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Comment to Haruto's resource about lack of volunteering information and opportunities

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Comment to Haruto's resource about lack of volunteering information and opportunities

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It is sad that university students want the opportunity to engage with their community and contribute to society through volunteering but this is inaccessible to them. Volunteering can have positive mental health benefits for those that volunteer and those that are the recipients of the volunteer work. If more university students had the option to volunteer, isolation and poor mental health could be reduced. I believe that providing a volunteering option on our app can fill this void and help university students find an easy way to volunteer

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Comment to Daichi's newspaper cartoon resource

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Comment to Daichi's newspaper cartoon resource

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This image is interesting because it shows three people on their own islands, doing their own thing without interacting with other people. The links to Japanese culture described here is fascinating, as it appears that social/civic activities are underdeveloped. Purely social groups do not seem to be emphasised or perceived as valuable in Japanese society. The idea that solitude is glorified is another root cause for isolation. I hope that our app will be able to challenge this thinking and allow people to see the benefits of belonging to a group

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Social isolation and loneliness prevalence during COVID-19 in Japan

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Social isolation and loneliness prevalence during COVID-19 in Japan

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9978762/
This study was interested in investigating whether there were changes to people's social isolation and loneliness during the first (2020) and second (2021) years of the pandemic. Social isolation is the objective separation from others while loneliness is the subjective feeling of being alone or isolated. The results of the study suggested that social isolation decreased between 2020 and 2021 but loneliness increased. Interesting to note that the subjective feeling of being alone may not correspond with the objective reality

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Hiroshi Murayama, 1 , * , † Takumi Suda, 1 , 2 , † Isuzu Nakamoto, 1 , 3 , † Tomohiro Shinozaki, 4 , † and Takahiro Tabuchi 5 , †

Abstract

Objective

The recent coronavirus disease 2019 (COVID-19) outbreak has changed people's social connections with others and society. This study aimed to describe changes in the prevalence of social isolation and loneliness by demographic characteristics, socioeconomic status, health conditions, and outbreak situations in residential prefectures among Japanese people between the first year (2020) and the second year (2021) of the COVID-19 pandemic.

Methods

We used data from the Japan COVID-19 and Society Internet Survey (JACSIS) study, a large-scale web-based nationwide survey conducted with 53,657 participants aged 15-79 years in August-September 2020 and September-October 2021 (25,482 and 28,175 participants, respectively). Social isolation was defined as less than once a week in the total frequency of contact with family members or relatives who were living apart and friends/neighbors. Loneliness was assessed using the three-item University of California, Los Angeles (UCLA) Loneliness Scale (score range, 3-12). We used generalized estimating equations to estimate the prevalence of social isolation and loneliness in each year and the difference in prevalence between 2020 and 2021.

Results

The weighted proportion (95% confidence interval) of social isolation in the total sample was 27.4% (25.9, 28.9) in 2020 and 22.7% (21.9, 23.5) in 2021, representing a change of −4.7 percentage points (−6.3, −3.1). The weighted mean scores of the UCLA Loneliness Scale were 5.03 (4.86, 5.20) in 2020 and 5.86 (5.81, 5.91) in 2021, representing a change of 0.83 points (0.66, 1.00). The detailed trend changes for social isolation and loneliness were noted in the demographic subgroups of socioeconomic status, health conditions, and outbreak situation in the residential prefecture.

Conclusion

Social isolation decreased from the first to the second year of the COVID-19 pandemic, whereas loneliness increased. Assessing the COVID-19 pandemic's impact on social isolation and loneliness contributes to understanding who was particularly vulnerable during the pandemic.

Keywords: COVID-19, loneliness, social isolation, prevalence, Japan

Introduction

Social isolation is the objective separation from others, and loneliness is the subjective feeling of being alone or separated. Associations between social isolation, loneliness, and various adverse health outcomes have been reported ( 1- 5). Moreover, scholars have argued that the health risks associated with isolation and loneliness are equivalent to the well-established detrimental effects of smoking and obesity ( 6).

The recent outbreak of the coronavirus disease 2019 (COVID-19) forced people to socially isolate themselves ( 7) and to feel lonely ( 8, 9) as a result of strategies enacted in efforts to reduce the risk of infection. This was because people were unable to engage in casual interactions under social distancing and stay-at-home orders ( 10, 11). One pandemic-related review confirmed that visiting restrictions during the pandemic led to social isolation, loneliness, and negative consequences such as reduced nutritional intake and physical inactivity ( 12). Several studies have also reported both social isolation ( 13) and loneliness ( 14- 16) during the pandemic as potential risk factors for poor mental health. Additionally, Murayama et al. reported that those who became socially isolated during the pandemic were likely to experience greater loneliness ( 7).

Because both social isolation and loneliness had deleterious impacts on people's health conditions not only before but also during the pandemic, the trends in social isolation and loneliness due to the unique context of the COVID-19 pandemic should be carefully monitored. Pedersen et al. investigated time trends in social isolation and loneliness over the first 16 months of the COVID-19 pandemic (between March 2020 and July 2021) in Denmark using nationally representative, repeated cross-sectional data ( 17). Overall, poorer levels of social isolation and loneliness were observed during the strict lockdown periods, whereas better levels were observed during the reopening phases. Sugaya et al. reported no improvement in social isolation and loneliness between May 2020 and February 2021 among Japanese people, whereas psychological distress and depression significantly decreased ( 18).

