Researchers at Kyushu University have developed a new “hikikomori questionnaire” to detect the condition at an earlier stage. Preliminary results indicate that “isolation” is a possible factor that can discriminate between non-hikikomori and pre-hikikomori individuals, allowing possible validation of the new questionnaire as a tool for early detection and treatment.
Hikikomori is a complex pathological condition in which a person withdraws from society and stays at home almost every day for more than six months. Although it can be considered a condition unique to Japan, hikikomori has been reported worldwide from across Asia, Europe and North America.
“Hikikomori was first defined in 1998. When we examined the condition, we found that it is a very complex pathology caused by an intersection of physical, societal and psychological conditions,” explains Takahiro A. Kato of the Faculty of Medical Sciences at Kyushu University and First author of the study. “His growing international recognition has brought Hikikomori to the attention of many researchers and medical professionals, especially after the years of the COVID-19 pandemic. Just this year, Hikikomori was recognized in the revised edition of the DSM-5.”
Kato and his team worked on measures to evaluate, identify and treat hikikomori patients until 2013, when they opened the world’s first outpatient clinic for hikikomori people. In 2018, the team developed the “Hikikomori Questionnaire,” or HQ-25, designed to assess whether individuals experiencing social withdrawal at six months are symptomatic of hikikomori.
“This questionnaire allowed us to identify symptomatic individuals with hikikomori. As our work progressed, we found that we needed an assessment tool that could assess symptomatic individuals at an earlier stage to detect and potentially prevent hikikomori,” Kato continues.
The new Hikikomori Questionnaire, or HQ-25M — created in collaboration with Nihon University and Oregon Health and Science University — consists of 25 questions that rate the three sub-factors of socialization, isolation, and emotional support on a 0-4 scale , 4 means “completely agree”.
For example, questions such as “I feel uncomfortable around other people” measure socialization, while “there are few people with whom I can discuss important issues” covers emotional support.
The pilot test of the new questionnaire, reported in Psychiatry and Clinical Neuroscience, was conducted with 762 Japanese. The questionnaire first asked about the person’s social withdrawal status in the previous month to classify participants into hikikomori, non-hikikomori, and pre-hikikomori groups. The team also added a questionnaire that assesses the person’s psychological distress over the same month.
“We analyzed the data to see comparable differences between the different category groups,” explains Kato. “Multiple models have shown us that hikikomori groups perform significantly better than non- and pre-hikikomori on all metrics.”
Interestingly, of all three sub-factors measured, those with and without hikikomori differed isolation Subfactor was the only one that showed a significant difference in the ratings.
While still preliminary, the team is satisfied with their initial results and plans to use them to improve the questionnaire and data collection.
“These initial results are promising and show that our questionnaire could be a good tool for early detection of hikikomori,” concludes Kato. “Nevertheless, we need to work on expanding and diversifying our sample size and refining our questions. Additionally, since hikikomori pathology is reported around the world, we need to collaborate with researchers and patients outside of Japan.”
Materials provided by Kyushu University. Note: Content can be edited for style and length.