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Characteristics of and gender difference factors of hikikomori among the working-age population: A cross-sectional population study in rural Japan

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Objectives This study aimed to assess the relevance of hikikomori to a variety of socio-demographic characteristics and socio-psychological conditions and examined these relationships by gender.Methods The study employed a cross-sectional design. A questionnaire survey was conducted among 2,459 participants aged 15-64 years and living in Happo-cho, Akita. The outcome variable, hikikomori, was characterized by "not having participated in any social events nor interacted with others besides family members for more than six months." Exposure variables included sex, age, marital status, occupational status, outdoor frequencies, health, socio-psychological well-being, and availability of social support. Using Chi-square test of independence and multiple logistic regression, the results indicated the impact of the individual factors and the combined impact of all potential variables on the likelihood of being hikikomori in both participant groups: men and women.Results The effective response rate was 54.5%. Those who socially withdrew for six months or more (n=164 (6.7%); 53.7% men, 46.2% women) were classified as being hikikomori; of these, 45.7% had been withdrawn for more than 10 years. Hikikomori men were more likely to have severe symptoms of mental illness, poorer overall self-rated health, feelings of distress, and passive suicidal ideation than non-hikikomori men, but not hikikomori women. Furthermore, after adjusting for all tested variables as possible confounding factors, being jobless and having fewer outdoor frequencies were associated with being a hikikomori man, and being a homemaker and having no social support were associated with being a hikikomori woman.Conclusion Occupational status and outdoor frequencies are relevant factors for assessing the likelihood of being a hikikomori. Characteristics of hikikomori manifest differently in men and women. Having social support may help women avoid transitioning into a hikikomori. Incorporating emotional and mental health management into intervention programs may help better target potential beneficiaries among Japanese men.
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237
Akita University Graduate School of Medicine, Akita,
Japan
2
Japan Support Center for Suicide Countermeasures,
Tokyo, Japan
3
The Chinese Hong Kong University, Shatin, Hong
Kong SAR
4
Akita University Graduate School of Health Science,
Akita, Japan
Akita University Graduate School of Medicine,
Department of Public Health
1
1
1 Hondo, Akita City, Akita Prefecture, Japan
010
8543
Corresponding Author: Roseline KF Yong
237
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2020 Japanese Society of Public Health
Original Article
Characteristics of and gender diŠerence factors of hikikomori among the
working-age population: A cross-sectional population study in rural
Japan
Roseline KF Y
ONG
,KojiF
UJITA
2
,PatsyYKC
HAU
3
and Hisanaga S
ASAKI
4
Objectives
This study aimed to assess the relevance of hikikomori to a variety of socio-demographic
characteristics and socio-psychological conditions and examined these relationships by gender.
Methods
The study employed a cross-sectional design. A questionnaire survey was conducted among
2,459 participants aged 15
64 years and living in Happo-cho, Akita. The outcome variable,
hikikomori, was characterized by ``not having participated in any social events nor interacted
with others besides family members for more than six months.'' Exposure variables included
sex, age, marital status, occupational status, outdoor frequencies, health, socio-psychological
well-being, and availability of social support. Using Chi-square test of independence and multi-
ple logistic regression, the results indicated the impact of the individual factors and the com-
bined impact of all potential variables on the likelihood of being hikikomori in both participant
groups: men and women.
Results
The eŠective response rate was 54.5
. Those who socially withdrew for six months or more
(
n
164
(
6.7
)
; 53.7
men, 46.2
women
)
were classiˆed as being hikikomori; of these,
45.7
had been withdrawn for more than 10 years. Hikikomori men were more likely to have
severe symptoms of mental illness, poorer overall self-rated health, feelingsofdistress,andpas-
sive suicidal ideation than non-hikikomori men, but not hikikomori women. Furthermore, after
adjusting for all tested variables as possible confounding factors, being jobless and having fewer
outdoor frequencies were associated with being a hikikomori man, and being a homemaker and
having no social support were associated with being a hikikomori woman.
Conclusion
Occupational status and outdoor frequencies are relevant factors for assessing the likeli-
hood of being a hikikomori. Characteristics of hikikomori manifest diŠerently in men and wo-
men. Having social support may help women avoid transitioning into a hikikomori. Incorporat-
ing emotional and mental health management into intervention programs may help better tar-
get potential beneˆciaries among Japanese men.
Key words
hikikomori, gender diŠerence, social support, rural Japan, outdoor frequencies
Nihon Koshu Eisei Zasshi 2020; 67
(
4
)
: 237
246. doi:10.11236
/
jph.67.4
_
237
I. INTRODUCTION
Hikikomori is deˆned as a situation wherein a per-
son has been staying at home for an extended period,
avoiding social participation such as going to school or
work, or spending time with others besides his
/
her fa-
mily members. Furthermore, the person may leave
home but not interact with others, and these condi-
tions can last from six months to a whole lifespan. In
the existing literature, there are no standardized tools
to assess hikikomori situations
1
4
)
; however, consen-
sus is that hikikomori is a state of social withdrawal or
non-social participation that lasts more than six
months. Among the multitude of factors contributing
to someone becoming hikikomori, having a psychotic
disorder is one that may be underdiagnosed
5
)
.
238238
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The ˆrst epidemiological evidence, identiˆed by the
World Mental Health Survey Japan
(
WMHJ
)
, proves
that hikikomori aged 20
49 have a 54.5
possibility of
being diagnosed with comorbid psychiatric disorders
and even higher odds of having a mood disorder
1
)
.
Another survey, conducted by the Cabinet O‹ce
Government of Japan, found that among the
hikikomori aged 40
64, 36.1
have been socially
withdrawn for more than ten years, 23.4
of whom
were homemakers
4
)
. Furthermore, hikikomori people
have been reported to have less trust in interpersonal
relationships
6,7
)
, lack of appreciation for the communi-
ty that they live in
8
)
, loneliness
9
)
,depression
9
)
,suicidal
ideation
10
)
, comorbidity with mental illness
11
14
)
,and
a lower quality of life
15
)
. These ˆndings mostly
represent limited age groups studied in case reports
and clinical experiments.