However, this area of research can be improved in at least two ways. First, trends of social isolation and loneliness during the pandemic have not been well-documented because much of the research related to these conditions and experiences was derived from a cross-sectional design. Second, detailed information, such as the changes in people's characteristics and residential environments, is not available, warranting further analysis. This information could contribute to developing effective strategies not only for the current COVID-19 pandemic but also for future pandemics.

Did the COVID-19 pandemic have a negative impact on people's social connections with others and society? To address the gaps mentioned above, this study aimed to describe changes in the prevalence of social isolation and loneliness between the first year (2020) and the second year (2021) of the COVID-19 pandemic among Japanese people using data from large-scale, web-based nationwide surveys. In particular, we compared the prevalence of social isolation and loneliness by demographic characteristics, socioeconomic status, health conditions, and outbreak situations in residential prefectures of Japan.

Methods

Study design and participants

Data were obtained from the Japan COVID-19 and Society Internet Survey (JACSIS) study, which is a nationally representative web-based self-reported questionnaire survey. The JACSIS study was performed in 2020 and 2021-the first and second years of the COVID-19 pandemic-using a large internet survey agency (Rakuten Insight, Inc., Tokyo, Japan).

For the 2020 survey, 224,389 panelists aged 15-79 years were invited using random sampling stratified by sex, age, and prefecture (covering all 47 prefectures; Japan is divided into 47 prefectures). The survey was conducted from August 25 to September 30, 2020, after achieving the target number of respondents per gender, age, and prefecture category. This period was determined based on the population distribution in 2019. Consequently, 28,000 individuals responded to the survey. In the 2021 survey, 59,219 panelists were invited, including those who participated in 2020. The second survey period was from September 29 to October 28, 2021, and the newly added panelists were recruited according to stratification of sex, age, and prefecture to have a sample that better represents the regional and national general populations. In total, 31,000 people responded to the survey. Supplementary Figure 1 illustrates the number of new infection cases of COVID-19 reported per day until December 31, 2021, in Japan. The 2020 and 2021 surveys were conducted during the latter half of the second wave and at the end of the fifth wave of the pandemic in Japan.

Responses with discrepancies and/or artificial/unnatural responses were excluded from the analysis to validate data quality. Three categories (providing invalid responses to the items with the instructions "Please choose the second from the bottom," choosing positive in all sets of questions for drug use, and choosing positive in all sets of questions for the presence of chronic diseases) were used to detect any discrepancies. Consequently, we excluded 2,518 in the 2020 survey and 2,825 in the 2021 survey with discrepant or artificial/unnatural responses (the remaining 25,482 and 28,175 in 2020 and 2021, respectively).

The protocol of the JACSIS study was approved by the Research Ethics Committee of the Osaka International Cancer Institute (approved on June 19, 2020; approval number 20084). Participants were asked to provide web-based informed consent before responding to the online questionnaire, and the option to opt out at any point was provided. The Internet survey agency respected the Protection of Personal Information Act of Japan. After completing the survey, the participants received a credit point known as an "E-point," which could be used for Internet shopping and cash conversion, as an incentive.

Measures

Social isolation

Social isolation was measured by each participant's frequency of direct and indirect contact with people other than co-residing family members, based on previous studies ( 19- 21). We assessed the frequency of direct and indirect contact using the following eight questions.

(i) Frequency of meeting your family members or relatives who are living apart.

(ii) Frequency of contact with family members or relatives who are living apart by email or text messages (e.g., mobile, LINE, Facebook Messenger).

(iii) Frequency of contact with family members or relatives who are living apart by voice call (e.g., telephone, mobile, LINE, Facebook Messenger, Skype).

(iv) Frequency of contact with your family members or relatives who are living apart by video call (e.g., LINE, Facebook Messenger, Skype, Zoom).

(v) Frequency of meeting your friends or neighbors.

(vi) Frequency of contact with your friends or neighbors by email or text message.

(vii) Frequency of contact with your friends or neighbors by voice call.

(viii) Frequency of contact with your friends or neighbors by video call.

The responses included seven options: "almost every day (6-7 times a week)," "4-5 times a week," "2-3 times a week," "once a week," "2-3 times a month," "once a month," and "rarely." The total frequency of contact was calculated based on a previous article ( 7). We applied the sum of the frequency of contact using the eight questions and regarded contacts less than once a week in the total frequency of contact as social isolation because people who had contacts less than once a week were reportedly more likely to have higher risks of all-cause mortality and onset of dementia and disability ( 18).

