The global pandemic of COVID-19 has forced people to restrict their outings. In Japan, self-restraint behavior (SRB) has been requested by the government, and some of those decreasing their outings may shift to pathological social withdrawal; hikikomori. The purpose of this study was to examine the risk factors of hikikomori conducting an online prospective survey. An online survey was conducted in June 2020 and December 2020; (1) SRB-related indicators (degree of SRB, motivation for SRB, stigma and self-stigma toward COVID-19, anxiety and depressive feelings toward COVID-19) and (2) general mental health (hikikomori tendency, depressive symptoms, modern type depression (MTD) tendency, internet addiction) were collected. A cross-lagged effects model was performed to examine the association between these variables. Lack of emotional support and lack of socialization in June 2020 increased isolation in December 2020. Besides, MTD and hikikomori interacted with each other. Interestingly, although hikikomori tendency increased depressive tendencies, SRB itself did not have a significant path on any mental health-related variables. Poor interpersonal relationships, rather than SRB per se, are suggested to be a risk factor for increased isolation among office workers in the COVID-19 pandemic. Appropriate early interventions such as interpersonal or emotional support may prevent the transition to pathological hikikomori. The association between MTD and hikikomori seems to reveal the interesting possibility that MTD is a gateway to increased risk of hikikomori, and that hikikomori is a gateway to MTD as well. Future research is required to elucidate the relationship between hikikomori and MTD.

Hikikomori is a pathological condition of social withdrawal in which a person remains at home almost every day for more than 6 months. 1 Although first observed in Japan, hikikomori is described around the world, causing serious impacts on healthcare, welfare, and the economy. [1][2][3] The COVID-19 pandemic has further led to social isolation at home to avoid the risk of infection, and perhaps increased the number of people with hikikomorilike conditions. 4,5 The 25-item Hikikomori Questionnaire (HQ-25) was designed to assess social withdrawal after at least 6 months of symptoms. 6 However, assessment tools that can quickly evaluate social withdrawal at an earlier stage are needed to help detect and potentially prevent hikikomori. Therefore, we herein developed a modified version of the HQ-25 to assess the prior 1 month and preliminarily examined its validity.Hikikomori is much more prevalent among males than females. 1 Thus, as an initial investigation, we focused on males. An online survey was conducted in March 2022, and 762 unemployed males in Japan participated (Table S1).HQ-25M: The HQ-25M is a modified version of the HQ-25, asking about socially withdrawal status in the prior month (Table 1). The total number of items (25) and three proposed factors (socialization, isolation, and emotional support) are the same as in the original HQ-25. The only different PCN Psychiatry and Clinical Neurosciences

Internet addiction (IA) is defined as the condition of being addicted to all sorts of activities on the Internet. Individuals with neurodevelopmental disorders, including autism spectrum disorder (ASD), may be susceptible to IA. Early detection and intervention for probable IA are important to prevent severe IA. In this study, we investigated the clinical usefulness of a short version of the Internet Addiction Test (s-IAT) for the screening of IA among autistic adolescents. The subjects were 104 adolescents with a confirmed diagnosis of ASD. They were requested to answer 20 questions from the original Internet Addiction Test (IAT). In the data analysis process, we comparatively calculated the sum of scores to the 12 questions of s-IAT. In total, 14 of the 104 subjects were diagnosed as having IA based on the face-to-face clinical interview that was regarded as the gold standard. Statistical analysis suggested that the optimal cut-off for s-IAT was at 35. When we applied the cut-off of 70 on the IAT, only 2 of 14 subjects (14.3%) with IA were screened positive, whereas 10 (71.4%) of them were screened by using the cut-off point of 35 on s-IAT. The s-IAT might be useful for the screening of IA in adolescents with ASD.

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