In terms of social roles, men and women usually
respond diŠerently to social settings and have diŠerent
social health behavior
16,17
)
. Men are usually more so-
cially isolated than women
18
)
,yetwomenoftenhavea
higher depression rate
19
)
, feel lonelier
20
)
,expressmore,
and have more conversations than men
16,21
)
.Existing
literature demonstrates that hikikomori people are
younger, most usually men, often from wealthier fami-
lies, and reside more in the cities; however, it is argued
that women as homemakers are often excluded from
hikikomori studies because their hikikomori situations
can often be overlooked because of the roles of a
homemaker
(
including help with housework, child-
raising, or care-giving to family members
)
22
)
.This
factor makes clarifying the features of hikikomori wo-
men cases di‹cult. Furthermore, the eŠects of gender
diŠerences in hikikomori have never been explored.
In addition to gender diŠerences, social environ-
ments can contribute to social isolation
18
)
. Therefore,
prevalence of hikikomori in urban and rural areas
should be analyzed. Hikikomori has become a growing
concernindevelopednations
1
4
)
and fast-developing
nations
23
26
)
. While hikikomori is thought to be more
of an urban issue, rural-area surveys have raised con-
cerns regarding the prolonged social withdrawal period
of hikikomori, and about the prevalence of hikikomori
being 7
8
, which is far higher than the national esti-
mates
(
1.45
1.79
)
8,27
)
. The high reported number
of hikikomori people in rural areas has drawn our con-
cern about whether there is a common factor shared by
developed and fast-developing nations, insofar as ur-
banization may lead to depopulated rural areas with
reduced social and employment opportunities. To ad-
dress the existing gaps in current literature, we aimed
to identify the extent of the problem of hikikomori in
rural areas, and to examine the relevant factors of
hikikomori based on gender diŠerences.
II. METHODS
1. Setting and participants
This study was a collaborative project between the
municipality o‹ce of Akita Prefecture and The
Department of Public Health, Akita University in
Japan. The participants were recruited from a local
rural municipality, which had more than 30
reduc-
tion in population over the past 45 years, an aging rate
of 43
, and two-fold lower ˆscal health than the na-
tional average. The characteristics of the research area
hadbeenmarkedwitheconomiccontributionsinfarm-
ing
/
ˆshery
/
forestry. The most laborious and socially
active season in this area has been between March and
October, before heavy snowfall, and with two major
local festivals held in the month of August.
Local volunteers distributed a set of self-ad-
ministered questionnaires door-to-door to all
registered residents aged 15
64
(
n
4,515
)
,who
stayed at home between Aug 1
12. Institutionalized
residents were excluded from the study. Informed con-
sent was obtained from participants before the study,
both orally and in written form. The participants had
all rights to refuse participation or choose not to dis-
close speciˆc information. Completed questionnaires
were sealed in reply envelopes and collected by the
volunteers two weeks later. The Institutional Review
Board and the Ethics Committee of Akita University
approved the study protocol
(
December 13, 2011
)
.
2. Measures
The outcome variable was set as hikikomori. Ex-
posure variables were socio-demographic factors,
health, socio-psychological well-being, and social sup-
port. Socio-demographic factors included sex, age, oc-
cupational status, marital status, and outdoor frequen-
cies. Health status was represented by existing sickness
and overall self-rated health. Socio-psychological well-
being was indicated using yes
/
no questions for emo-
tional distress, loneliness, isolation, passive suicidal
ideation, and severe mental illness symptoms. Social
support was deˆned as having someone to talk to when
problems occur.
Symptoms of severe mental illness were measured
using a simple six-item questionnaire rated on a 5-
point Likert scale
(
K6
)
,
(
0
never, 1
a little of the
time, 2
sometimes, 3
most of the time, 4
all the
time
)
and Cronbach
a
0.85
31
. Responses to the six
items were calculated to yield a K6 score between 0
and 24 per individual, with higher scores indicating
greater depressive tendencies. K6 scores
13 were
considered to indicate signiˆcant clinical levels of se-
vere mental illness
28,29
)
. Detailed descriptions of all the
measured items are provided in the appendix.
To further understand the aggregate eŠect of socio-
psychological well-being factors, the total number of
socio-psychological well-being factors was created via
the summation of all socio-psychological well-being
239
Figure 1 Sample Flow Chart
239
67
巻 日本公衛誌 第
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factors.
3. Statistical analysis
Chi-square tests for proportional diŠerences be-
tween hikikomori status and all potential exposure fac-
tors were computed for all participants. Multiple logis-
tic regression was then performed on hikikomori to
assess the impact of individual variables of health sta-
tus and socio-psychological well-being factors with ad-
justment for all socio-demographic factors
(
Model 1
)
and adjusted eŠects of all potential factors
(
Model 2
)
.
For all models, collinearity diagnostics were run ac-
cording to tolerance, and variance in‰ation factors
were calculated to avoid multi-collinear problems due
to having several socio-psychological well-being factors
in the model. The goodness of ˆt of the model was also
checked using the Hosmer and Lemeshow test. All
models were applied to the entire sample, and to male
and female participants separately.
Odds of the total number of socio-psychological
well-being factors were obtained using a multiple logis-
tic regression model on hikikomori by adjusting for so-
cio-demographic factors and health status. All analyses
were performed for all participants, and for men and
women separately, using SPSS V.17.0
(
SPSS Inc.,
Chicago, IL, USA
)
, and the signiˆcance level was
P
0.05.
III. RESULTS
The sampling ‰ow chart is illustrated in Fig. 1. A
total of 3,059 completed questionnaires were received,
yielding a response rate of 67.8
. Our analyses were
based on 2,459 respondents
(
48.6
men, 51.4
wo-
men; 32.9
age 15
39 years old, 67.1
40
64 years
old
)
, after excluding the incomplete questionnaires.
