Examining the relationship between social withdrawal motivations and symptoms of hikikomori.

Objective: This study aimed to examine the association between social withdrawal motivations (peer isolation, shyness, unsociability, low mood, and avoidance) and symptoms of hikikomori using both variable- and person-oriented analyses.Method: Adolescents (N = 212) participated in this cross-sectional study. Data were collected using the Social Withdrawal Motivations Scale and the Avoidance subscale of the Child Social Preference Scale-Revised, the 25-item Hikikomori Questionnaire, the Personality Inventory for the DSM-5 Brief Form, and the Interpersonal sensitivity subscale of the Brief Symptom Inventory.Results: Path analysis revealed that peer isolation, shyness, unsociability, and avoidance were associated with symptoms of hikikomori while covarying for age, sex, maladaptive personality, and interpersonal sensitivity. Cluster analysis based on social withdrawal motivations identified four subtypes of adolescents. The group with high social withdrawal motivations showed the highest level of overall personality dysfunction and interpersonal sensitivity. Additionally, the group with high social withdrawal motivations and the group with high avoidance demonstrated higher symptoms of hikikomori compared to the other two groups, after accounting for the effects of the covariates.Conclusions: The findings highlight that the evaluation of co-occurrent social withdrawal motivations may improve the ability to identify those adolescents most in need of support.

Estimating the prevalence and characteristics of people in severe social isolation in 29 European countries: A secondary analysis of data from the European Social Survey round 9 (2018-2020).

The main aim of the present study was to estimate the prevalence of people in severe social isolation as a proxy for high risk of hikikomori using data from 29 European countries. The relationship between the presence/absence of severe social isolation and demographic and psychosocial variables was also investigated. Publicly available data from the European Social Survey (ESS) round 9 collected between August 2018 and January 2020 were used. Data from the ESS round 1 (September 2002 -December 2003) and round 10 (September 2020 -May 2022) were also examined to investigate changes in the prevalence of severe social isolation over time. Analyses were restricted to the working-age population (15-64 years). A complex sampling design to obtain weighted prevalence and results was used. The study protocol was preregistered online on the Open Science Framework (https://osf.io/6a7br/). The weighted prevalence of severe social isolation was 2.01% for the sample from the ESS 1, 1.77% for the sample from the ESS 9, and 1.71% for the sample from the ESS 10, indicating a decrease over time, mainly in males. Logistic regression models showed that different sociodemographic factors (e.g., being retired, being permanently sick or disabled, doing housework, living in Central and Eastern Europe, living uncomfortably on household income, having no income) were associated with severe social isolation. Further, feeling unsafe when walking alone in the neighbourhood after dark, low social trust, and support, decreased happiness and lack of future planning correlated with severe social isolation after adjustment for the effect of sociodemographic factors was made. In this study, the prevalence of severe social isolation as a proxy for hikikomori in European countries is in line with that found by previous representative studies conducted in Asian countries. The novelty of the findings as well as implications for hikikomori research are discussed according to recent scientific literature.

Symptoms of Prolonged Social Withdrawal, Problematic Internet Use, and Psychotic-Like Experiences in Emerging Adulthood: A Moderation Model.

Objective: Prolonged social withdrawal (PSW) or hikikomori and problematic internet use (PIU) have attracted the attention of mental health experts worldwide. The scientific literature suggests a complex relationship between these conditions and psychotic-like experiences (PLEs) or disorders. In the present cross-sectional study, we tested the role of PIU symptoms as a moderator of the relationship between symptoms of PSW and PLEs in a sample of 238 Italian emerging adults. Method: Data was collected using the 25-item Hikikomori Questionnaire, the Internet Disorder Scale, the Brief Prodromal Questionnaire, and the Brief Symptom Inventory. In addition, lifetime psychological disorders and drug and alcohol use during the last month were explored. No participant reported a lifetime episode of schizophrenia or other psychotic disorder. Results: Symptoms of PSW and PIU were significantly associated with PLEs total distress and PLEs total number of symptoms endorsed, after adjustment for age and symptoms of depression and anxiety. Further, PIU symptoms moderated the relationship between symptoms of PSW and PLEs total distress (b= 2.745, s.e.= 1.089, p= 0.012). However, PIU symptoms did not moderate the relationship between PSW and PLEs total symptoms (b= 0.615, s.e.= 0.349, p= 0.078). This study is limited because the participants were most likely university students and because of the cross-sectional design. Conclusions: Findings from this study partially support the role of high symptoms of PIU as a risk factor in the relationship between symptoms of PSW and PLEs. Future longitudinal research is needed to confirm our findings examining the temporal relationship between PSW, PIU, and PLEs using both dimensional and categorical approaches.