Loneliness

Loneliness was assessed using the University of California, Los Angeles (UCLA) Loneliness Scale version 3, Short Form three-item (hereafter the UCLA Loneliness Scale) ( 22, 23). In the JACSIS study, we used the Japanese version of the scale, whose validity and reliability had already been confirmed ( 24). The original UCLA Loneliness Scale used a four-point scale ("1 = never," "2 = rarely," "3 = sometimes," or "4 = always"). While we asked the question using the original response categories in the 2021 survey, the 2020 survey used a five-point scale ("never," "rarely," "sometimes," "often," or "always"). Therefore, we combined the "often" and "always" categories after checking the distribution of responses (i.e., "1 = never," "2 = rarely," "3 = sometimes," or "4 = often/always"). The possible scores ranged from 3 to 12, with a higher score indicating more severe loneliness. In this study, Cronbach's alphas, which were calculated using the three items of the scale, were 0.93 and 0.92 in 2020 and 2021, respectively.

Demographics, socioeconomic status, and health conditions

Sex, age, marital status (married or unmarried), and household composition (living alone or cohabiting) were included as demographics. Educational attainment (junior high school graduate, high school graduate, junior/vocational college graduate, university/graduate school graduate, or unknown/undisclosed), annual household income (≤2.9, 3.0-4.9, 5.0-6.9, 7.0-9.9, ≥10.0 million yen, or unknown/undisclosed), working status, and house ownership (yes or no) were asked as socioeconomic status. We used multiple indicators for working status because several studies reported that the COVID-19 outbreak affected mental health conditions as well as working situations among hospitality industry and medical/welfare workers ( 25- 28): employment conditions [self-employed, permanent employment, temporary employment, or unemployed (including students)], job type (restaurant business, lodging business, medical service, welfare service, or others). In addition, participants were asked about the presence of chronic diseases [hypertension, diabetes, asthma, pneumonia, heart disease, stroke, chronic obstructive pulmonary disease (COPD), cancer, depression, and mental illness (other than depression)] as health conditions.

Prefectural COVID-19 outbreak situation

The cumulative number of confirmed cases per 100,000 population in the residential prefecture from January 15, 2020 (the day the first case of COVID-19 was confirmed in Japan) to September 30, 2021, was calculated, and the participants were divided into four groups based on quartiles. We used the following four categories: highest (≥1162.22 cases per 100,000 population), second highest (713.03-1162.21 cases per 100,000 population), second lowest (461.30-713.02 cases per 100,000 population), or lowest (≤461.29 cases per 100,000 population).

Statistical analyses

We estimated the prevalence of social isolation (population proportion) and loneliness (population mean) using 95% confidence intervals (CIs) in the 2020 and 2021 surveys, respectively. In addition, we estimated the difference in prevalence between 2020 and 2021 with a 95% CI. These were calculated for the total sample and the stratified groups by demographics, socioeconomic status, and health conditions. Furthermore, we illustrated the prevalence by residential prefectures according to the COVID-19 outbreak. In the estimations, we used generalized estimating equations that considered the extra component of variation within participants in order to adjust for correlation among repeated measures. The analysis was performed using IBM SPSS Statistics 29 (IBM Corp., Armonk, NY, USA).

To describe the prevalence of social isolation and loneliness, we used sampling weights that were calculated based on logistic regression analysis using sex, age, and socioeconomic factors to adjust for differences between the respondents of the present web-based survey and the respondents in a widely used population-based sample representative of the Japanese population from the 2016 Comprehensive Survey of Living Conditions ( 29). The weighting was expected to adjust for a biased demographic distribution.

In addition, the age distributions of social isolation and loneliness were visualized with a weighted scatterplot smoothing spline curve fitted to the bivariate distributions of age and social isolation/loneliness in 2020 and 2021, respectively. Both the mean lines and smoothing spline curves were plotted with 95% confidence bands. We used the SAS PROC SGPLOT procedure (SAS Institute Inc., Cary, NC, USA).

Results

Table 1 presents the weighted prevalence of social isolation and loneliness among the participants. The proportion (95% CI) of individuals with social isolation in the total sample was 27.4% (25.9, 28.9) in 2020 and 22.7% (21.9, 23.5) in 2021. The percentage difference from 2020 to 2021 was −4.7 percentage points (−6.3, −3.1), indicating that social isolation decreased during the interval. Concerning loneliness, the weighted mean score of the UCLA Loneliness Scale was 5.03 (4.86, 5.20) in 2020 and 5.86 (5.81, 5.91) in 2021, and the score difference was 0.83 points (0.66, 1.00). This suggests that, contrary to social isolation, loneliness increased from 2020 to 2021.

Table 1

Distribution

Social isolation (possible proportion range: 0-100%)

Loneliness (possible score range: 3-12)

2020 %

2021 %

Difference percentage point (95% CI)

2020 mean (95% CI)

2021 mean (95% CI)

Difference mean (95% CI)

The weighted prevalence of social isolation and loneliness, according to sex and age, is shown in Table 1 . Social isolation was significantly greater in men than in women both in 2020 and 2021, but the decrease was similar for men and women [men: −4.4 percentage points (−7.0, −1.8); women: −4.9 percentage points (−7.0, −2.8)]. The level of loneliness was not different by sex in 2020, but in 2021, women had greater loneliness than men: 5.01 (4.71, 5.30) in men and 5.05 (4.90, 5.21) in women in 2020, and 5.62 (5.55, 5.68) in men and 6.09 (6.02, 6.16) in women in 2021. The level of increase in loneliness tended to be greater in women than men [men: 0.61 points (0.31, 0.91); women: 1.04 points (0.88, 1.20)].