Among them, 288 respondents
(
11.7
)
withdrew
from social interaction. There were 164 hikikomori
cases
(
6.7
)
,ofwhich,53.7
were men and 46.2
were women. Among them, 28.1
(
n
46
)
had so-
cially withdrawn for between six months to three
years, 26.3
(
n
43
)
for between three to ten years,
and 45.7
(
n
75
)
for more than ten years
(
Fig. 1
)
.
The chi-square test
(
Table 1
)
reported that a high
proportion of hikikomori tended to have signiˆcantly
fewer outdoor frequencies, poorer overall self-rated
health, more emotional distress, more passive suicidal
ideation, loneliness, social isolation, and less social
support, compared to non-hikikomori. In terms of so-
cial demographic factors, there were no signiˆcant
240
Table 1
Basic characteristics of the participants
Total Men Women
Non-hikikomori
(
n
2,295
)
Hikikomori
(
n
164
)
P
-value Non-hikikomori
(
n
1,107
)
Hikikomori
(
n
88
)
P
-value Non-hikikomori
(
n
1,188
)
Hikikomori
(
n
76
)
P
-value
Social-demographic factors
Sex
(
Women
)
1,188
(
51.8
)
76
(
46.3
)
0.207
b
Age
(
15
39 years old
)
761
(
33.2
)
48
(
29.3
)
0.348
b
369
(
33.3
)
21
(
23.9
)
0.088
a
392
(
33.0
)
27
(
35.5
)
0.743
a
Marital status 0.059
a
0.130
a
0.399
a
Single 623
(
27.1
)
52
(
31.7
)
361
(
32.6
)
34
(
38.6
)
262
(
22.1
)
18
(
23.7
)
Married 1,506
(
65.6
)
94
(
57.3
)
686
(
62.0
)
46
(
52.3
)
820
(
69.0
)
48
(
63.2
)
Divorced
/
Widowed 166
(
7.2
)
18
(
11.0
)
60
(
5.4
)
8
(
9.1
)
106
(
8.9
)
10
(
13.2
)
Job classiˆcations
.001
a
.001
a
0.002
a
Full-time workers 1,284
(
55.9
)
77
(
47.0
)
761
(
68.7
)
54
(
61.4
)
523
(
44.0
)
23
(
30.3
)
Freeters
/
Part-time workers 362
(
15.8
)
18
(
11.0
)
84
(
7.6
)
5
(
5.7
)
278
(
23.4
)
13
(
17.1
)
Homemakers
/
Jobless 322
(
14.0
)
48
(
29.3
)
101
(
9.1
)
21
(
23.9
)
221
(
18.6
)
27
(
35.5
)
Students
/
Others 327
(
14.2
)
21
(
12.8
)
161
(
14.5
)
8
(
9.1
)
166
(
14.0
)
13
(
17.1
)
Fewer outdoor frequencies 443
(
19.4
)
58
(
35.4
) <
.001
b
217
(
19.6
)
30
(
34.1
)
0.002
b
226
(
19.1
)
28
(
36.8
) <
.001
b
Health status
Existing sickness 744
(
32.4
)
56
(
34.1
)
0.711
b
343
(
31.0
)
31
(
35.2
)
0.480
b
401
(
33.8
)
25
(
32.9
)
0.977
b
Poor overall self-rated health 566
(
24.7
)
59
(
36.0
)
0.002
a
273
(
24.7
)
36
(
40.9
)
0.001
b
293
(
24.7
)
23
(
30.3
)
0.339
b
Socio-psychological well-being factors
Severe mental illness 133
(
5.8
)
19
(
11.6
)
0.005
b
59
(
5.3
)
13
(
14.8
)
0.001
b
74
(
6.2
)
6
(
7.9
)
0.737
b
Emotional distress 488
(
21.3
)
50
(
30.5
)
0.008
b
172
(
15.5
)
27
(
30.7
) <
.001
b
316
(
26.6
)
23
(
30.3
)
0.572
b
Loneliness 719
(
31.3
)
73
(
44.5
)
0.001
b
301
(
27.2
)
36
(
40.9
)
0.009
b
418
(
35.2
)
37
(
48.7
)
0.024
b
Isolation 391
(
17.0
)
44
(
26.8
)
0.002
b
177
(
16.0
)
25
(
28.4
)
0.004
b
214
(
18.0
)
19
(
25.0
)
0.171
b
Passive suicidal ideation 427
(
18.6
)
44
(
26.8
)
0.013
b
156
(
14.1
)
24
(
27.3
)
0.002
b
271
(
22.8
)
20
(
26.3
)
0.573
b
Social support 1,993
(
86.8
)
129
(
78.7
)
0.005
b
900
(
81.3
)
67
(
76.1
)
0.296
b
1,093
(
92.0
)
62
(
81.6
)
0.003
b
a
P
-value derived using the Pearson chi-square test
b
P
-value derived using the continuity correction computer only for a 2
×
2 table chi-square test
240
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241
Table 2
Associations between the hikikomori condition and the individual variables of interest among all participants, and its comparison between men and women
Total Men Women
Model 1
OR
(
95
)
Model 2
OR
(
95
)
Model 1
OR
(
95
)
Model 2
OR
(
95
)
Model 1
OR
(
95
)
Model 2
OR
(
95
)
Social-demographic factors
Sex
(
Women
)
0.75
(
0.53
1.07
)
Age
(
15
39 years old
)
0.76
(
0.50
1.15
)
0.54
(
0.30
0.98
)
1.12
(
0.60
2.09
)
Marital Status
Single 1 1 1
Married 0.76
(
0.49
1.17
)
0.60
(
0.35
1.04
)
1.07
(
0.52
2.23
)
Divorced
/
Widowed 1.20
(
0.64
2.25
)
1.03
(
0.42
2.50
)
1.69
(
0.65
4.39
)
Job Classiˆcations
Full-timeworkers 111
Freeters
/
Part-time workers 0.86
(
0.50
1.49
)
0.67
(
0.25
1.75
)
1.07
(
0.53
2.18
)
Homemakers
/
Jobless 2.30
(
1.53
3.45
)
2.00
(
1.10
3.64
)
2.60
(
1.43
4.74
)
Students
/
Others 1.03
(
0.60
1.76
)
0.74
(
0.33
1.65
)
1.57
(
0.73
3.39
)
Fewer outdoor frequencies 1.83
(
1.28
2.62
)