Responding to the COVID-19 public health emergency: The usefulness of an online brief psychological intervention with Italian university students.

The COVID-19 pandemic has brought about new stressors on university students, with a negative impact on their mental health and well-being. The purpose of this study was to examine the usefulness of a brief psychodynamically oriented intervention on general functioning by investigating changes in symptoms of depression, anxiety, hopelessness, and burnout. The sample was comprised of 67 university students (22.4% males), with a mean age of 23.27 (standard deviation (SD) = 3.27), who asked for psychological help at a psychological university service. Pre- and posttreatment data showed a significant improvement in general functioning and symptom reduction due to the psychological intervention. The mean change was very high for depression (d = 1.11) and high for general functioning (d = 0.70) and anxiety (d = 0.69). Our findings showed the importance of considering university students a vulnerable population that requires specific services within the university context and underlined the fact that mental-health-promotion policies should be extensively implemented.

Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire.

A serious form of social withdrawal, initially described within Japan as hikikomori, has received increasing attention from the international scientific community during the last decade. The 25-item Hikikomori Questionnaire (HQ-25) was initially developed and validated in Japan. To date, data on its psychometric properties in other populations where cases of hikikomori have been described are still scarce. Thus, the aims of this study were to (1) translate, adapt, and validate the Italian version of the HQ-25 analyzing its psychometric properties; and (2) verify the association between hikikomori and personality functioning, social support, and problematic Internet use. A sample of 372 Italian adults aged 18 to 50 years completed the HQ-25 and measures of psychoticism, personality dysfunction, social support, and problematic Internet use were employed to test the convergent validity of the HQ-25. The data showed a satisfactory fit for a three-factor model, significantly better than a one-factor model. The three factors (socialization, isolation, and emotional support, as in the original study on the HQ-25) correlated positively with psychoticism, personality dysfunction, and problematic Internet use, and correlated negatively with social support. A lifetime history of hikikomori was present in 1.1% of the sample (n = 4). This is the first study to use the Italian validated version of the HQ-25 with an adult population. The findings from this study provide evidence of the satisfactory psychometric properties of the Italian version of the HQ-25 and support further investigation of the HQ-25 as an instrument to help screen for and investigate the presence of hikikomori.

Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire for Adolescents.

Hikikomori is a form of social withdrawal that is commonly described as having an onset during adolescence, a life stage when other psychiatric problems can also emerge. This study aimed to adapt the 25-item Hikikomori Questionnaire (HQ-25) for the Italian adolescent population, examining its psychometric properties; associations between hikikomori and psychoticism, depression, anxiety, problematic internet use (PIU), psychotic-like experiences (PLEs), to confirm convergent validity of the HQ-25; and the interaction effect between symptoms of hikikomori and PIU in predicting PLEs. Two-hundred and twenty-one adolescents participated in the study. Measures included the HQ-25, the Psychoticism subscale of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, the Depression and Anxiety subscales of the Brief Symptom Inventory, the Internet Disorder Scale, and the Brief Prodromal Questionnaire. Data showed a satisfactory fit for a three-factor model for the HQ-25 that is consistent with the original study on the HQ-25. Three factors (socialization, isolation, and emotional support) were associated with psychopathology measures. Six participants reported lifetime history of hikikomori. Symptoms of hikikomori and PIU did not interact in predicting PLEs. This is the first study to validate the HQ-25 in a population of adolescents. Findings provide initial evidence of the adequate psychometric properties of the Italian version of the HQ-25 for adolescents.

Indirect Relations between Language and Behavior Problems in Preschoolers: The Role of Executive Difficulties.

The present study investigated the concurrent relations between language ability, executive difficulties, and behavior problems in a sample of 142 preschoolers ranging in age between 3 and 6 years of age. Language skills were assessed with a direct task, whereas ratings of executive difficulties and behavior problems were obtained from teachers. Regression analyses indicated that difficulties in flexibility and inhibitory self-control were positively associated with internalizing problems, and difficulties in inhibitory self-control were positively associated with externalizing problems. The associations between emergent metacognition and internalizing problems and between inhibitory self-control and externalizing problems were both moderated by sex, being stronger in boys than in girls. Lastly, language had indirect effects on internalizing problems by decreasing children's difficulties in flexibility, as well as on externalizing problems by decreasing children' difficulties in inhibitory self-control. Overall, these findings support the idea that low language skills may interfere with preschoolers' ability to exploit the executive functions of inner language to self-regulate their own behaviors, especially in boys.

Patterns of internalizing symptoms and disability functioning in children and adolescents.

Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8-16 years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: "High somatic symptoms and average depression/anxiety"; cluster 2: "High somatic symptoms and high depression/anxiety"; cluster 3: "Average somatic symptoms and above average depression/anxiety"; and cluster 4: "Low somatic symptoms and low depression/anxiety". Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.

