Development of depression assessment tools using humanoid robots -Can tele-operated robots talk with depressive persons like humans?

BACKGROUND: Depression is a common mental disorder and causes significant social loss. Early intervention for depression is important. Nonetheless, depressed patients tend to conceal their symptoms from others based on shame and stigma, thus hesitate to visit psychiatrists especially during early phase. We hypothesize that application of humanoid robots would be a novel solution. Depressed patients may feel more comfortable talking with such robots than humans. METHODS: We recruited 13 patients with major depressive disorder (MDD) and 27 healthy volunteers as controls. Participants took both tele-operated humanoid robot and human interviews to evaluate severity of depression using the Hamilton Depression Rating Scale (HDRS). In addition, participants completed a self-administered questionnaire asking about their impressions of the robot interview. RESULTS: Confidence interval and t-test analysis have revealed that the HDRS scores are equally reliable between robot and human interviews. No significant differences were observed between the two interviews regarding "nervousness about the interview" and "hesitancy to talk about depressed moods and suicidal ideation." Compared to human interviews, robot interviews yielded significantly lower scores on shame-related factors especially among patients with MDD. LIMITATION: Small sample size, and the evaluator is male only. CONCLUSIONS: This is the first report to show the reliability of tele-operated humanoid robot interviews for assessment of depression. Robot interviews are potentially equally reliable as human interviews. Robot interviews are suggested to be more appropriate in assessing shame-related suppressed emotions and hidden thoughts of depressed patients in clinical practice, which may reduce the stigma associated with depression.

Autism spectrum conditions in hikikomori: A pilot case-control study.

AIM: Hikikomori, a form of pathological social withdrawal, has been suggested to have comorbidity with autism spectrum disorder (ASD). This study aimed to clarify how characteristics of hikikomori are associated with ASD, including undiagnosed autism spectrum conditions (ASC), in clinical settings. METHODS: A total of 416 clinical patients were recruited through the Mood Disorder/Hikikomori Clinic at Kyushu University Hospital. A total of 103 hikikomori cases and 221 clinical controls without hikikomori conditions were extracted using a semi-structured interview, and completed a series of self-rated scales, including the Japanese version of the Autism-Spectrum Quotient (AQ-J). RESULTS: Compared to non-hikikomori controls, hikikomori cases were more likely to have higher autistic tendency based on the AQ-J. The cases showed more severe subjective depressive symptoms based on the self-rated Beck Depression Inventory II, whereas no significant difference was found on interview-based severity evaluation using the Hamilton Depression Rating Scale. Comparison within hikikomori cases based on the AQ-J cut-off score revealed that hikikomori cases with high ASC were significantly more likely to have higher traits of modern-type depression, smaller social networks, and less social support. CONCLUSION: The present data suggest that hikikomori sufferers are more likely to have autistic tendency, and that hikikomori sufferers with high ASC may have much more difficulty in social communication and social interaction. In addition, those with high ASC may also have lower self-esteem and higher complaint tendencies as aspects of modern-type depression traits, which may relate to the occurrence of hikikomori. Thus, evaluating autistic tendencies is important for appropriate interventions in hikikomori. Further investigations should be conducted to validate our pilot findings using structured diagnostic systems of ASD.

Social withdrawal in major depressive disorder: a case-control study of hikikomori in japan.

BACKGROUND: Social withdrawal is a feature of a number of psychiatric disorders including major depressive disorder (MDD), yet research examining social withdrawal as a feature of MDD is rare. METHODS: This was a retrospective case-control study. Participants (N = 67) were recruited through an outpatient clinic at an academic medical center in Japan. Major depressive disorder (MDD) and social withdrawal were established with the Structured Clinical Interview for DSM-IV Axis I Disorders and a semi-structured psychiatric interview, respectively. Participants also completed self-report measures. RESULTS: We classified 24 participants as cases (MDD with social withdrawal) and 43 participants as controls (MDD without social withdrawal). Cases, on average, were more likely to have lower education level, prior episodes of depression, and higher suicidal ideation at baseline than controls. In unadjusted regression models, cases had significantly less social connection, less reward dependence, less self-directedness, and higher scores on scales of modern-type depression and hikikomori. In adjusted regression models, associations between social withdrawal and hikikomori (p<0.01) and reward dependence (p = 0.03) remained significant. LIMITATIONS: The sample was limited in size and drawn from a single site. CONCLUSIONS: In patients with MDD, social withdrawal may have subtle associations with clinical symptoms, social connection, and personality traits. Developing a better understanding of social withdrawal's phenotype in depression requires more in-depth examination.

Clarifying Deeper Psychological Characteristics of Hikikomori Using the Rorschach Comprehensive System: A Pilot Case-Control Study.

Hikikomori, a form of severe social withdrawal more than 6 months, has increasingly become a crucial issue especially among adolescents. Loneliness, avoidant personality, Japanese culture-related attachment style ("amae"), and difficulty in expressing emotions are suggested to be related to hikikomori. However, deeper psychological aspects have not been well clarified. The Rorschach test is one of the most popular psychological assessment tools to evaluate deeper personality traits. The Rorschach Comprehensive System (CS) has been established as the most reliable scoring method. Until now, no CS research has been conducted focusing on hikikomori. Therefore, we herein conducted a pilot case-control study using CS in clinical cases with and without hikikomori condition. Participants were recruited from the Mood Disorder/Hikikomori Clinic at Kyushu University Hospital. Twenty-two patients with hikikomori (HK patients) and 18 patients without hikikomori (non-HK patients) participated in the present study. All the 40 participants conducted the self-report Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) personality questionnaire and CS. Regarding the SCID-II personality questionnaire, various personality traits including passive aggressive trait were significantly higher in HK patients. Among CS variables, HK patients showed higher scores on FC (Form Color) and SumT (total number of texture-related responses). In addition, frequency of SumT was higher in HK patients. The present results suggest that persons with hikikomori are more likely to express emotions indirectly and expect others to presume their feelings and thoughts. Persons with hikikomori may also have difficulty in becoming independent emotionally from primitive dependence and attachment on significant others. Further investigations with larger samples are warranted for validation.