First year students enrolled in university during the COVID-19 disaster and online classes: physical and mental health and desire for Hikikomori

The purpose of this study was to quantitatively clarify the physical and mental health of first year university students whose classes were conducted online due to COVID-19. The checklist of Visual Display Terminal (VDT) syndrome suggested that physical stress was placed mainly on the eyes, shoulders, neck, and head. In addition, from the results of the Kessler Psychological Distress Scale (K6) scale, higher values were obtained than those of previous studies, which indicated the poor mental health of first year university students. Consequently, university academics who conduct online classes must consider the physical and mental fatigue of the students. In contrast, there was a correlation between university students who had desire for Hikikomori and students who preferred on line classes. In other words, for students who experienced difficulties with existing face-to-face classes, it is suggested that online classes are one of the potential solution. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Review of hikikomori: A global health issue, identification and treatment.

In the early 2000s, Japanese society became aware of the social phenomenon of hikikomori or social withdrawal among Japanese youth. However, the hikikomori phenomenon was not a domestic Japanese social problem, but a global social and health issue or a global silent epidemic. A literature review was conducted on the global silent epidemic issue and identifying hikikomori and effective treatment. This paper will reveal how to identify hikikomori with biomarkers or determinants and treatments for hikikomori. Impact of COVID-19 on hikikomori was briefly investigated.

The Existence of Personality and Hikikomori State: a Socio-Philosophical Reflection on the Consequences of the COVID-19 Pandemic

The article is devoted to the problem of humans joining the ranks of hikikomori at the time of and after the introduction of strict quarantine measures during the COVID-19 pandemic. The lifestyle of the hikikomori, as a specific subcultural trend that focuses on the physical distancing of the individual from the space of social communication, is emphasised. During the COVID-19 pandemic, the hikikomori lifestyle became common to many people under a regime of enforced self-isolation. However, even when quarantine measures are relaxed and a return to familiar communication practices is allowed, not all people are willing to return to offline life. Attitudes towards temporality also change under conditions of pandemic and enforced self-isolation, where complex ethico-social dilemmas arise, bringing psychological discomfort to the individual on micro-and macro levels.

3-day intervention program for family members of hikikomori sufferers: A pilot randomized controlled trial.

Backgrounds: Hikikomori, 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. Methods: This 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. Results: Perceived 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). Conclusion: We 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.

Boredom, loneliness and modern type depression in a cohort of Italian university students

Introduction: COVID-19-related physical isolation, fear and anxiety determined de novo mental illnesses, by potentially facilitating the emergence of Hikikomori traits (i.e., a severe social withdrawal condition). Objective(s): The present study aims at screening a cohort of university students for the Hikikomori traits and assessing a set of psychopathological determinants associated with Hikikomori, particularly boredom and loneliness dimensions. Method(s): A cross-sectional web-based survey was carried out by administering Hikikomori Questionnaire (HQ-11), Italian Loneliness Scale (ILS), Multidimensional State Boredom Scale (MSBS), Depression Anxiety Stress Scale (DASS-21) and Toronto Alexithymia Scale (TAS-20). Result(s): 1,148 respondents (767 women and 374 men, mean age: 23.2+/-SD=2.8 years old) were recruited. 70.7% declared to have experienced psychological distress. HQ-11 average total score was 18.4+/-SD=7.5 with statistically significant higher values in the males (p=0.017) and amongst students studying Informatics, Mathematics/Physics/Chemistry, Science of Communication and Engineering. The HQ-11 positively correlated with ILS (r=0.609), MSBS (r=0.415), TAS-20 (r=0.482) and DASS-21 (r=0.434). Conclusion(s): This study represents the first screening of the Hikikomori phenomenon in Italian university students. Hikikomori traits appear to be particularly represented in the Italian youth population and should be carefully investigated in future studies.

Risk factors of hikikomori among office workers during the COVID-19 pandemic: A prospective online survey.

The global pandemic of COVID-19 has forced people to restrict their outings. In Japan, self-restraint behavior (SRB) has been requested by the government, and some of those decreasing their outings may shift to pathological social withdrawal; hikikomori. The purpose of this study was to examine the risk factors of hikikomori conducting an online prospective survey. An online survey was conducted in June 2020 and December 2020; (1) SRB-related indicators (degree of SRB, motivation for SRB, stigma and self-stigma toward COVID-19, anxiety and depressive feelings toward COVID-19) and (2) general mental health (hikikomori tendency, depressive symptoms, modern type depression (MTD) tendency, internet addiction) were collected. A cross-lagged effects model was performed to examine the association between these variables. Lack of emotional support and lack of socialization in June 2020 increased isolation in December 2020. Besides, MTD and hikikomori interacted with each other. Interestingly, although hikikomori tendency increased depressive tendencies, SRB itself did not have a significant path on any mental health-related variables. Poor interpersonal relationships, rather than SRB per se, are suggested to be a risk factor for increased isolation among office workers in the COVID-19 pandemic. Appropriate early interventions such as interpersonal or emotional support may prevent the transition to pathological hikikomori. The association between MTD and hikikomori seems to reveal the interesting possibility that MTD is a gateway to increased risk of hikikomori, and that hikikomori is a gateway to MTD as well. Future research is required to elucidate the relationship between hikikomori and MTD.