1.72
(
1.03
2.85
)
2.12
(
1.26
3.57
)
Health status
Existing sickness 0.88
(
0.61
1.27
)
0.78
(
0.53
1.15
)
0.93
(
0.57
1.53
)
0.76
(
0.45
1.28
)
0.83
(
0.48
1.42
)
0.81
(
0.45
1.46
)
Poor overall self-rated health 1.39
(
0.98
1.97
)
1.28
(
0.86
1.91
)
1.66
(
1.04
2.66
)
1.41
(
0.82
2.42
)
1.12
(
0.66
1.90
)
1.12
(
0.45
1.46
)
Socio-psychological well-being factors
Severe mental illness 1.55
(
0.91
2.66
)
1.12
(
0.60
2.05
)
2.22
(
1.11
4.44
)
1.42
(
0.62
3.27
)
0.96
(
0.39
2.34
)
0.69
(
0.25
1.87
)
Emotional distress 1.44
(
1.01
2.07
)
1.19
(
0.77
1.84
)
2.00
(
1.22
3.30
)
1.53
(
0.82
2.85
)
1.03
(
0.62
1.74
)
0.98
(
0.52
1.83
)
Loneliness 1.52
(
1.09
2.11
)
1.30
(
0.88
1.91
)
1.52
(
0.97
2.46
)
1.12
(
0.63
1.97
)
1.44
(
0.89
2.32
)
1.40
(
0.82
2.42
)
Isolation 1.46
(
1.01
2.13
)
1.08
(
0.69
1.69
)
1.63
(
0.98
2.73
)
1.18
(
0.63
2.23
)
1.25
(
0.72
2.19
)
0.94
(
0.49
1.81
)
Passive suicidal ideation 1.38
(
0.95
2.01
)
1.03
(
0.66
1.63
)
1.78
(
1.05
3.00
)
1.16
(
0.60
2.26
)
1.04
(
0.61
1.79
)
0.92
(
0.48
1.75
)
Social support 0.76
(
0.50
1.16
)
0.89
(
0.57
1.39
)
1.05
(
0.60
1.83
)
1.40
(
0.77
2.52
)
0.45
(
0.24
0.85
)
0.44
(
0.22
0.88
)
Model 1
Individual eŠect of each health status and socio-psychological wellbeing factors with an adjustment for social demographic factors
Model 2
EŠect of all health status, socio-psychological well-being factors and social-demographic factors
241
67
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4
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242
Table 3
Associations between the hikikomori condition and the individual variables of interest among all participants,
and its comparison between men and women considering the eŠect of all potential factors
Total
OR
(
95
CI
)
Men
OR
(
95
CI
)
Women
OR
(
95
CI
)
Social-demographic factors
Sex
(
Women
)
0.74
(
0.53
1.05
)
Age
(
15
39 years old
)
0.74
(
0.49
1.13
)
0.56
(
0.31
1.01
)
1.06
(
0.57
1.97
)
Marital Status
Single 1 1 1
Married 0.73
(
0.48
1.12
)
0.62
(
0.37
1.07
)
1.01
(
0.49
2.09
)
Divorced
/
Widowed 1.20
(
0.64
2.24
)
1.03
(
0.43
2.46
)
1.70
(
0.66
4.39
)
Job Classiˆcations
Full-timeworkers 111
Freeters
/
Part-time workers 0.86
(
0.50
1.49
)
0.65
(
0.25
1.69
)
1.05
(
0.52
2.12
)
Homemakers
/
Jobless 2.34
(
1.56
3.51
)
1.98
(
1.10
3.59
)
2.66
(
1.47
4.82
)
Students
/
Others 1.04
(
0.61
1.77
)
0.71
(
0.32
1.58
)
1.64
(
0.76
3.52
)
Fewer outdoor frequencies 1.89
(
1.33
2.69
)
1.70
(
1.04
2.78
)
2.24
(
1.34
3.73
)
Health status
Existing sickness 0.77
(
0.53
1.14
)
0.79
(
0.47
1.32
)
0.77
(
0.43
1.37
)
Poor overall self-rated health 1.40
(
0.92
2.02
)
1.44
(
0.85
2.43
)
1.25
(
0.68
2.29
)
Socio-psychological well-being
(
Aggregated
)
1.10
(
0.98
1.24
)
1.21
(
1.03
1.42
)
0.99
(
0.83
1.17
)
242
67
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4
15
diŠerences between men and women
(
Table 1
)
.In
terms of socio-psychological well-being factors, men
and women had opposite signiˆcant characteristics, ex-
cept for loneliness. Both sexes demonstrated the sig-
niˆcant proportional diŠerence between loneliness and
hikikomori
(
Table 1
)
.
Table 2 shows that the likelihood of hikikomori
being unemployed
/
homemakers
(
Model 2, OR
2.30, 95
CI
1.53
3.45
)
and having fewer outdoor
frequencies
(
Model 2, OR
1.83, 95
CI
1.28
2.62
)
remained signiˆcantly high. The logistic regres-
sion analysis showed that individuals who were unem-
ployed
/
homemakers
(
Model2,men,OR
2.00, 95
CI
1.10
3.64; women, OR
2.60, 95
CI
1.43
4.74
)
and had fewer outdoor frequencies
(
Model 2,
men, OR
1.72, 95
CI
1.03
2.85; women, OR
2.12, 95
CI
1.26
3.57
)
were consistently at risk of
transitioning to the hikikomori lifestyle. Overall, self-
rated health
(
Model 1, OR
1.66, 95
CI
1.04
2.66
)
, emotional distress
(
Model 1, OR
2.00, 95
CI
1.22
3.30
)
, severe mental illness
(
Model 1, OR
2.22, 95
CI
1.11
4.44
)
, and passive suicidal ide-
ation
(
OR
1.78, 95
CI
1.05
3.00
)
were sig-
niˆcantly associated with hikikomori men. Social sup-
port was signiˆcantly negatively associated with female
hikikomori in both models
(
Model 1, OR
0.45, 95
CI
0.24
0.85; Model 2, OR
0.44, 95
CI
0.22
0.88
)
.