The proportion of social isolation in younger ages, particularly 20-29 years, was lower than that in other age subgroups in both 2020 and 2021. The decrease was greatest in the 15-19 years age group [−15.7 percentage points (−22.8, −8.5)]. The UCLA Loneliness Scale score was the highest in the subgroup aged 20-29 years in 2020 [7.01 (6.18, 7.83)], but the score decreased to 6.13 (5.98, 6.28) in 2021. In the other age subgroups, the score increased from 2020 to 2021, particularly among the middle-aged and older populations.

Figures 1 , ​,2 2 display the observed distribution of social isolation and loneliness across age groups (solid lines). Regarding social isolation, the age distribution in 2020 was characterized by a dip around age 20 in early life; however, in the period of middle and old ages, the distribution was almost stable. In 2021, although the proportion of social isolation decreased among those under the age of 20 compared to 2020, the overall trend after the age of 20 was similar to the 2020 distribution. In contrast, the age distribution of loneliness in 2020 was characterized by a sharp peak around the age of 20 and a downward trend in middle and late adulthood. However, as indicated by the broad confidence band, there was large inter-individual variability in loneliness in this age group. After 1 year, the level of loneliness flattened across young and middle adulthood and declined continuously into old age.

Table 2 represents the weighted prevalence of social isolation and loneliness by demographics and socioeconomic status. Those who were married had a greater proportion of social isolation in 2020, but it significantly decreased in 2021 compared to unmarried people. Loneliness was consistently greater in unmarried individuals than in married individuals in both years. In 2020, people cohabiting had a higher proportion of social isolation than those living alone; however, this disparity was attenuated by 2021. Loneliness was greater among those living alone than among those living with others in both 2020 and 2021.

Table 2

Distribution

Social isolation (possible proportion range: 0-100%)

Loneliness (possible score range: 3-12)

2020 %

2021 %

Difference percentage point (95% CI)

2020 mean (95% CI)

2021 mean (95% CI)

Difference mean (95% CI)

Junior/vocational
college graduate

19.3%

20.1%

26.4
(24.8, 28.0)

19.9
(18.6, 21.2)

−6.5***
(−8.4, −4.6)

5.04
(4.93, 5.14)

5.97
(5.88, 6.06)

0.93***
(0.81, 1.06)

University/graduate
school graduate

35.2%

25.8%

21.6
(18.7, 24.8)

21.9
(20.9, 22.9)

0.3
(−2.9, 3.4)

5.28
(4.85, 5.71)

5.87
(5.80, 5.93)

0.59**
(0.16, 1.01)

Unknown/
undisclosed

0.8%

1.2%

36.2
(19.3, 57.3)

36.5
(24.7, 50.1)

0.3
(−23.4, 23.9)

4.75
(3.85, 5.66)

5.60
(5.02, 6.19)

0.85
(−0.24, 1.94)

Unknown/
undisclosed

22.0%

23.3%

33.2
(29.8, 36.7)

24.8
(23.2, 26.6)

−8.3***
(−12.1, −4.5)

4.77
(4.61, 4.94)

5.87
(5.76, 5.97)

1.09***
(0.91, 1.27)

People with lower education were more likely to be socially isolated but have lower loneliness in 2020, whereas people with lower income tended to be socially isolated and have higher loneliness. These trends continued in 2021. Concerning employment conditions, those with permanent jobs and those who were unemployed (including homemakers) had a higher proportion of social isolation by 2020. These decreased in 2021, but the proportions remained higher than those in the other categories. Social isolation among students remarkably improved in 2021 compared to 2020. The disparity in loneliness by employment condition observed in 2020 was suppressed by 2021. Social isolation among restaurant workers was high in 2020 but decreased in 2021.

Finally, Table 3 illustrates the weighted prevalence of social isolation and loneliness by health conditions and outbreak situation in the residential prefecture. People with each chronic disease were less likely to be socially isolated, but they experienced higher loneliness in 2020. The changing trend of social isolation varied according to the type of chronic disease, and there was a general decrease in loneliness in 2021. Changes in the proportion of social isolation and loneliness scores were smaller in prefectures with greater numbers of COVID-19 infection cases.

Table 3

Distribution

Social isolation (possible proportion range: 0-100%)

Loneliness (possible score range: 3-12)

2020 %

2021 %

Difference percentage point (95% CI)

2020 mean (95% CI)

2021 mean (95% CI)

Difference mean (95% CI)

Mental illness
(other than depression)

Not possessing

94.9%

95.6%

27.8
(26.4, 29.3)

22.7
(21.9, 23.5)

−5.1***
(−6.7, −3.5)

4.83
(4.70, 4.97)

5.77
(5.72, 5.82)

0.94***
(0.80, 1.08)

Discussion

This study investigated changes in the prevalence of social isolation and loneliness among Japanese people between the first and second years of the COVID-19 outbreak. The study also examined the differences among subgroups defined by demographic characteristics, socioeconomic status, health conditions, and outbreak situations in residential prefectures. Overall, we found that social isolation decreased from 2020 to 2021, whereas loneliness increased.

