. Major depressive disorder (MDD) and social withdrawal were established with the Structured Clinical Interview for DSM-IV Axis I Disorders and a semi-structured psychiatric interview, respectively. Participants also completed self-report measures. Results: We classified 24 participants as cases (MDD with social withdrawal) and 43 participants as controls (MDD without social withdrawal). Cases, on average, were more likely to have lower education level, prior episodes of depression, and higher suicidal ideation at baseline than controls. In unadjusted regression models, cases had significantly less social connection, less reward dependence, less self-directedness, and higher scores on scales of modern-type depression and hikikomori. In adjusted regression models, associations between social withdrawal and hikikomori (p <0.01) and reward dependence (p = 0.03) remained significant. Limitations: The sample was limited in size and drawn from a single site. Conclusions: In patients with MDD, social withdrawal may have subtle associations with clinical symptoms, social connection, and personality traits. Developing a better understanding of social withdrawal's phenotype in depression requires more in-depth examination.