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Objectives: The 25‐item Hikikomori Questionnaire (HQ‐25) is an instrument developed to measure a condition characterized by extreme social withdrawal that was first described in Japan. This study aimed to translate the HQ‐25 into German and validate the German version (HQ‐25‐G). Methods: Translation was conducted according to established guidelines. Validation was based on data from a quota sample of individuals living in Germany, ranging from 18 to 74 years old (representing the distribution of age, sex and federal state, n = 5000). Data collection occurred during August and September 2023. We tested reliability, construct validity and concurrent validity. Moreover, HQ‐25 scores for key sociodemographic group were reported. Results: Internal reliability for the HQ‐25‐G was excellent (Cronbach's alpha = 0.93). We confirmed the original three‐factor model. Moreover, higher hikikomori levels were significantly associated with more depressive symptoms (r = 0.50), more anxiety symptoms (r = 0.45), higher loneliness levels (r = 0.56), higher levels of objective social isolation (r = −0.47), higher levels of perceived social isolation (r = 0.59) and a higher preference for solitude (r = 0.45). Conclusions: In a large population‐based sample (including younger adults, middle‐aged adults and older adults), the HQ‐25‐G version proves to be a psychometrically robust instrument, which is useful for further exploring the phenomenon of hikikomori within the German‐speaking population. [ABSTRACT FROM AUTHOR]

Introduction: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has been widely disseminated, rigorous evaluation is lacking. Methods: In a pilot randomized controlled trial of a brief, video‐based version of VA S.A.V.E., individuals were recruited through Facebook, randomized to VA S.A.V.E. versus an attention control condition, and completed 6‐month follow‐up. A subgroup (n = 15) completed interviews. We used a mixed methods framework to integrate quantitative and qualitative findings. Results: Among 214 participants, 61% were spouses/partners of veterans and 77% had prior suicide exposure. Sixty‐seven percent (n = 68) of VA S.A.V.E. participants watched the entire video, and satisfaction and usability were highly rated. At 6‐month follow‐up, compared to the control group, the VA S.A.V.E. group had a higher proportion of participants use each gatekeeper behavior (66.7%–84.9% vs. 44.4%–77.1%), and used significantly more total gatekeeper behaviors (2.3 ± 0.9 vs. 1.8 ± 1.0; p = 0.01). Interviews supported positive reactions, learning, and behavior change from VA S.A.V.E. Conclusion: VA S.A.V.E. merits further investigation into its effectiveness as a brief, scalable gatekeeper training for suicide prevention in veterans. [ABSTRACT FROM AUTHOR]

ObjectiveAlthough 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.MethodsThe 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).ResultsReceiver 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.ConclusionsHaving less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

BackgroundA “concerning post” is a display of a user’s emotional crisis on a social media platform. A better understanding of concerning posts is relevant to suicide prevention, but little is known about social media users’ attitudes and responses to concerning posts. Military veterans in the United States are disproportionately affected by suicide, often use social media, and may have exposure to individuals with elevated suicide risk via concerning posts. ObjectiveThe objective of the study was (1) to obtain insight into whether and how US military veterans respond to members of their social network on social media (ie, “friends”) who are experiencing substantial emotional distress, and (2) to identify potential interventions that could assist in users’ response to concerning posts. MethodsWe recruited veterans through Facebook and conducted semistructured interviews with 30 participants between June and December 2017. We used a summary template for rapid analysis of each interview, followed by double-coding using a codebook based on topic domains from the interview guide. Members of the research team met regularly to discuss emerging patterns in the data, generate themes, and select representative quotes for inclusion in the manuscript. ResultsVeterans were reluctant to disclose emotional and health issues on Facebook, but they were open to reaching out to others’ concerning posts. There was a complex calculus underlying whether and how veterans responded to a concerning post, which involved considering (1) physical proximity to the person posting, (2) relationship closeness, (3) existing responses to the post, and (4) ability to maintain contact with the person. Veterans desired additional training, backed by community-based veteran organizations, in how to respond to concerning posts from peers. ConclusionsThere is a need to incorporate features that will help veterans effectively respond to concerning posts from peers into suicide prevention training and to expand access for veterans to such training.

Aims: Hikikomori is a common phenomenon reported in Japan and many other countries. However, the broad trends of the research publications on hikikomori are unclear. Therefore, this study examined the patterns of research on hikikomori using bibliometric analysis. Methods: Relevant publications were searched in Web of Science. Bibliometric analyses were performed with CiteSpace, R and VOSviewer. Results: In total, 297 publications on hikikomori met the eligibility criteria. The International Journal of Social Psychiatry (IF = 10.461) published the most papers (K = 17, or 5.7%) on hikikomori. Takahiro A. Kato from Kyushu University (41; 13.8%; H‐index = 18) was the most influential author, while Takahiro A. Kato (total link strength [TLS]: 235), Alan R. Teo (TLS: 157), and Masaru Tateno (TLS: 153) separately had the strongest research collaboration with other researchers. Of all countries that published on hikikomori, Japan had the highest number of publications (K = 91). The keywords "United States" and "psychiatric diagnosis" received the most attention between 2013 and 2015, whereas "health" and "autism spectrum disorder" received the most attention in 2021 and 2022. Conclusions: Peer‐reviewed research publications on hikikomori are growing rapidly and the research trends in this field are also changing. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide a clinical review of a unique, emerging form of severe social withdrawal that has been described in Japan. This paper begins with a case vignette, then reviews the case defi nition, epidemiology, psychopathology, differential diagnosis, and treatment and management of the condition. Called hikikomori, it is well known to both the psychiatric community and general public in Japan but it has never been reviewed in the English medical literature. Patients are mostly adolescent and young adult men who become recluses in their parents' homes for months or years. They withdraw from contact with family, rarely have friends, and do not attend school or hold a job. Never described before the late 1970s, hikikomori has become a silent epidemic with tens, perhaps hundreds, of thousands of cases now estimated in Japan. The differential diagnosis includes anxiety and personality disorders, but current nosology in the Diagnostic and Statistic Manual of Mental Disorders may not adequately capture the concept of hikikomori. Treatment strategies are varied and lack a solid evidence base, but often include milieu, family, and exposure therapy. Much further research, including population-based and prospective studies, needs to be conducted to characterize and provide an evidence base for treatment of this condition.