Prolonged social withdrawal (hikikomori) and psychological distress in adolescents and young adults: a systematic review of depression, anxiety, and suicidality

Abstract

Prolonged withdrawal from society or social seclusion is a phenomenon often seen among the Japanese that is referred to as "hikikomori". It was first described as a culture-bound phenomenon but it has gradually become acknowledged as a public health problem; yet, there continues to be a limited number of studies showing a connection between it and mental distress. This comprehensive review combines a series of research works which look at the association of prolonged social reclusion with the occurrence of depression, anxiety, and suicidality among the youth. Under PRISMA 2020, three databases-Scopus, PubMed, and ScienceDirect-were interrogated to find relevant literature. A total of 532 records were found; out of these 15 were duplicates so removed, the remaining 517 were screened, 65 of which were evaluated, and 20 studies were finally included. The main variables of the reviewed studies such as population, study design, and outcomes were listed together, the quality of the mixed methods research was assessed with the use of the Mixed Methods Appraisal Tool, and the data were synthesized based on thematic analysis. The four main categories that resulted from clustering analyses were (a) prevalence and characterization, (b) depression and internalizing distress, (c) suicidality and self-harm, and (d) risk and protective factors. Results showed the withdrawal consistently being correlated with the presence of depression, and several-fold rises in suicidal ideation in the different samples were moderated by attachment, coping, loneliness, and Internet use. It is concluded that the findings call for earlier relational screening as well as longitudinal and cross-cultural research studies.