Prevalence of hikikomori and associations with suicidal ideation, suicide stigma, and help-seeking among 2,022 young adults in Hong Kong.

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.

Social withdrawal and shyness

This chapter provides a conceptual overview of the construct of social withdrawal. It describes the developmental origins, with an emphasis on the contributions of biology and parents, and details the psychosocial costs of child and adolescent social withdrawal. Social withdrawal and shyness appear to develop from a biologically based temperamental predisposition toward heightened fear reactivity and ineffective fear regulation. From early childhood through adolescence, shyness is concurrently and predictively associated with a wide range of socioemotional difficulties. The chapter outlines the correlates and outcomes of shyness, with a focus on implications for social development. Numerous studies also indicate that many socially withdrawn youth experience peer victimization during childhood and early adolescence. The chapter suggests the potential impact of increased social isolation and solitude on socially withdrawn youth during Covid-19 global pandemic. The Covid-19 pandemic, however, may be particularly challenging for already vulnerable socially withdrawn youth. © 2022 John Wiley & Sons Ltd.

Detrimental impact of contagious disease cues on consumer preference for anthropomorphic products.

Despite the extensive use of anthropomorphism strategy in marketing practices, little research attention has been given to the environmental factors that influence consumer preference for anthropomorphic products. This research examines when and why contagious disease cues can influence consumer preference for anthropomorphic products. The results from four empirical experiments consistently show that when exposed to contagious disease cues, consumers exhibit a lower preference for anthropomorphic products (Study 1), which is mediated by social withdrawal (Study 2). Furthermore, our findings demonstrate that this detrimental effect would be attenuated for products in digital (vs. physical) format (Study 3), or in regions with low (vs. high) local severity of the contagious disease (Study 4). These findings contribute to the literature on contagious diseases and anthropomorphism and offer important managerial implications. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11002-022-09614-x.

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.

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.

Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study

Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population.

Social Engagement and Distress Among Home Care Recipients During the COVID-19 Pandemic in Ontario, Canada: A Retrospective Cohort Study.

OBJECTIVES: To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients. DESIGN: Retrospective cohort. SETTING AND PARTICIPANTS: Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020. METHODS: Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P < .01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs). RESULTS: We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic. CONCLUSIONS AND IMPLICATIONS: Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.

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)

Severe social withdrawal: General considerations and interventions by Child and Adolescent Neuropsychiatry Services

Social withdrawal in adolescence presents itself as a spectrum of phenomena ranging from the variant of the norm to severe psychopathology. According to recent data, this condition involves almost 100.00 youths, mostly male. This work summarizes the clinical characteristics of Serious Social Withdrawal (RSG), the possible paths of diagnosis and management, and its correlation with the phenomena induced by the COVID-19 pandemic. The main aspects of this phenomenon are self-reclusion at home for 6 months, with rare exits and early school leaving, reduction of direct communication with family members and external relations, partly substituted from virtual relationships via web. The typical onset is in pre-adolescence, with a second peak at the threshold of adulthood, occasionally associated with frustration, bullying or exposure to narcissistic traps. The family systemic function could be displaced by the social withdrawal. Primary and secondary social withdrawal differential diagnosis represents a complex and discussed topic also due to the potentially pathogenic role of social withdrawal itself. RSG does not appear in diagnostic manuals as a nosological entity "per se", but as a symptom of other pathologies (anxiety disorders, mood disorders, etc.) but it is placed in the intersection of individual, developmental, family and social trajectories. On one side the "evolutionary" role of RS can be linked to a temporary narcissistic reorganization in adolescence or could represents the onset of a structured disorder of affective and emotional functioning. Services and Mental Health Specialists may have difficulties to reach less severe patients or with lower efficient family networks. The difficulties of reorganizing the NPIA Services in the COVID-19 are discussed maintaining flexible and multidimensional interventions. The standard situation of the Services forces to structure the interventions based on the available resources, and not only based on clinical needs;earliness and integration of the interventions are related to a more favorable prognosis. In a second section, we discuss the specific characteristics of the reception, diagnosis and care pathways of patients with RSG in an out-patient and semi-residential setting, and in a hospital setting (from the A&E to admission to the Day Hospital). Italian Care Services organizational characteristics are heterogeneous, with diversified protocols, structures and paths. The prevention and an early and synergistic care and stable and formal collaboration agreements between health, social and educational skills are fundamental. The available diagnostic tools are discussed, as well as the criteria for the direct care project, based on necessity, coherence, feasibility, both to the minor and to the family and its environment, and their possible use by a mobile and competent team. The general and practical theoretical aspects of home and semi-residential interventions are outlined. The path and effectiveness indicators and their modification from the beginning of 2020, still in progress due to the distortions induced by the COVID-19 pandemic, are discussed. We focus on changes in the very concept of "school" and "presence", and to their meaning for narcissistically fragile, anxious or depressed subjects. Possible semi-residential, therapeutic, rehabilitative, intensive, complex and coordinated interventions are discussed in detail, with particular regard to their transitional role between acute and hospitalization, as an "enlarged psychic space". Finally, the existing experiences in the hospital, ward and A&E setting are mentioned. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Subtypes of social withdrawal and mental health trajectories during COVID-19 pandemic.

