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Kato TA, Sartorius N, Shinfuku N. Shifting the paradigm of social withdrawal: a new era of coexisting pathological and non-pathological hikikomori. Curr Opin Psychiatry 2024; 37:177-184. [PMID: 38415743 PMCID: PMC10990035 DOI: 10.1097/yco.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Social withdrawal syndrome, known as "hikikomori," has been highlighted since the late 1990 s in Japan. Hikikomori is more common in urban areas, and often comorbid with mental disorders, and now spreading throughout the world. In the post-COVID-19 era, not outing is no longer considered pathological in itself as the "new normal," and a novel concept of hikikomori is needed. This review summarizes the concept of hikikomori, and presents the latest methods for identification of hikikomori. RECENT FINDINGS The novel definition can distinguish between pathological and non-pathological hikikomori using the scale of "Hikikomori Diagnostic Evaluation (HiDE)," which has been developed in the hikikomori research lab at Kyushu University. An online survey among non-working adults has revealed that persons who have become pathological hikikomori for less than three months showed a particularly strong tendency toward gaming disorder and depression. SUMMARY Now, physical isolation itself is not pathological, but when dysfunction and distress are present, rapid mental health support should be provided. In the novel urban society, the establishment of a checkup system to assess whether persons who stay home are happy or suffering is important for prevention against mental disorders triggered by social isolation.
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Affiliation(s)
- Takahiro A. Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
- Mood Disorder & Hikikomori Clinic, Kyushu University Hospital
- Hikikomori Research Lab, Kyushu University, Fukuoka, Japan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
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Miou M, Fujimoto H, Yotsumoto K, Hirota M, Nishigaki S, Hashimoto T. Exploring Psychiatric Home-Visit Nursing Practices for Patients with Schizophrenia and Hikikomori with a Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:181. [PMID: 38397672 PMCID: PMC10887901 DOI: 10.3390/ijerph21020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
The phenomenon of some patients with schizophrenia withdrawing and becoming hikikomori needs to be resolved. In some countries, outreach methods are being employed. In Japan, psychiatric home-visit nursing for patients with schizophrenia and hikikomori is being implemented. However, it is not based on sufficient evidence and relies on the experience and intuition of individual nurses. This study explored the underlying themes in the nursing practices of psychiatric home-visit nurses via semi-structured interviews with 10 nurses and a thematic analysis. Nine key themes emerged. Four themes-(i) understanding the patient's world, (ii) supporting the patients as they are, (iii) providing a sense of relief, and (iv) having equal relationships-highlighted the nurses' commitment to respecting patients' individuality while building and sustaining relationships. Two themes-(v) exploring the right timing and (vi) waiting for the appropriate timing-illustrated the nurses' anticipation of proactive patient engagement. Finally, three themes-(vii) working together on things, (viii) continuing care for expanding the patient's world, and (ix) nursing care for the patient's future-underscored the nurses' gradual and methodical approach to working alongside patients. Nursing practices based on these nine themes cultivated meaningful relationships and secured a sense of relief for the patients. Additionally, they awaited patients' proactive engagement and delivered timely support to facilitate positive daily life changes. These findings contribute to the establishment of evidence-based nursing practices for patients with schizophrenia and hikikomori.
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Affiliation(s)
- Maki Miou
- Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 6540142, Japan; (K.Y.); (M.H.); (T.H.)
- Faculty of Nursing, Osaka Shin-Ai Gakuin University, 6-2-28 Tsurumi, Tsurumi-ku, Osaka 5380053, Japan
| | - Hirokazu Fujimoto
- Faculty of Nursing, Hyogo Medical University, 1-3-6 Minatojima, Chuo-ku, Kobe 6508530, Japan
| | - Kayano Yotsumoto
- Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 6540142, Japan; (K.Y.); (M.H.); (T.H.)
| | - Misato Hirota
- Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 6540142, Japan; (K.Y.); (M.H.); (T.H.)
| | - Satoshi Nishigaki
- School of Nursing, Takarazuka University, 1-13-16 Shibata, Kita-ku, Osaka 5300012, Japan;
| | - Takeshi Hashimoto
- Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe 6540142, Japan; (K.Y.); (M.H.); (T.H.)
