title: Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries.
abstract: BACKGROUND
  Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking.
  
  
  OBJECTIVE
  To identify individuals with hikikomori in multiple countries and describe features of the condition.
  
  
  METHODS
  Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index.
  
  
  RESULTS
  A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features.
  
  
  CONCLUSIONS
  Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment.
authors.affiliation: Portland VA Medical Center, Health Services Research & Development, Portland, OR, USA teoa@ohsu.edu takahiro@npsych.med.kyushu-u.ac.jp.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Teo
authors.affiliation: Japanese Family Health Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Stufflebam
authors.affiliation: Sapporo Hana Developmental Psychiatry Clinic, Department of Neuropsychiatry, Sapporo Medical University, Hokkaido, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Tateno
authors.affiliation: National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Yatan
authors.initials: Y
authors.lastname: Balhara
authors.affiliation: Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, South Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Choi
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Kanba
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mathews
authors.affiliation: Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Innovation Center for Medical Redox Navigation, Kyushu University, Fukuoka, Japan.
authors.forename: Takahiro A
authors.initials: TA
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007194:India; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D011613:Psychotherapy / Q000379:methods; D012044:Regression Analysis; D056910:Republic of Korea; D057566:Self Report; D012934:Social Isolation / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Social isolation; cross-national; culture