Further analyses on aggregated socio-psychological
well-being factors
(
Table 3
)
were conducted to further
determine their impact on being hikikomori, and the
results demonstrated that being a homemaker
/
jobless
and exhibiting fewer outdoor frequencies remained
signiˆcant factors in the populations of men and wo-
men. When men had more socio-psychological
problems, there were higher odds
(
OR
1.21, 95
CI
1.03
1.42
)
that they would be hikikomori. Multicol-
linearity among socio-psychological factors were not
identiˆed as all tolerance values far exceeded 0.1, and
VIF values were less than 2. Hosmer and Lemeshow
Test showed a
P
-value of 0.065, indicating the model
is good-ˆt.
IV. DISCUSSION
1. Prevalence and social withdrawal duration of
hikikomori
To our knowledge, this is the ˆrst study relating to
hikikomori in rural areas at the population level.
Given the previous surveys, the prevalence of
hikikomori was 1.8
in 2009
2
)
,1.57
in 2015 among
people aged 15
39
3
)
,aswellas1.45
older
hikikomori among people aged 40
64 in 2018
4
)
.The
prevalence of hikikomori in this study is relatively high
(
6.7
)
compared to the national estimates
(
0.56

1.8
)
1
4
)
. Although the previous surveys and the
present study are not targeted at the same population,
our study demonstrates that age group is not a factor
aŠecting the transition to a hikikomori lifestyle.
Furthermore, almost half of our hikikomori samples
have been socially withdrawn for more than a decade.
In an earlier study, the proportion of hikikomori
people was smaller in residential areas with more busi-
243243
67
巻 日本公衛誌 第
4
2020
4
15
ness opportunities compared to other residential
characteristics
10
)
, indicating that socio-economic char-
acteristics may contribute to the high prevalence of
hikikomori situations in rural areas. Contextual factors
between urban and rural areas should be further inves-
tigated to design proper strategies to tackle the
hikikomori phenomenon.
2. Characteristics of hikikomori: homemakers,
unemployment, and fewer outdoor frequencies
In our study, 10.4
of the hikikomori samples are
homemakers, all of which are women. Interestingly,
the prevalence of homemakers found in this study is
half of the nation's estimates
(
23.4
)
4
)
, suggesting
that homemakers living in rural areas are less likely to
be hikikomori.
Unemployment and fewer outdoor frequencies ap-
pear to be the predominant socio-demographic factors
that control all other socio-psychological factors for
hikikomori in general, as well as male and female
hikikomori. These ˆndings further validate the
hikikomori samples found in this study. However, our
study also includes a noticeable number of people who
classify themselves as having a job. Although almost
half of the hikikomori in this study report being full-
time workers, it is unlikely that they would be able to
meet the criteria for both these social identities simul-
taneously. Spring and summer are the busiest seasons
in a town that supports a primary sector economy, and
it is virtually impossible to retain employment when
avoiding job appointments or social events in this
period. As such, we believe that the occupational sta-
tus reported in these instances may represent the par-
ticipants' preferred social identity moreso than their
actual employment status.
3. DiŠerence in characteristics between men and
women
The impacts of having severe mental illness sym-
ptoms, poorer overall self-rated health, emotional dis-
tress, and passive suicidal ideation are stronger in
hikikomori men than in non-hikikomori men. Since
the frequency of the socio-psychological factors are sig-
niˆcant, we hypothesize that it might be due to a dose-
response relationship, where men must reach a certain
level of poor socio-psychological factors to become
hikikomori.
We believe that gender role expectations for men in
Japanese society
for example, avoiding any display
of their weaknesses in front of others, being the bread-
winner in the family, and being out in the ˆeld
con-
tribute to worsening mental health situations in
hikikomori men. Jones
(
1998
)
identiˆed how unem-
ployment aŠects an individual's social identity, caus-
ing the person to feel like a social misˆt
30
)
.Whena
man does not attend work, the reversal in social status
can have a negative impact on self-e‹cacy, thereby
creating enormous stress that would signiˆcantly im-
pact the mental health of a hikikomori man
16,21,31
)
.
In contrast to the men, there is no signiˆcant
relationship between these variables in hikikomori and
non-hikikomori women. We believe that this can be
explained using the generalization that women more
often report being depressed and having suicidal
thoughts regardless of whether they are
hikikomori.
19,20
)
. Therefore, being a hikikomori may
not necessarily make them more mentally vulnerable
than non-hikikomori women.
However, hikikomori women can feel lonelier than
non-hikikomori women since they may have less social
support. Women who do receive social support beneˆt
from the positive impact, which can reduce the risk of
being a hikikomori by half. Thus, the availability of
social support, in this case, being able to articulate per-
sonal problems to others, may be a factor preventing
women from being hikikomori. As women often have
more social support than men
18
)
, this may also explain
why hikikomori tend to be men. We previously report-
ed that conversational power increased when
hikikomori people felt secure
32
)
; therefore, we suggest
that incorporating a secure platform for social interac-
tions into hikikomori intervention may be helpful.
Furthermore, as men generally display less help-seek-
ing behavior than women
16,21
)
, eŠective intervention
methods for hikikomori men may need to be developed
more proactively.
4. Limitations
There are several limitations to this study. First, this
was a cross-sectional study, so we were not able to exa-
mine the cause-eŠect relationships between the indica-
tors and the outcome factors. Additionally, sample
bias may have occurred as people in more severe
hikikomori conditions may have rejected the survey,
leading to an underestimation of the prevalence. As
there are no formal questionnaires to determine the
prevalence of hikikomori, we cannot conclude if the
prevalence from this study is comparable to those from
other studies. However, a simple yes
/
no question stat-
ing the deˆnition provided by the Ministry of Health,
Labour and Welfare was used to gauge the prevalence,
in addition to the participants' duration of social
withdrawal.