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Fong TC, Yip PS. Prevalence of hikikomori and associations with suicidal ideation, suicide stigma, and help-seeking among 2,022 young adults in Hong Kong. Int J Soc Psychiatry 2023; 69:1768-1780. [PMID: 37191282 DOI: 10.1177/00207640231174376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Young adults are at elevated risks of hikikomori (severe social withdrawal) under the COVID-19 pandemic, which could lead to psychological distress and suicidal ideation. AIMS The present study aimed to examine the associations among hikikomori, suicide stigma, suicidal ideation, and help-seeking behaviors among young adults in Hong Kong. METHOD This study recruited a large sample of 2,022 young adults in Hong Kong via an online survey at the end of 2021. The participants completed the Hikikomori Questionnaire and validated measures on psychological distress, suicide stigma, and suicidal ideation severity and report their help-seeking behaviors. Multivariate analysis of variance was conducted to compare the profiles of the hikikomori groups. Path analysis evaluated the effects of hikikomori and suicide stigma on occurrence and severity of suicidal ideation and their associations with help-seeking behaviors. RESULTS Hikikomori showed significant and positive indirect effects on prevalence and severity of suicidal ideation via psychological distress. Glorification positively predicted hikikomori and suicidal ideation severity among suicidal persons. Hikikomori was associated with reduced help-seeking. Isolation and suicidal ideation were associated with greater barriers to seek help among the non-help-seekers. Perceived helpfulness of sought help was negatively associated with hikikomori and suicidal ideation among the help-seekers. CONCLUSIONS The present findings demonstrated greater prevalence and severity of suicidal ideation and less help-seeking in young adults with hikikomori. Suicide stigma showed differential associations with hikikomori, suicidal ideation, and help-seeking behaviors.
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Affiliation(s)
- Ted Ct Fong
- Centre on Behavioral Health, The University of Hong Kong, China
| | - Paul Sf Yip
- HKJC Centre for Suicide Research and Prevention, University of Hong Kong, China
- Dept of Social Work & Social Administration, University of Hong Kong, China
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Neoh MJY, Carollo A, Lim M, Esposito G. Hikikomori: A Scientometric Review of 20 Years of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095657. [PMID: 37174175 PMCID: PMC10177810 DOI: 10.3390/ijerph20095657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
The Japanese term hikikomori was first used to describe prolonged social withdrawal in the 1990s. Since then, research across the world have reported similar prolonged social withdrawal in many countries outside Japan. This study systematically analyses the evolution of literature on hikikomori in the past 20 years to gain a better understanding of the development of the knowledge base on hikikomori since it garnered attention in Japan. Findings from the scientometric review indicate many perspectives on the etiology of hikikomori including cultural, attachment, family systems and sociological approaches. However, similarities with modern type depression, a novel psychiatric syndrome, have been proposed and there are signs of a recent paradigm shift of hikikomori as a society-bound syndrome rather than a cultural-bound syndrome unique to Japan. As research into hikikomori continues to grow, results from the review also highlight the need for a more universally shared definition of hikikomori in order to better consolidate cross-cultural research for meaningful and valid cross-cultural comparisons which can help to promote evidence-based therapeutic interventions for hikikomori.
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Affiliation(s)
- Michelle Jin Yee Neoh
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore
| | - Alessandro Carollo
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Mengyu Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore 639818, Singapore
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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Khiatani S, Liu D, Yeo BSS, Wong JCM. Reaching hidden youth in Singapore through the Hidden Youth Intervention Program: A biopsychosocial approach integrating mental health and social work interventions. Front Psychiatry 2023; 14:1133659. [PMID: 37009115 PMCID: PMC10061831 DOI: 10.3389/fpsyt.2023.1133659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Hidden youth are youth who withdraw from society for at least 6 months, physically isolating within their homes or rooms. There has been a steady rise in this phenomenon across many developed countries, and this trend is expected to continue. As hidden youths often present with complex psychopathology and psychosocial issues, multi-factorial intervention approaches are recommended. To reach this isolated population and address gaps in services, a community mental health service and a youth social work team collaborated to develop the first specialized intervention for hidden youth in Singapore. This pilot intervention combines components from Hikikomori treatment models from Japan and Hong Kong, and a treatment program for isolated individuals diagnosed with Internet Gaming Disorder. This paper describes the development of the pilot intervention model- a four-stage biopsychosocial intervention targeting the complex needs of hidden youth and their families- and illustrates its implementation and challenges faced through a case study. Based on 2 years of service delivery to 25 youths, good practices such as utilizing novel outreach strategies and the importance of involving and caring for caregivers are also highlighted. Preliminary outcomes of this ongoing pilot intervention indicate reductions in social withdrawal behavior and increased engagement in school or work, especially for youth at the final stage of intervention. Strengths of the program include its multi-disciplinary and flexible nature, and the whole-family approach. Limitations of this program included a lack of information on Singaporean hidden youth and the lack of quantitative outcome data of this pilot program. In future, we aim to further enhance program elements through collaboration with international and local partners, and to develop an evaluative framework to determine program effectiveness.
