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

Abstract

Abstract 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.