Social desirability bias may also lead respondents to
underreport characteristics of hikikomori. Further-
more, details of physical and mental illness among
hikikomori have not been assessed. Thus, the classiˆ-
cation of hikikomori may include existing psychiatric
disorders or physical disabilities. It should also be not-
ed that though there are many types of social support
available, opportunities to articulate personal
problems is the only factor measured in this study.
Also, other crucial socio-economic factors, such as
education level and household income, are not availa-
ble for further analysis. Lastly, there is only one study
area selected for this study, and the possibility of
generalizability of the results is limited to rural areas.
244244
67
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4
2020
4
15
5. Strengths and future implications
This study is one of few studies that report
hikikomori among a general population inclusive of all
working adults. This study is not only one of the very
few studies on the association of mental health and
hikikomori, but also the ˆrst to report these associa-
tions separately in men and women. Also, the high
response rate encourages the generalizability of the
ˆndings. We believe that this study provides insight
into hikikomori in highly competitive societies with
fewer job opportunities and developed countries that
fear rapid aging and the growing number of depopu-
lated areas due to urbanization.
Future studies should consider testing ideas compar-
ing rural and urban areas. Also, qualitative studies
should be considered to gain understanding of why
and how hikikomori is related to geographic factors,
and more quantitative studies are needed to clarify the
association between hikikomori and other social deter-
minants including social inequalities such as gender,
social support, social values, diversiˆcation of activi-
ties, lifestyle, infrastructure, and economic activities.
V. CONCLUSION
In this study, we found that occupational status and
outdoor frequencies are important factors in assessing
the potential for being hikikomori. It should also be
noted that characteristics of hikikomori diŠer between
men and women. Moreover, social support may help
women avoid hikikomori, while incorporating emo-
tional and mental health management into the design
of intervention programs may help hikikomori men.
RY, KF, and HS contributed to the conception and design
of the study. KF organized the database, RY and PC per-
formed the statistical analyses, and RY wrote the ˆrst draft
of the manuscript; PC and KF edited sections of the
manuscript. All authors contributed to the manuscript revi-
sion, read, and approved the submitted version.
We would also like to express our heartfelt thanks to Miss
Megan Lum, the visiting researcher from the Department of
Public Health, Akita University, who helped us proofread
the manuscript, tables, and appendix. Finally, we would like
to thank Editage
[
https:
//
www.editage.com
/]
for editing
and reviewing this manuscript for English language.
The authors declare that the research was conducted in the
absence of any commercial or ˆnancial relationships that
could be construed as a potential con‰ict of interest.
This study is funded by the Japan Society for the Promo-
tion of Science, grant numbers JP23590773, 15K08726, and
17K09191.
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246
Appendix
Variables Questions Scale
(
orignial
)
Scale
(
modiˆed
)
1 Hikikomori
1.1 ``Have you not been participating in any
social activities
and not having close interper-
sonal relationship with others than your family
members for a long time?''
(
Social activities
including attending schools, going to work,
joining local events, volunteering, socializing.
)
Yes
(
go to question 2
)
No
1.2 ``How long have you been in this situa-
tion?''
x
1month
1
x
3months
3
x
6months
6
x
12 months
1
x
3years
3
x
5years
5
x
10 years
x
10 years
1. Non-hikikomori
(◯
)
2. Hikikomori
(◯
)
2Sex
Male
Female
3Age
15
39 years old
40
64 years old
4 Marital Status ``What is your current marital status?''
Unmarried
Married and cohabiting
Married but living separately
Married but widowed
Divorced
1. Single
(◯
)
2. Married
(◯
)
3. Divorced
/
Widowed
(◯
)
5 Job Classiˆca-
tions ``What is your current job?''
Agriculture
/
Forestry
/
Fishery
(
including family employees
)
Buisness
/
Self-employed
Clerical
Manager
(
department chief and above
)
Professional skilled
Technical
/
labored
Service industry
Corporate CEO
Freeters
Part-time
Housewives
/
husbands
Jobless
Students
Others
1. Full-time workers
(◯
)
2. Freeters
/
Part-time workers
(◯
)
3. Homemakers
/
Jobless
(◯
)
4. Students
/
Others
(◯
)
6Outdoorfre-
quencies
``How often do you go out from your house?''
(
for students and people who are working,
please answer according to your oŠ-days
)
very often
quite often
not often
almost never
1. More
(◯
)
2. Fewer
(◯
)
7 Existing sick-
ness
``Are you seeing a doctor now or do you have a
sickness that needs medical follow-up?''
no
yes
8Pooroverall
self-rated
health
``In general, how would you rate your health?''
very healthy
quite healthy
not so healthy
not healthy
1. Healthy
(◯
)
2. Not healthy
(◯
)
9 Severe mental
illness
K6 scales
(
detailed description please refer to
reference 31
)
normal
(
K6
13
)
severe mental illness
(
K6
13
)
10 Emotional dis-
tress
``Have you been having emotionally dis-
tressed?''
no
yes
11 Loneliness ``How often do you feel lonely in life?''
often
sometimes
not so
rarely
1. Yes
(◯
)
2. No
(◯
)
12 Isolation ``How often do you feel being isolated from the
community that you are living in?''
often
sometimes
not so
rarely
1. Yes
(◯
)
2. No
(◯
)
13 Passive suicidal
ideation ``Have you ever wished to die?''
no
little
yes
1. Yes
(◯
)
2. No
(◯
)
14 Social support ``Do you have someone that you can talk to
about your problems?''
no
yes
246
67
巻 日本公衛誌 第
4
2020
4
15
... Many of the studies included an element of avoidance of social participation, whereas some of them included cases in which people were working (Frankova, 2019;Liu et al., 2018;Wong et al., 2015;Yong et al., 2020). This implies that in some cases, people 'avoid' social participation, but actually engage in it. ...