The outbreak of Coronavirus Disease 2019 (COVID-19) has pervasive implications for the well-being of people, especially for the social withdrawn individuals. The present study examined changes of well-being among people in distinct subgroups of social withdrawal - shyness, unsociability, and social avoidance -in different phases of the COVID-19 pandemic using six-wave longitudinal data in China (N = 222; 54.50% female). Results showed that, in general, well-being sharply decreased from the initial phase to the peak phase of the pandemic, but steadily recovered after the peak phase. People in different withdrawal groups displayed different levels and trajectories of well-being during a period of six months. The current study has implications for developing targeted interventions for vulnerable people in public health crisis.

Inflammatory reactivity to the influenza vaccine is associated with changes in automatic social behavior.

Recent evidence suggests differential patterns of social behavior following an inflammatory challenge, such that increases in inflammation may not uniformly lead to social withdrawal. Indeed, increases in inflammation have been associated with enhanced self-reported motivation to approach a specific close other, and greater neural sensitivity to positive social cues. However, no known studies have examined the association between inflammation in response to an inflammatory challenge and social behavior in humans, nor has past research examined specifically how approach and withdrawal behavior may differ based on whether the target is a close other or stranger. To address this, 31 participants (ages 18-24) received the influenza vaccine to elicit a low-grade inflammatory response. The morning before and approximately 24 h after the vaccine, participants provided a blood sample and completed a computer task assessing automatic (implicit) approach and withdrawal behavior toward a social support figure and strangers. Greater increases in the inflammatory cytokine interleukin-6 (IL-6) in response to the vaccine were associated with an increase in accuracy in avoiding strangers and a decrease in accuracy in approaching them. Increases in IL-6 were also associated with a decrease in reaction time to approach a support figure, but only when controlling for baseline IL-6 levels. There were no associations between change in IL-6 and changes in self-reported motivation to engage in social behavior with either close others, or strangers. Together, these findings reveal that increases in inflammation following the influenza vaccine are associated with automatic social behavior, especially behavior suggesting avoidance of unfamiliar social targets and ease in approaching a support figure. These data add to the growing literature suggesting that the association between inflammation and social behavior includes both social withdrawal and social approach, depending on the specific target.

School refusal and isolation: The perspectives of five adolescent school refusers in London, UK.

Research has identified a subset of young people who feel unable to engage in mainstream education. Given the hard-to-reach nature of this group, their views on what has caused their isolation from others have received little focus in previous literature. The present study aimed to explore the experiences and views of a subset of young people seen within an inner London Pupil Referral Unit who were extremely socially withdrawn and unable to attend mainstream education. They were asked what they believe led them to their current situation, the impact of isolation, how their life is going and what they value. Key themes identified were the role of anxiety in withdrawal from education and the protective capacity of social contact, even via social media, in preventing negative outcomes of withdrawal. Sleep, health, education, family and social contact were identified as risk and protective factors and were also things participants identified as values. This research provides insight into potential ways to support young people in returning to mainstream education as well as ideas for preventative measures that may protect future generations from such extreme isolation. This research was conducted before the COVID-19 pandemic, but lessons learned bear relevance in current times.