[Hikikomori: the silent suffering among young people]. / Hikikomori: la sofferenza silenziosa dei giovani.

The Japanese term hikikomori is used to describe young people who lives a condition characterized by social withdrawal and isolation for an extended period of time. It is a particularly widespread phenomenon in Japan, in particular among adolescents and adults, and it represented the focus of an increasing attention from mental health professionals in many other countries, including Italy. The aim of this paper review is to explore the concept of hikikomori within Japanese sociocultural context, epidemiological aspects, risk factors clinical characteristics. Moreover, some theoretical models are discussed which allow possible interpretations of this condition which characterizes young people who convey their suffering more and more silently. A detailed review of the phenomenon is given considering the lack of a clear definition of the hikikomori that doesn't allow to plan preventive interventions.

Adaptation and Psychometric Analysis of the Test of Mobile Phone Dependence-Brief Version in Italian Adolescents.

Since the diffusion of recent models of mobile phones, anyone with an internet connection can communicate continuously and search for information. This raises some questions about the possible consequences of problematic mobile phone use (PMPU) in a complex life phase such as adolescence. Therefore, we performed a psychometric analysis of the brief version of the Test of Mobile Phone Dependence (TMD) in Italy. The sample comprised 575 Italian adolescents aged 11 to 18 years. Data were collected using the TMD-brief, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form. Regarding test dimensionality, the best-fit measurement model included four factors: "Abstinence"; "Abuse and interference with other activities"; "Tolerance"; and "Lack of control" (Satorra-Bentler χ2 (48) = 185.96, p < 0.01; robust root mean square error of approximation (RMSEA) = 0.079 (90% confidence interval (CI): 0.067; 0.091); robust TLI = 0.904; robust comparative fit index (CFI) = 0.930). The Italian version of the TMD-brief was found to have good reliability and psychometric properties, and a four-factorial structure. PMPU predicted significant sleep disturbances and this relationship was moderated by clinical personality traits. Findings from this study support the use of the Italian version of the TMD-brief as a screening tool to investigate PMPU in Italian adolescents.

Mental health of Italian adults during COVID-19 pandemic.

OBJECTIVES: On 31 January 2020, a new type of coronavirus was first confirmed in Italy and spread rapidly across the country leading to a national lockdown. The aim of this pilot study was to explore the impact of the public health emergency due to COVID-19 on individual's mental health among 299 Italian adults after a month of home isolation due to COVID-19. DESIGN: Cross-sectional study design. Adults of the general population were invited to a voluntary online health survey. METHODS: Hierarchical multiple regressions were used to examine diverse psycho-social and stressful contextual factors associated with symptoms of psychopathology. RESULTS: Results indicated that females reported higher symptoms of depression, anxiety and circadian rhythm dysregulation, than males. Age and the capacity to adapt to a new environment and to cope with illness were negatively associated with all symptoms of psychopathology. Conversely, engaging in verbally aggressive behaviours and having experienced stressful events related to COVID-19 were positively related to psychopathological symptoms. Finally, social support was negatively associated with depressive symptoms, and substance use during the past months was related to circadian rhythm dysregulation. CONCLUSIONS: The findings of this study raise particular concern about psychological well-being considering the negative associations between stressful events during the COVID-19 pandemic, symptoms of psychological distress, and perceived social support. These results have possible significant clinical implications.

The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach.

In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18 years (M age  = 13.80; SD = 2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.

Attachment-Related Representations and Suicidal Ideations in Nonsuicidal Self-Injury Adolescents with and without Suicide Attempts: A Pilot Study.

OBJECTIVES: Consistent with the debate surrounding the association between nonsuicidal self-injury (NSSI), suicidal intent, and suicidal behavior, and between NSSI and dysregulation processes, we attempted to analyze suicide intent and emotion dysregulation in NSSI adolescents, in the framework of the attachment representations and exploring these clues of emotion dysregulation characteristics of insecure attachment. Furthermore, we intended to focus on these attachment-related segregated systems regarding death and suicidal ideations, to explore how differently they would characterize self-injuring adolescents with and without suicide attempts. METHODS: Thirty-four NSSI inpatient adolescents, 17 with suicide attempts, 17 without suicide attempts, and 17 healthy controls (age 11-17) were assessed using Adult Attachment Projective, which allows for the classification of attachment status and related emotion dysregulation and segregated systems. RESULTS: The majority of the NSSI group with and without suicide attempts showed unresolved (disorganized) attachment-related representations and clues of damaged reflective functions, whereas only the NSSI with suicide attempts showed clues of impaired interpersonal relationships. The two clinical groups used words expressing suicidal intent, whereas the healthy group did not. CONCLUSIONS: Therapists are encouraged not to underestimate suicidal ideation in NSSI regardless of whether or not they have already attempted suicide.