Article
Objective This review, which was registered with PROSPERO (CRD42021237988), aimed to systematically extract common elements in the hikikomori definition or criteria applied by researchers and examine cultural differences and chronological changes in the demographic characteristics of hikikomori individuals such as age, gender and hikikomori duration. Method For inclusion in the review, the hikikomori criteria, age and gender of the hikikomori individuals had to be specified, and the article had to be peer-reviewed and written in Japanese or English, focusing on hikikomori individuals or their families. Case studies, reviews and qualitative studies were excluded. Results The total sample size for the 52 studies included in the review was 4744. Over 80% of the studies included the elements ‘not working or attending school’, ‘not socializing outside one’s home’ and ‘duration of hikikomori’ in their hikikomori criteria, and many studies included the element ‘staying at home on most days except solitary outings’. A cross-temporal meta-analysis showed the possibility that the age of hikikomori individuals increased chronologically (β = 0.44, B = 0.50, 95% confidence interval = [0.16, 0.84]). Comparisons weighted by sample size between Japan and other countries showed the possibility that the age of hikikomori individuals was higher ( d = 0.32), the percentage of males was lower ( d = 0.91) and the hikikomori duration was shorter ( d = 2.06) in studies conducted in countries other than Japan. However, many of the included studies had a high risk of selection bias, and this bias may have influenced the results obtained. Thus, the results of this study may represent the researcher’s perception of hikikomori rather than accurately representing the actual condition of hikikomori. Conclusion Researchers should specifically identify similarities and differences in the clinical picture of hikikomori and compare the studies to organize the findings derived from studies focusing on hikikomori.
... 7,8 The elemental attribute of hikikomori is the social isolation; the distinctive element is the sociospatial self-segregation of affected individuals, who are predominately adolescents and marginally young adults. 9 This form of physical isolation typically take place at home, where these persons spend most of the day avoiding exposure to any form of socialization (at school, sport centers, and similar socializing contexts) for days, weeks, or months. 10 Hikikomori seems to be more prevalent in males. ...
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Background 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. Aims To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students. Method 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. Results 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. Conclusions Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.
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There have been few population studies of hikikomori (that is, prolonged social withdrawal and isolation), and the basic correlating factors of hikikomori are yet to be identified. Therefore, this study aimed to identify the associated basic characteristics and psychiatric factors of hikikomori. Data were obtained from the Survey of Young People’s Attitudes of 5,000 residents (aged 15–39 years) who were randomly selected from 200 urban and suburban municipalities in Japan in February 2010. The chi-square test and multiple logistic regression were used in the analysis. The data contained 3,262 participants (response rate: 65.4%); 47.7% were men (n = 1,555) and 52.3% were women (n = 1,707). Its prevalence was 1.8% (n = 58), and 41% had been in the hikikomori state for more than 3 years. There were fewer hikikomori people in neighborhoods filled with business and service industries. Significantly more men were in the hikikomori group (65.5%) than in the non-hikikomori group (47.3%). The hikikomori group was more likely to drop out of education (p < .001) and to have a psychiatric treatment history compared with non-hikikomori (37.9% vs 5%, p < .001). The multiple logistic regression analyses revealed that interpersonal relationships were significantly associated with hikikomori across three models (Model 1 adjusting for all basic characteristics, OR = 2.30, 95% CI = 1.92–2.76; Model 2 further adjusting for mental health-related factors, OR = 2.1, 95% CI = 1.64–2.68; Model 3 further adjusting for a previous psychiatric treatment history, OR = 1.95, 95% CI = 1.52–2.51). Additionally, the hikikomori group was more likely to have suicide risk factors (Model 1: OR = 1.85, 95% CI = 1.56–2.20; Model 2: OR = 1.33, 95% CI = 1.05–1.67), obsessive–compulsive behaviors (Model 1: OR = 1.57, 95% CI = 1.20–2.05), and addictive behaviors (Model 1: OR = 1.93, 95% CI = 1.37–2.70). This is the first study to show that hikikomori is associated with interpersonal relationships, followed by suicide risks. Hikikomori people are more likely to be male, have a history of dropping out from education, and have a previous psychiatric treatment history.
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Background: Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature. Objective: The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China. Methods: A cross-sectional open Web survey was conducted from October 2015 to May 2016 to identify and reach socially withdrawn youth in 3 metropolitan cities in China: Beijing, Shanghai, and Shenzhen. To advertise the survey, 3 social media platforms were used: Weibo, WeChat, and Wandianba, a social networking gaming website. Results: In total, 137 participants completed the survey, among whom 13 (9.5%) were identified as belonging to the withdrawal group, 7 (5.1%) to the asocial group, and 9 (6.6%) to the hikikomori group (both withdrawn and asocial for more than 3 months). The cost of recruitment via Weibo was US $7.27 per participant. Conclusions: Several social media platforms in China are viable and inexpensive tools to reach socially withdrawn youth, and internet platforms that specialize in a certain culture or type of entertainment appeared to be more effective in reaching socially withdrawn youth.
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Background: Empirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India's slums. Methods: The study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through individual face-to-face in-depth interviews with a semi-structured questionnaire. Results: The data analysis shows six categories of reasons underlying women's preferences for informal healers, which are presented in the form of the following themes: cultural competency of care, easy communication, gender-induced affordability, avoidance of social stigma and labelling, living with the burden of cultural expectations and geographical and cognitive distance of formal health care. In case of men ease of access, quality of treatment and expected outcome of therapies are the three themes that emerged as the reasons behind their preferences for formal care. Conclusion: Our results suggest that both men and women utilise formal and informal care, but with different motives and expectations, leading to contrasting health-seeking outcomes. These gender-induced contrasts relate to a preference for socio-cultural (women) versus technological (men) therapies and long (women) versus fast (men) treatment, and are linked to their different societal and familial roles. The role of women in following and maintaining socio-cultural norms leads them to focus on care that involves long discussions mixed with socio-cultural traits that help avoid economic and social sanctions, while the role of men as bread earners requires them to look for care that ensures a fast and complete recovery so as to avoid financial pressures.