Hikikomori: A Society-Bound Syndrome of Severe Social Withdrawal

Background: Hikikomori, a severe and often prolonged social withdrawal observed primarily in young people, was first described in Japan, but cases have now been reported in many other countries. Methods: A review paper on hikikomori has been prepared following the literature searches in 3 databases. Search terms related to hikikomori included epidemiology, globalization, diagnosis, treatment, comorbidity, and COVID-19. Conclusions: Hikikomori was first reported in Japan and has been described in detail by researchers there, but there are now reports in many countries of hikikomori-like cases. It occurs primarily in young people, often men in their late teens and early twenties who isolate themselves, sometimes confining themselves to their homes for months or even years. It has been proposed that hikikomori has increased in recent years in part because of advances in information technology that result in decreased socialization. Hikikomori was originally considered a non-psychotic phenomenon, but comorbidity with psychiatric disorders is often present and should be considered during diagnosis. Considerable efforts have been made in recent years to establish reliable, widely applicable guidelines for the diagnosis and treatment of hikikomori. There is very little information with regard to neurobiology, although involvement of the immune system, oxidative stress, and the social brain network has been proposed. It is widely agreed that hikikomori must be treated in a multi-dimensional fashion, with family support very important. Lessons learned from these treatment approaches are relevant to the potential increased risk of social withdrawal arising from COVID-19 pandemic lockdowns.

Peer Power! Secure Peer Attachment Mediates the Effect of Parental Attachment on Depressive Withdrawal of Teenagers.

Adolescents' depressive social withdrawal is a relevant concern for mental health professionals, and it is widespread among community teenagers in form of subclinical symptoms. Different studies suggest that insecure attachment representations increase the adolescents' likelihood to show symptoms of withdrawal (e.g., loneliness). This study explored the effect of the general attachment internal working model (IWM) and the independent and cumulative effects of the specific attachment representations of parents-in terms of secure base/safe haven-and peers on adolescents' withdrawal. Additionally, the mediation of peer attachment on the effect of parental attachment on symptoms was explored. All analyses were conducted controlling for the difference between teenagers living with parents together or divorced/separated, as children of divorcees are considered more exposed to stressors. Ninety-one adolescents aged 12-17 years old were assessed online during the COVID pandemic period, employing the Youth Self-Report to assess withdrawal and the Friends and Family Interview to assess attachment-general IWM and attachment-specific representations. Results show no influence of parents together/separated or of the general IWM on withdrawal, but higher parent secure base/safe haven and peer attachment cumulatively predicted 10-21% less withdrawal. Moreover, more positive peer attachment mediated 61% of the effect of the parental secure attachment on withdrawal, revealing an indirect effect of parental attachment on withdrawal through peer attachment. In conclusion, both parents and peers are influential on adolescent mental health, and fostering positive peer relationships can buffer the effect of dysfunctional family relationships on teenagers' withdrawal.

The Relationship Between Hikikomori Risk and Internet Use During COVID-19 Restrictions.

This study explores the phenomenon of hikikomori, or extreme social isolation, which for the past 20 years has been associated with a range of negative outcomes, including psychological, financial, and social. As hikikomori is associated with marked social withdrawal in one's home and increased Internet use, it has been suggested that the social and technological changes brought about by COVID-19 restrictions may exacerbate the risk of hikikomori in young adults. This study, therefore, sought to identify the relationship between hikikomori risk and changes in Internet use for young people aged 16-24 years during COVID-19 restrictions. An international sample of 826 participants completed an online survey consisting of questions about demographics, experience of lockdown restrictions in the previous 12 months, changes to Internet use in the previous 12 months and a hikikomori risk scale. Higher hikikomori risk was associated with being male, greater time spent in lockdown, and leaving the house less frequently. An increase in Internet use during lockdown was associated with reduced risk of hikikomori. Findings are discussed in relation to gender differences in the type of Internet use engaged in by males and females. It is concluded that online social interaction may be a means of mitigating hikikomori risk in post-COVID-19 societies.

Severe social withdrawal in the developmental age: Results of a fact-finding survey about the experts' opinions, the resources, and the dedicated interventions in the Italian Child and Adolescent Neuropsychiatry Services