Alexithymic Traits and Somatic Symptoms in Children and Adolescents: a Screening Approach to Explore the Mediation Role of Depression.

The association among alexithymia, somatic symptoms and clinical correlates has been scantly investigated in children. The present study examined alexithymic features and somatic symptomatology in schoolchildren with high and low levels of depression, testing the role of depressive symptoms in mediating the associations between alexithymia and somatic symptoms. Seven-hundred schoolchildren were involved in this study and divided into two subgroups (8-10 years and 11-14 years) in order to test differences according to the age. Participants completed the Children's Somatization Inventory-24 for the assessment of somatic symptoms, the Alexithymia Questionnaire for Children to evaluate alexithymic features and the Children's Depression Inventory-2 to investigate depressive symptoms. Results showed that children with high levels of depression reported both higher alexithymia and somatic symptoms levels. Despite a direct effect of alexithymia on somatic symptoms, the mediation analyses also highlighted an indirect effect of alexythimia on somatic symptoms through depressive symptoms. Findings suggested that a depressive symptomatology may clarify why schoolchildren with high alexithymia scores tend to report higher levels of health problems. Results also support the possibility that depressive symptoms may contribute to the development of somatic symptomatology among schoolchildren in the presence of high levels of alexithymia.

Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study.

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents' life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale "Negative Meta Worrying" of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" than controls. Moreover, children between 8 and 10 years statistically differed from older children in "Difficulty Identifying Feelings" and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA.

Behavioral therapies in headache: focus on mindfulness and cognitive behavioral therapy in children and adolescents.

Introduction: A wide proportion of children and adolescents with headache tends not to respond to various pharmacological treatments in use. The failure to respond to symptomatic treatment and prophylaxis is often due to the presence of a comorbid psychopathology undiagnosed or not properly treated. For these reasons and for the negative impact of headache on the quality of life of the patients and on the costs for the public health system, the adoption of an integrated multi-disciplinary perspective in the diagnosis and treatment of headache is needed.Areas covered: Several researchers have shown that behavioral treatment is effective as pharmacological treatment, not only for headache management but also to maintain a lifetime response to the headache treatment. In particular, Cognitive Behavioral Therapy (CBT) and Mindfulness have proven to be very resolutive both in the management of pain and in the management of stressful situations that can trigger the headache in children and adolescents with headache.Expert opinion: Although studies on behavioral treatments on children and adolescents with primary headaches are still few but a combined approach seems to be very useful in improving the quality of life of these subjects, especially in those who have internalizing disorders in comorbidities.

Italian validation of the Children's Shyness Questionnaire: Exploring associations between shyness and psychosocial functioning.

BACKGROUND: In recent years, researchers have begun to explore the implications of shyness for the psychosocial wellbeing of children and adolescents, exploring its association with internalizing problems. Research in an Italian context is hindered by the lack of a validated self-report measure of shyness. We report two studies aimed to assess the psychometric properties of an Italian translation of the Children's Shyness Questionnaire (CSQ-it) and investigate its correlations with convergent and divergent constructs. The first study aimed to examine associations between CSQ-it and self-report measures of anxiety and somatic symptoms and attachment with parents and peers. The second study aimed to investigate its relations to internet addiction. METHODS: The self-report measures were completed by 550 participants in the first study and 131 participants in the second study. Parents provided information on their child's problems. Psychometric properties were assessed by Cronbach's alpha in both studies and by exploratory and confirmatory factor analysis in Study 1. The relations between shyness and measures of internalizing problems and attachments were analyzed by correlational methods. In Study 2 a moderated mediation model tested the hypothesis that the relationship between shyness and internet addiction is mediated by somatic symptoms and that shyness moderates the relationship between somatic symptoms and internet addiction. RESULTS: The reliability and validity of the Italian Version of the Children's Shyness Questionnaire were satisfactory. Results from confirmatory factor analyses confirmed the single-factor model of the questionnaire previously identified in North American and Chinese studies. There were significant correlations between shyness, anxious and somatic symptomatology, impaired psychosocial functioning and specific components of attachment relationships. In Study 2 the indirect effect of shyness on internet addiction through somatic symptoms was significant as well as significantly moderated for high shyness scores but not for low levels of shyness. CONCLUSION: To our knowledge this is the first study that explored the psychometric proprieties of the Children's Shyness Questionnaire in the Italian context. Findings demonstrated that this self-reported measure of shyness has sound psychometric properties and can be used as a sensitive and appropriate instrument for the assessment of shyness in children and adolescents.