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居場所への参加がひきこもりに与える影響について、彼らの社会的孤立状況と精神的健康状態に関して初めて明らかにすることを目的として、大仙市における当事者中心の支援プログラムである居場所「ふらっと」の実践について報告する。そして、利用者が利用しやすい居場所モデルを示し、ひきこもり支援のあり方について考察する。研究期間は、平成28年1月から平成29年2月までとした。「ふらっと」の利用状況、当事者の基本属性、ひきこもりの状態、統合失調症の有無、「ふらっと」に参加してからの変化について分析した。また、自由回答(居場所の意味、利用し続けている理由、ピア・サポートを通して自身の変化と居場所に期待すること)についてテキストマイニングの手法を用いて支援効果を分析した。当事者のうち、男性は64.7%、女性は35.3%、年齢階級別では20~29歳の割合が最も高く(41.2%)、次は30~39歳(35.3%)であった。「ふらっと」の利用によって、就労意識の変化及び、前向きな決心、家族や対人関係の改善が見られた。自由回答の分析から、出現率が最も多かった言葉は、「悩み共有・分かち合い・話し合い・繋がりたい」(18回)、「仲間」(13回)、「癒し・憩い・安らぐ」(10回)、「気楽・気軽く・いつでも」(5回)、「安心」(4回)であった。ひきこもりの社会復帰に関連した、居場所に欠かすことの出来ない要因は、当事者に安心感を与えること、同じ悩みを抱えている仲間の存在、家族以外の他人と接する時間、気づくこと、成長すること、次のステップと繋がることであったと考えられる。 This is an observation study aimed to explore the effect of an “ibasho” (a place where one belongs) intervention program on the psychosocial well-being and the social condition for people with hikikomori syndrome. The study reported the fieldwork on a peer-focused hikikomori intervention program launched in “Furatto”, an “ibasho” located in Daisen City. It reported a user friendly framework of “ibasho”, and proposed the essential factors that should be considered in hikikomori intervention. The study was held in between Jan 2016 to Feb 2017. Measurable variables included the basic characteristics of users, the conditions of hikikomori, the diagnosis of schizophrenia, the frequency of use and changes in behaviors. Open-ended questions (the meaning of “ibasho”, the reason for continuing the program, the changes through peer support, and the expectations towards “ibasho”) were also adopted to further analyze the intervention effect. Among the hikikomori users, 64.7% were male and 35.3% were female. Larger proportions were observed among the age 20-29 (41.2%) followed by the age 30-39 (35.3%). The ideology about work, the desire to move forward, the relationship between family and towards others were improved. Text analysis shown the relative frequency for words or phrases pointing to “sharing and bonding” (18 times), “peers” (13 times), “feeling at ease” (10 times), “carefree” (5 times), “relieve” (4 times). The essential factors for an effective hikikomori intervention program held in an “ibasho” are therefore, providing a sense of relief to the hikikomori users, peers, time to be with others besides family members, awareness, personal growth, and possible chances to move forward.
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Hikikomori is a recent phenomenon among young adults in which they isolate themselves from social contacts and responsibility for more than 6 months. This problem has assumed epidemic proportions in Japan and has been widely discussed across disciplines. Previous studies have associated hikikomori with a maladaptation to structural change, an emergent mental problem that needs new diagnosis, or an under-diagnosed schizophrenic disorder. Most previous work has adopted a clinical perspective, and there have been no qualitative studies exploring the individual feelings of people suffering from the syndrome. We adopted a qualitative method using a grounded theory approach. Data collection and analysis took place between September 2006 and August 2008. Theoretical sampling included eight informants from snowball sampling and an online observation consisting of 160 online participants. Analysis focused on informants’ first- and second-person experiences of hikikomori. Data analysis revealed one overriding theme: coping difficulties consisting of the two categories stasis and expression. As a result of conflicting demands and reduced autonomy, respondents experienced stasis, which prevented them from moving forward; “hiding” or “avoiding” heightened the expression of their behaviors. This is the first study to explore the in-depth experience of individuals suffering from hikikomori syndrome in a non-clinical setting. We argue that hikikomoriis not a result of asocial behavior, but rather an anomic response to a situation that informants felt powerless to change and from which they could see no way out. We also observed that feelings of hopelessness and relationship fatigue might be overcome by introducing a relaxed social environment that people can control during rehabilitation.
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Background: Severe social withdrawal behaviors among young people have been a subject of public and clinical concerns. Aims: This study aimed to explore the prevalence of social withdrawal behaviors among young people aged 12-29 years in Hong Kong. Methods: A cross-sectional telephone-based survey was conducted with 1,010 young individuals. Social withdrawal behaviors were measured with the proposed research diagnostic criteria for hikikomori and were categorized according to the (a) international proposed duration criterion (more than 6 months), (b) local proposed criterion (less than 6 months) and (c) with withdrawal behaviors but self-perceived as non-problematic. The correlates of social withdrawal among the three groups were examined using multinomial and ordinal logistic regression analyses. Results: The prevalence rates of more than 6 months, less than 6 months and self-perceived non-problematic social withdrawal were 1.9%, 2.5% and 2.6%, respectively. In terms of the correlates, the internationally and locally defined socially withdrawn youths are similar, while the self-perceived non-problematic group is comparable to the comparison group. Conclusions: The study finds that the prevalence of severe social withdrawal in Hong Kong is comparable to that in Japan. Both groups with withdrawal behaviors for more or less than 6 months share similar characteristics and are related to other contemporary youth issues, for example, compensated dating and self-injury behavior. The self-perceived non-problematic group appears to be a distinct group and the withdrawal behaviors of its members may be discretionary.
Article
The purpose of the present study was to examine the effect of hikikomori, a Japanese term denoting "prolonged social withdrawal", on quality of life (QOL). Individuals with hikikomori at present (n = 26) and in the past (n = 31), as well as mildly depressed individuals without hikikomori (n = 114) and highly depressed individuals without hikikomori (n = 27) were requested to complete the WHO Quality of Life 26 (QOL26). The results of MANOVA indicated that the present hikikomori group's scores on the social relationships domains of the QOL26 were significantly lower than the scores of the highly depressed group. The results of this study suggest that it might be important to intervene to improve QOL in individuals with hikikomori.