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Therefore, we examined the association between the HQ-25M total score and the duration of "social withdrawal" using Spearman's rank correlation coefficients (Table S3). 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], [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 hikikomori-like conditions.[[4]] 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. HQ-25M: The HQ-25M is a modified version of the HQ-25, asking about socially withdrawal status in the prior month (Table 1). [Extracted from the article]

The article discusses a study which looked at hikikomori, a form of social withdrawal reported in Japan. Topics mentioned include conditions associated with hikikomori including avoidance of social situations and social relationships, measures used to assess the social disorder such as the Lubben Social Network Scale, Sheehan Disability Scale, and modified Cornell Treatment Preferences Index, and possible psychosocial impairment and disability associated with hikikomori.

The article discusses a study which evaluated comorbid social withdrawal or hikikomori in outpatients with social anxiety disorder (SAD). The study enrolled 141 consecutive patients with SAD diagnosed according to DSM-IV criteria by a semi-structured interview and were treated with a combination of psychotherapy, pharmacotherapy and group activity. It found no diagnostic differences between hikikomori and non-hikikomori SAD patients.

The article describes the case of social withdrawal called Hikikomori with depression. The case was the first report of Hikikomori in the U.S. of a man who showed three years of continuous isolation. During the first year, he remained in a closet, ate ready-to-eat food, did not bathe, and urinated and defecated in jars and bottles. He just surfed the internet and played video games. He felt conflicted about his withdrawal, explaining this is due to disdain for society but desiring to go out.

Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems.Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help.Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and nonusers were compared via t tests, Chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models.Results: The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and nonusers, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (eg, psychologists), informal (eg, friends), or phone helpline sources of support were significantly higher. Results did not substantially change when examining users of other social media, women, or younger adults.Conclusions: In its current form, the social media platform Facebook is not seen as a venue to seek help for emotional problems or suicidality among veterans with major depression in the United States. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Identification of the hikkikomori syndrome of social withdrawal: Psychosocial features and treatment of preferences in four countries" in the February 2015 issue is presented.

Objectives: Among the many intervention programs for children with autism spectrum disorder (ASD), the Early Start Denver Model (ESDM) is one of the few approaches that has succeeded in demonstrating clinical efficacy in randomized control trials. Here, we inves-tigate the clinical efficacy of ESDM intervention in young children with ASD in a community setting within Japan., Methods: All subjects were children with ASD who received ESDM intervention during the study period. Each ESDM session lasted 75 min and occurred once per week for at least 12 weeks. The outcome measures consisted of the Kyoto Scale of Psychological Develop-ment (K-test), Aberrant Behavior Checklist-Japanese version (ABC-J), and the Clinical Global Impression-Severity scale (CGI-S)., Results: Twenty-seven subjects (29.4±6.4 months old) received ESDM intervention that lasted for 8.0±2.6 months on average. The score on Language and Social developmental quotient on the K-test increased significantly after the intervention. The total scores on the ABC-J and CGI-S significantly decreased after completion of the ESDM intervention., Conclusion: Our results suggest that ESDM intervention could reduce the severity of distinct clinical features of ASD, such as impair-ments in social interaction and communication assessed by the K-test, and maladaptive behavior rated by the ABC-J and CGI-S. We be-lieve that the ESDM adapted to each institution might become one of the standard options for children with ASD in Japan., Competing Interests: Conflicts of Interest The authors have no potential conflicts of interest to disclose., (Copyright © 2021 Korean Academy of Child and Adolescent Psychiatry.)

We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi-structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning., (© Published 2014. This article is a U.S. Government work and is in the public domain in the USA.)

Objective: Although clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians' evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists with those performed by psychiatric residents. It also examined the potential of a structured decision support tool to improve residents' risk assessments., Methods: The study used a retrospective case-control design. Medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N=38) for 52 patients and by attending psychiatrists (N=41) for 249 patients. Trained research clinicians, who were blind to whether patients later became violent, coded information available at hospital admission by using a structured risk assessment tool-the Historical, Clinical, Risk Management-20 clinical subscale (HCR-20-C)., Results: Receiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (area under the curve [AUC]=.70), whereas assessments by residents were no better than chance (AUC=.52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC=.67) close to that of attending psychiatrists., Conclusions: Having less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

A number of Western physicians have highlighted shortcomings in Japanese medical education over the years. In recent years, however, there has been dramatic change in the system of medical education in Japan that renders some of these observations inaccurate and others worthy of several caveats. Using a recent review article in the Keio Journal of Medicine as a starting point for discussion, the author responds to a number of historical concerns about medical education in Japan and includes updated information on recent reforms.