In the first year of the pandemic in Japan, most schools were closed, and students received classes online. The extracurricular activity was also assessed. Many companies have introduced teleworking, including, as of April through May 2020, 56.4% of all companies, 83.3% of medium-sized companies, and 50.5% of small-sized companies ( 30). Additionally, most community activities were forced to refrain. In contrast, in the second year of the pandemic, the situation regarding COVID-19 had changed. For example, COVID-19 vaccination has been widespread, and people have understood and adopted infection-prevention behaviors naturally. Schools and community activities were reopened. An increasing number of workers were going to the office; the proportion of teleworkers was 38.4% in March 2021 ( 30). Under these circumstances, the COVID-19 outbreak struck everyone's social connections with others and society; however, the influence was relieved in the second year. Therefore, social isolation decreased by September and October of 2021 compared to 2020.

However, there were variations in the degree of change according to participants' characteristics. The decrease was particularly large for those aged 15-19 years, which is likely due to the school's shift to face-to-face classes in 2021. The proportion of social isolation among the older population was higher than that among the younger population as of 2020, but the percentages decreased more sharply among those in the older groups than among those in the younger groups by September and October of 2021. As previous research indicated ( 7), older people in Japan were not familiar with online communication tools such as the Internet (e.g., Zoom and Skype) and social networking services (SNSs) ( 31). Another survey showed that the proportion of older people who reported an increase in the frequency of use of online connections was lower in Japan than in Western countries, including the United States, Germany, and Sweden ( 32). Thus, social isolation tended to be prevalent in the older population during the first year of the pandemic. However, because community activities, the major participants of which were older people ( 33), have been reopened, they could be less socially isolated in the second year.

People who were married and cohabiting were more likely to be socially isolated than their counterparts in the first year of the pandemic. A previous study conducted before the COVID-19 pandemic reported that older people living with others tended to become more socially isolated than those living alone ( 21). People who were married or living with someone tended to complete their social interactions within the household without having connections with those outside the household, particularly during the pandemic period. However, these gaps observed in 2020 were attenuated in 2021, which implies that people expanded their daily activities in the second year of the pandemic when restrictions on people's behaviors eased.

The proportion of social isolation has decreased significantly among restaurant workers. In the first year of the outbreak, most prefectural governments in Japan requested shorter hours or restaurant closures. Contrarily, in the second year, prefectures (except those with large numbers of COVID-19 cases) did not. Therefore, a remarkable decline in the proportion of restaurant workers is observed. In the prefectures with fewer COVID-19 infection cases, we observed a greater decrease in social isolation. In such prefectures, municipal governments tend to request fewer behavioral restrictions on people, especially in the second year. People in the prefectures were somewhat free of social activities; thus, they were unlikely to be socially isolated.

In contrast to social isolation, loneliness increased in almost all the strata. This implies that the prolonged pandemic may have caused people to feel overwhelmed and exhausted, which is sometimes called "COVID-19-related psychological fatigue" ( 34), resulting in an increase in loneliness from 2020 to 2021. By age group, loneliness was higher among younger generations in 2020, especially among those aged 15-29 years, although they were not likely to be socially isolated. This result is consistent with those of a public cross-sectional survey conducted in Japan ( 35). Social isolation and loneliness are similar concepts but not the same. While the younger generation is good at connecting through the Internet and SNSs, such online connections are less likely to generate support that can address function limitation concerns ( 36, 37). Therefore, they might feel lonely, even if they have more online connections. In addition, people who were unmarried and living alone had greater loneliness during the study period, although the proportions of social isolation among them were lower in 2020. Earlier research presented a similar trend ( 38, 39). These similar findings provide evidence to support that social isolation and loneliness are not necessarily the same concept.

As an exception, loneliness was higher among those with chronic illness than their counterparts in the first year, and it decreased in the second year. A study in Denmark reported a similar trend ( 17). Psychological burdens such as anxiety and worries about COVID-19 may have decreased with the gradual establishment of infection-prevention behaviors in the population and with the spread of COVID-19 vaccination ( 17). Those with chronic illness and at a higher risk of COVID-19 infection might have carried a greater psychological burden in 2020 due to alienation from others, but this condition may have eased by 2021. Loneliness was higher in prefectures with more infections in the first year. However, in the second year, it increased in all prefectures, particularly within those with fewer infection cases. As a result, the disparity among the prefectures was reduced, suggesting that loneliness was pervasive, regardless of infection status.

Some limitations must be considered. First, because we used data from the web-based survey, the sample did not necessarily reflect the demographic distribution of the general population. This potential selection bias was likely to result in more optimistic estimates than the true levels in the population. Fundamentally, average social isolation and loneliness levels are likely to be worse than those reported in this study. Considering this, a weighting technique using external nationally representative data was applied to reduce bias. However, a residual bias may still exist. For example, people who were less negatively affected by the pandemic tended to answer online surveys. Furthermore, older people with better cognitive function and technological competencies were more likely to participate in the survey than those with worse status and those lacking technological competencies. Second, questions regarding social isolation did not include work-related connections, although we measured the frequency of contact with family members or relatives who were living apart and friends/neighbors. Thus, the prevalence of social isolation, particularly in young and middle-aged individuals, may have been underestimated. Various forms of social connections should be assessed in future surveys to capture social isolation conditions correctly. Third, this study only investigated participants' experiences at two time points during/after the pandemic. The level of social isolation and loneliness could be influenced by social events of the moment (e.g., infection spread, lockdown, stay-at-home order) ( 17). A time trend study is necessary to capture the status of these indicators accurately. Finally, the results included some response categories with small proportions of participants (e.g., job types and health conditions). We deemed that the prevalence of social isolation and loneliness in these categories could be useful information to understand vulnerable populations that were strongly influenced by the COVID-19 pandemic. However, because a small sample size possibly leads to low statistical power, the results must be interpreted with caution.

