Using difficulty in going out and social participation to assess for risk of hikikomori: nationally representative data from the European health interview survey.

Amendola S, Teo AR. Using difficulty in going out and social participation to assess for risk of hikikomori: nationally representative data from the European health interview survey. Social psychiatry and psychiatric epidemiology. 2025 Dec 1; 60(12):2871-2885, DOI: 10.1007/s00127-025-02938-9.

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Abstract:

PURPOSE: Epidemiologic studies of hikikomori, a form of prolonged social withdrawal, are limited. This study aimed to look for indicators in a European country of a problem first detected in Japan, estimating the prevalence of hikikomori risk and examining the relationship between hikikomori risk and sociodemographic factors, health status, and health services use. METHODS: Data from the European Health Interview Survey collected in 2019 were used, consisting of a nationally representative sample (unweighted N = 45,962; weighted N = 52,012,922.578) of persons aged 15-75 years and over in Italy. Difficulty in going out not due to medical illnesses/functional limitations or chronic illnesses was considered a proxy condition for hikikomori, i.e., hikikomori risk. Hikikomori risk was further differentiated based on difficulty in social participation. RESULTS: The overall prevalence of hikikomori risk was 1.7% (95%CI: 1.6-1.9) corresponding to a weighted count of 866,743 persons. This was comprised of a 0.7% prevalence of hikikomori risk with no difficulty in social participation (95%CI: 0.6-0.8%; weighted n = 343,920), 0.9% prevalence of hikikomori with difficulty in social participation (95%CI: 0.8-1.0%; weighted n = 445,165) and 0.1% prevalence of hikikomori risk with no interest for social participation (95%CI: 0.1-0.2%; weighted n = 77,657). Low vitality and mental health index, low social support, high depressive symptoms, and difficulty accessing mental health services were significantly associated with hikikomori risk. CONCLUSION: The prevalence of individuals at risk for hikikomori is on par with many psychiatric disorders. Given the prevalence and functional impairment faced by individuals at risk for hikikomori, they represent a group worthy of the attention of public health experts and other stakeholders in the health arena and beyond.