The Characteristics and Social Functioning of Pathological Social Withdrawal, "Hikikomori," in a Secondary Care Setting: a One-Year Cohort Study.

BACKGROUND: Pathological social withdrawal, named "Hikikomori," is a Japanese culture-bound syndrome and a serious social problem in Japan. The number of Hikikomori cases in Japan was estimated at about 563,000 in 2016 according to governmental surveys. However, no studies have reported how many people with Hikikomori have access to community-based psychiatry clinics, and how different they are from non-Hikikomori patients regarding their baseline characteristics and outcomes. The aim of the present study is to evaluate the baseline characteristics, clinical attendance, and social functioning of community psychiatric clinic patients treated for social withdrawal at one-year follow-up. METHOD: Participants (n = 304) were all patients (aged under 65) of a psychiatric clinic in a one-year period. Baseline patient characteristics were compared among "current" Hikikomori patients, "past" Hikikomori," and "other" patients. Logistic regression analysis of clinic attendance status and social functioning at one-year follow-up was used to assess patient outcomes. Independent variables were age, gender, Hikikomori status, and support from clinical staff. RESULTS: Numbers of "current", "past" Hikikomori, and "other" patients were 60 (19.7%), 81 (26.6%), and 163 (53.6%), respectively. The percentage of "current" Hikikomori who attended in person (56.7%) was significantly smaller than for "past" (92.6%) and "other" (92.6) (p < .001). The age distribution of "current" Hikikomori patients was bimodal, peaking at 20 and 40-45 years. The "current" state predicted significantly fewer regular visits (OR = 0.43; 95% CI = 0.22-0.83; p = .012); support from psychiatric social workers increased visits (OR = 2.35; 95% CI = 1.14-4.86; p = .021). Among the "current" Hikikomori patients, first visit attendance in person predicted regular attendance; no factor consistently predicted working/schooling status. CONCLUSION: A sizable percentage of community clinic patients experienced Hikikomori. The "current" Hikikomori state corresponded with low clinic attendance and social function; "support from clinical staff" may increase visit regularity; no factors consistently improved social functioning. Further multi-site study is warranted to examine the generalizability of the findings from the current single-center study.

Scale for measuring self-recoverability in daily life for people with schizophrenia.

AIM: A new scale has been developed to assess the self-recoverability in the daily life of people with schizophrenia. Self-recoverability in daily life includes coping with stress events and taking care of one's mental and physical health. The new scale, called Self-Recoverability in Daily Life (SRDL), is a semi-structured instrument with 10 items. The aim of the present study was therefore to test the scale accordingly. METHODS: A total of 57 subjects who were outpatients with a diagnosis of schizophrenia or schizoaffective disorder as defined by DSM-IV, were enrolled in the study. The SRDL scale was assessed with four other scales: the World Health Organization Quality Of Life (WHO-QOL)-26, the Visual Analog Scale (VAS) for health state, the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: The mean total score of the SRDL scale was positively correlated with both the WHO-QOL-26 and VAS, while the SRDL scale was negatively correlated with the BPRS total score. CONCLUSION: The SRDL scale may be useful for assessing living skills in the daily life of people with schizophrenia.