Conclusion

Social isolation decreased from the first year (2020) to the second year (2021) of the COVID-19 pandemic, whereas loneliness increased among the Japanese population. However, the trends in these changes differed according to the characteristics of the participants. Furthermore, the assessment of the impact of the COVID-19 pandemic on social isolation and loneliness will lead to an understanding of who was vulnerable during the pandemic. Based on the findings, the government and public health sector can take measures to prioritize those most affected by social isolation and loneliness and establish efficient strategies to prevent mental disorders in future pandemics.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving human participants were reviewed and approved by Research Ethics Committee of the Osaka International Cancer Institute. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author contributions

HM and TT designed the study and collected data. HM, TSu, IN, and TSh conducted data analyses. HM prepared the manuscript. TSu, IN, TSh, and TT provided critical feedback. All the authors have read and approved the final version of the manuscript.

Funding Statement

This research was funded by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant Nos. 17H03589, 19K10671, 19K10446, 18H03107, 18H03062, and 21H04856), the JSPS Grant-in-Aid for Young Scientists (Grant No. 19K19439), Research Support Program to Apply the Wisdom of the University to Tackle COVID-19 Related Emergency Problems, University of Tsukuba, the Health Labor Sciences Research (Grant Nos. 19FA1005, 19FA1012, and 19FG2001), Grants from Chiba Foundation for Health Promotion and Disease Prevention, Innovative Research Program on Suicide Countermeasures (R3-2-2), the Ministry of Health, Labor, and Welfare (MHLW) Special Research Program (Grant No. JPMH20CA2046), the Japan Agency for Medical Research and Development (AMED) (Grant No. 2033648), and JST RISTEX (Grant No. JPMJRX21K6).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

25. Gursoy D, Chi CG. Effects of COVID-19 pandemic on hospitality industry: review of the current situations and a research agenda. J Hosp Mark Manag. (2020) 29:527-9. 10.1080/19368623.2020.1788231 [[ CrossRef] Google Scholar]

30. Ministry of Internal Affairs and Communications . White Paper 2021: Information and Communications in Japan. Tokyo: Nikkei Printing Inc. (2021). [ Google Scholar]

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32. Cabinet Office. Annual Report on the Aging Society 2021. Tokyo: Nikkei Printing Inc. (2021). [ Google Scholar]

Articles from Frontiers in Public Health are provided here courtesy of Frontiers Media SA

# data[].attributes.attachment_link.title
Changes in social isolation and loneliness prevalence during the COVID-19 pandemic in Japan: The JACSIS 2020-2021 study

# data[].attributes.attachment_link.description
Hiroshi Murayama, 1 , * , † Takumi Suda, 1 , 2 , † Isuzu Nakamoto, 1 , 3 , † Tomohiro Shinozaki, 4 , † and Takahiro Tabuchi 5 , † The recent coronavirus disease 2019 (COVID-19) outbreak has changed people's social connections with others and society.

# data[].attributes.headline
Stigma and low prevalence of Common Mental Disorders (CMD) in Japan

# data[].attributes.subject
Stigma and low prevalence of Common Mental Disorders (CMD) in Japan

# data[].attributes.body
https://borgenproject.org/mental-health-in-japan/
This article suggests that Japan has a low prevalence of CMD due to the stigma and shame surrounding mental illness. It is also suggested that blame is attributed to the individual with a mental illness. It is also possible that mental illnesses have a low prevalence in Japan because they are underreported.

# data[].attributes.attachment_link.title
Mental Health in Japan: Stigmas and Low Inequality

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Mental health in Japan suffers due to stigma surrounding mental illnesses, but the country is taking positive steps to address this.

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Mental Health in Japan: Stigma and Low Inequality

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Comment to Hauto's resources by Daichi  

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Comment to Hauto's resources by Daichi  

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His resources are about how university students struggled with social withdrawal under Covid-19. Also, he found the resource that meeting people is essential for humans, which is very useful t explain the significance of our app.

In terms of social media he found, SNS is useful to make friends and get connected with others. Our app is based on this idea, and good resource to use.
Also, Japanese university students have difficulty to figure out how to contribute to society and find volunteer. Our app can solve this issue and support university students' desire.

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Comments on "getting professional advice"

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Comments on "getting professional advice"

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I thought this is contradicting as it mentions about how people refrain their selves from getting professional advice due to the cost but doesn't explain how the app is going to manage with that problem. However, I also can't come up with a solution for this...