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Affiliation(s)
- Sonia Khiatani
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
- *Correspondence: Sonia Khiatani
| | - Denise Liu
- Strategic Planning and Research Department, Fei Yue Community Services, Singapore, Singapore
| | | | - John Chee Meng Wong
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Contemporary Hermits: A Developmental Psychopathology Account of Extreme Social Withdrawal (Hikikomori) in Young People. Clin Child Fam Psychol Rev 2023; 26:459-481. [PMID: 36653555 PMCID: PMC9848719 DOI: 10.1007/s10567-023-00425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
Although it is widely accepted that human beings have an ingrained 'need to belong,' there seem to be a substantial subset of young people who seclude themselves for most of the time at home and no longer engage in education or work, ultimately withdrawing from participation in society. In Japan, this phenomenon has been labeled as 'hikikomori,' but given its global presence it may be preferable to use the term 'extreme social withdrawal' (ESW). In this qualitative review, we provide a description and definition of ESW, provide figures on its prevalence, and discuss a number of associated concepts, including loneliness and "aloneliness," school absenteeism and dropout, the 'new' developmental stage of adultolescence, and the labor force categories of freeter ('freelance arbeiter') and NEET (a young person not in employment, education, or training). The core of the paper is focused on the origins of ESW in young people and provides a narrative overview of relevant etiological factors, such as aberrant brain processes, unfavorable temperament, psychiatric conditions, adverse family processes including detrimental parenting, negative peer experiences, societal pressures, and excessive internet and digital media use, which are all placed within a comprehensive developmental psychopathology framework. We will close with a discussion of possible interventions for young people with ESW and formulate a guideline that describes (the temporal order of) various components that need to be included in such a treatment.
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Brosnan M, Gavin J. The impact of higher levels of autistic traits on risk of hikikomori (pathological social withdrawal) in young adults. PLoS One 2023; 18:e0281833. [PMID: 36809281 PMCID: PMC9942989 DOI: 10.1371/journal.pone.0281833] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Hikikomori is an extreme state of social withdrawal, originally identified in Japan but more recently recognised internationally. Many countries imposed restrictions during the COVID-19 pandemic which may have had a detrimental impact on those at risk of hikikomori, specifically young adults and those with high levels of autistic traits. AIMS To explore whether levels of autistic traits mediate the relationship between psychological wellbeing and hikikomori risk. We also looked at whether autistic traits mediated between lockdown experiences (e.g. not leaving the house) and hikikomori risk. METHODS 646 young people (aged 16-24) from a wide range of countries completed an online questionnaire assessing psychological wellbeing, autistic traits and experiences of lockdown for this cross-sectional study. RESULTS Autistic traits mediated the relationship between both psychological wellbeing and hikikomori risk, as well as frequency of leaving the house during lockdown and hikikomori risk. Greater hikikomori risk was associated with poor psychological wellbeing, higher autistic traits and leaving the house less frequently during the COVID-19 pandemic. CONCLUSIONS These findings suggest similarities with Japanese hikikomori research and are consistent with suggestions that psychological wellbeing and COVID-19 restrictions are associated with increased hikikomori risk in young adults, and both associations are mediated by higher levels of autistic traits.
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Affiliation(s)
- Mark Brosnan
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, United Kingdom
- * E-mail:
| | - Jeff Gavin
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, United Kingdom
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