The Italian Society of Childhood and Adolescent Neuropsychiatry (SINPIA) created a Working Group dedicated to the study of Severe Social Withdrawal (SSW) in children and adolescents. The Working Group produced an online questionnaire aimed at mapping and evaluating the cases of SSW that contacted the NPIA Services in the last year. The questionnaire was proposed to the Italian Child Neuropsychiatrists by email invitation from July to October 2020. The questionnaire had two independent sections: a first one, about the general characteristics of SSW, to be completed once ("Section A");a second one, optional, to be completed once for each SSW patient met in the last 12 months (from June 2019 to of June 2020) ("Section B"). At the closing date of the survey (3-12-2020), 119 "Section A" and 136 "Section B" answers had been collected. We illustrate the survey results and discuss possible risk factors, diagnostic frameworks, prognostic indicators, and treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) Il gruppo di lavoro della Societa Italiana di Neuropsichiatria dell'Infanzia e dell'Adolescenza (SINPIA), dedicato al ritiro sociale grave in eta evolutiva, ha realizzato un questionario finalizzato al mappaggio delle situazioni di ritiro che hanno contattato i Servizi nell'ultimo anno e alla valutazione delle stesse. Il questionario, diviso in due parti, una da compilare una sola volta e una opzionale, da compilare per ciascun ragazzo con le caratteristiche del ritiro sociale grave con cui il compilatore fosse venuto in contatto negli ultimi 12 mesi (dal mese di giugno 2019 al mese di giugno 2020), e stato proposto agli specialisti italiani in tre ondate ravvicinate. Al momento della chiusura dell'indagine (3/12/2020), i questionari parte A ricevuti sono stati 119, a fronte di 136 questionari parte B. Vengono illustrati i risultati dell'indagine e discussi i possibili fattori di rischio, inquadramenti diagnostici, indicatori prognostici e trattamenti. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Association between depressive state and behavioral changes induced by the state of emergency for Coronavirus disease 2019: Evidence from university students in Japan.

Coronavirus disease 2019 (Covid-19) has caused numerous problems worldwide since 2020. The pandemic and subsequent quarantine policies have resulted in numerous psychological problems among students. The quarantine policy forced students to change their behavior and refrain from going out. To date, the relationship between behavioral and psychological changes following the implementation of the quarantine policy has not been investigated. We conducted a web-based survey to investigate the change in time spent out of the house between before and after the implementation of the quarantine policy and how this related to changes in depression. We collected data from 12,088 students, which included the Patients Health Questionnaire-9, frequency of going out, and demographics. We divided subjects into three categories based on the frequency of going out before and after the policy was put in place. Results showed that students who frequently went out before the pandemic and strictly followed the government policy were significantly more depressed than those who did not frequently go out. In contrast, students who had always been reluctant to go out did not have a tendency for depression to worsen. Our findings indicate that behavioral modification leads to depression in those who previously had active social lives.

Hikikomori: a possible mental health consequence of the COVID-19 epidemic / Hikikomori: a COVID-19-járvány egy lehetséges mentálhigiénés következménye.

Összefoglaló. A COVID-19-járvány kényszeru tartós szociális távolságtartást idézett elo az emberek között, ami az egyéb mentális rendellenességek és mentálhigiénés következmények mellett egy sajátos pszichiátriai jelenségre, a hikikomori állapotra hívja fel a figyelmet. A hikikomori tartós és szélsoséges szociális visszahúzódással járó jelenség, melynek kidolgozott kritériumrendszere egyelore még nem található meg a mentális rendellenességeket osztályozó diagnosztikus kézikönyvekben. Kialakulásának pontos mechanizmusáról még keveset tudunk, de az állapot megjelenése és az internet térnyerése között egyes szerzok szoros kapcsolatot látnak. Klasszikusan az egyén egy társadalmi szempontból megalázó vagy elonytelenül alakuló helyzet következtében vonul vissza fokozatosan egy önként vállalt izolációba. Bár a külvilág nem teljesen érdektelen számukra, azonban a retraumatizáció elkerülése érdekében leginkább online követik a világ történéseit és tartanak kapcsolatot másokkal. A COVID-19-pandémia - különösen a lezárások következményeként elotérbe kerülo online életvitelhez kötodoen - jelentos mértékben hozzájárult az internet térnyeréséhez, miközben a valós társas kapcsolatok kényszeruen beszukültek. Ez a konstelláció jelentos kockázati tényezonek tekintheto a hikikomori szempontjából, amely hosszú távon a világjárvány egyik nem várt szövodménye lehet, különösen az adolescens és a fiatal felnott korosztályban. Orv Hetil. 2021; 162(41): 1637-1642. Summary. The COVID-19 pandemic forced prolonged social distancing between people. This, among other mental disorders and mental health consequences, highlights a specific psychiatric phenomenon: the hikikomori condition. The hikikomori is a phenomenon of persistent and extreme social withdrawal. The condition's established diagnostic set of criteria is not yet to be found in diagnostic manuals classifying mental disorders. Little is known about the exact mechanism of its development, but some authors see a close link between its emergence and the rise of the internet. Typically, the individual gradually withdraws into a voluntary isolation as a result of a socially humiliating or unfavourable situation. Although the outside world is not completely irrelevant to them, they tend to follow online the events of the world and they also keep in touch with others mostly online in order to avoid retraumatization. The COVID-19 pandemic, particularly in relation to the rise of online lifestyles as a consequence of lockdowns, has contributed significantly to the more and more frequent use of the internet, while real social contact has been inevitably reduced. This constellation can be seen as a major risk factor for hikikomori, which in the long term could be an unanticipated complication of the pandemic, especially in adolescents and young adults. Orv Hetil. 2021; 162(41): 1637-1642.