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Comment to "An app for local social events" 

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Comment to "An app for local social events" 

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I thought that focusing on connecting person to person or connecting to a group is better than just encouraging them to join an event because that is the hardest part. By connecting to a person or group, it is more likely for that person to attend an event as they can obtain a. sense that they actually belong to it.

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Comment to Daichi's resource about suicide by the worker in Japan

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Comment to Daichi's resource about suicide by the worker in Japan

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Although we are going to focus more on students rather than the office workers for our project , I thought we can use this resource to explain how important it is for a human to get connected to someone no matter what age they are.

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How SNS is contributing to university students  to make friends 

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How SNS is contributing to university students  to make friends 

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https://www.advertimes.com/20221228/article408084/

This is a Japanese web article about how SNS is used by university students to make friends during the Covid shutdown. I thought this article is relevant and useful for our project as it talk about how SNS is playing a key role for the university students to make friend which is something similar to what we are trying to create.

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SNS駆使して効率よく友達づくり　コロナ禍の大学生の行動が明らかに | AdverTimes.（アドタイ） by 宣伝会議

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コロナ禍で対人接触の機会が減った大学生は、SNSなどを駆使しながら効率の良い友人づくりを実践していた――。東京広告協会がこのほど発表した調査結果から、近年の大学生は友人関係構築を戦略的に実践している様子が浮かび上がった。

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How having friend in University for a students to grow and also maintain mental health 

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How having friend in University for a students to grow and also maintain mental health 

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https://www.nippon.com/ja/japan-data/h01400/

This is a Japanese web article by Benesse Corporation, Japan's most extensive education company. It is about the result of the interview asking university students how many friends they have from the university. The result suggested that most respondents are struggling to find a friend and finding this a problem because it is difficult for them to get the sense that they are growing up without a friend.. I thought this web article is relevant to our project as it talks about how important friends are for university students and the fact that most students struggle to make friends or join a group.

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ゼミの研究発表の前には仲間とディスカッションを重ね、学食で友だちとおしゃべりしながらランチを食べ、サークル活動で汗を流した後には居酒屋で盛り上がる―新型コロナウイルス感染症の影響で、かつては当たり前だったキャンパスライフが送れなくなった大学生の実態をベネッセが調査した。

ベネッセコーポレーションの「大学生の学習・生活実態調査」で、コロナ禍のキャンパスライフは友人関係を築きづらく、充実感を得られていないことが明らかになった。調査は2021年12月、インターネットを通じて全国の大学1～4年生4124人から回答を得た。ベネッセでは同様の調査を08年から4～5年おきに実施しており、今回で4回目。

友だちの数について聞いたところ、「話したり、一緒に遊んだりする」当たり障りのない付き合いをする友人関係はそこそこあっても、「悩み事を相談できる」「社会の課題などについて議論する」「学習やスポーツで競い合う」友だちについては、全体の8割近くがいたとしてもせいぜい2～3人と回答。いずれのタイプの友人も、16年調査時に比べて「0=いない」の割合が増えている。

友だちの数を基準に、回答者を3分の1ずつに分割すると、友だちの数が「少ない群」は「多い群」に比べて「学びの充実」「成長」を実感できていない傾向があった。

成長実感を学年別にみると、大学2年生（20年度入学）は成長を「実感しない」と答えた割合が39.6%で、他の学年と比べると16年調査からの落ち込みが顕著だった。

新型コロナウイルスの流行が始まり、最初の緊急事態宣言が出たのは20年4月。外出禁止、人との接触極力回避が求められ、入学式中止、授業はリモート、サークル活動禁止など、憧れのキャンパスライフとは程遠い生活をいきなり突き付けられた学年だ。

ベネッセでは、「20年度入学生を大学がどう送り出し、社会がどう受け入れるか、支援策の検討と実行が急がれる」と指摘している。

バナー写真 : PIXTA

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友だち少ないと、学びや成長を実感できない―ベネッセの大学生実態調査

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ゼミの研究発表の前には仲間とディスカッションを重ね、学食で友だちとおしゃべりしながらランチを食べ、サークル活動で汗を流した後には居酒屋で盛り上がる―新型コロナウイルス感染症の影響で、かつては当たり前だったキャンパスライフが送れなくなった大学生の実態をベネッセが調査した。 ...

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Academic article - Relation between Covid and Isolation of University students from the society

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Academic article - Relation between Covid and Isolation of University students from the society

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https://www.jstage.jst.go.jp/article/jjpsy/92/5/92_92.20320/_pdf/-char/ja

This academic literature examine the relation of influence of Covid to the university students and isolation. Moreover it focus on how attachment or sense of belonging is important for the university students just like the other literature and news article that I've attached. I thought this literature is related to our project as it talks about how University students are suffering from isolation due to the Covid.

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Academic article -The influence of Covid to University students

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Academic article -The influence of Covid to University students

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https://catalog.lib.kyushu-u.ac.jp/opac_download_md/4372005/43_p001.pdf

this academic literature is about a research how university stundents were mentally and phisically influenced by the Covid-19. I thought this essay is necessary for our project as it mentions about how meeting people and belonging to a group is very important for human especially when they are young like university students. Our app is going to be about how to solve this problem

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Academic article -Japanese University Students struggle to find friends and groups to belong to due to the Covid.

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Academic article -Japanese University Students struggle to find friends and groups to belong to due to the Covid.

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https://www.jstage.jst.go.jp/article/jjpsy/92/5/92_92.20076/_pdf/-char/ja

This is a Japanese academic kiterature about how University Students during the Covid period suffered from social withdrawal. I thought this essay is relevant and useful for our project because those people are the targets and the problem that we want to solve through this app.

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 The obstacle that stops people from volunteering 

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 The obstacle that stops people from volunteering 

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https://diamond.jp/articles/-/199432

This is a Japanese News article addressing about how in Japan, there are many people especially University students that are willing to contribute to the society through Volunteering but can't find enough information about how they can actually do it. I thought this article is helpful for our project in a way, our app is going to connect people who want help and people who want to volunteer.

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ダイヤモンド・オンライン

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信頼性の高いボランティア情報を網羅、他のボランティアたちや企業・団体ともつながれ、さらに行動するとポイントのような独自コインも付与されるという、ユニークな社会貢献の無料サービスが誕生した。個人の社会貢献活動に新しい息吹をもたらすサービスだ。

社会貢献に新潮流を
もたらすサイトがオープン

「社会に対して何か貢献したいが、何をすればよいかわからない」

そんな人のための、ボランティア活動や寄付などの社会貢献活動を可視化する無料サービス 「actcoin（アクトコイン）」 が登場し、話題となっている。

同サービスは、「より良い世界を作るために　愛と勇気とお金の等価交換を実現する」ことを目指し、ソーシャルアクションカンパニー株式会社が開発。プラットフォームに登録されている社会貢献活動情報をもとに何か行動を起こすと、ポイントのような独自コイン「actcoin」（仮想通貨ではない）が付与される。

特徴は、社会貢献に関する「3つの見える化」にある。

その1つ目は、「企業・ＮＰＯ・行政が募集している社会貢献活動の見える化」だ。

内閣府の「平成28年度 市民の社会貢献に関する実態調査」によると、ボランティア活動参加を妨げる要因の第2位は「ボランティア活動に関する十分な情報がない」（39.8％）だ。

そこで同サービスは、ＮＰＯなどの活動を支援する日本財団CANPANプロジェクトとの連携によって、信頼性の高い企業・ＮＰＯ・行政のプロジェクト・寄付情報をプラットフォームに掲載し、「いつ・どこで・どんな社会貢献活動ができるか」を簡単に入手可能とした。これまで「ボランティア活動に関心があっても、どこで情報を得たらよいかがわからなかった」という人たちも、行動を起こしやすくなっている。

掲載されているプロジェクト情報は、「障がい者スポーツ教室のボランティア」「途上国の教育格差に挑むＮＧＯの活動報告会」「高校生と関わるボランティアプログラム説明会」など多彩だ。

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社会貢献へのハードルを下げる「成果の見える化」サービスとは

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信頼性の高いボランティア情報を網羅、他のボランティアたちや企業・団体ともつながれ、さらに行動するとポイントのような独自コインも付与されるという、ユニークな社会貢献の無料サービスが誕生した。個人の社会貢献活動に新しい息吹をもたらすサービスだ。 「社会に対して何か貢献したいが、何をすればよいかわからない」 　そんな人のための、ボランティア活動や寄付などの社会貢献活動を可視化する無料サービス ...

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Another newspaper about isolation under covid-19 in Japanese university, published by Asahi Shinbun (Daichi)

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Another newspaper about isolation under covid-19 in Japanese university, published by Asahi Shinbun (Daichi)

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https://www.asahi.com/ajw/articles/14417200

This news article illustrates the relationship between the isolation and mental depression of university students under covid-19. The author claimed that restriction of their school life negatively affects their mental health. Based on the qualitative data (interview), they found that some of them could not get out of their bed for several days due to the mental depression caused by isolation. It also said that the feeling of loneliness and anxiety of their future developed to the thoughts of suicide.
So, we can use this news article to explain how significant it is to deal with the isolation by our app.

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A large number of Japan's college students report having endured serious psychological health issues as a result of the prolonged pandemic, including depression, loneliness and decreased motivation, a new survey shows.

Sophomores, who have been able to attend few classes in person since entering universities in spring last year and have rarely had opportunities to meet others in their age group, emerged as especially impacted by the fallout from the health crisis.

That's among the findings of the survey on campus life conducted by the National Federation of University Cooperative Associations.

"One time I couldn't get out of bed for three days or so," said Naoki Aoshima, a second-year student at Meiji Gakuin University, who attended a news conference to announce the findings. A friend of his has developed a psychological disorder, he added.

Results of the online survey were released on Aug. 10. The survey, conducted in July, covered 7,637 university students.

Respondents were asked what they are anxious about and could choose multiple answers. While 66.7 percent of all the students selected the answer "anxiety about the future," the figure rose to 74.1 percent among sophomores.

A total of 45.3 percent of students overall said they "feel like doing nothing out of laziness," while 51.4 percent of second-year students said they felt that way.

Respondents who said they were "depressed" accounted for 41.6 percent of students overall and 47.1 percent of those in their second year.

A total of 33.0 percent of all students and 39.2 percent of sophomores said that they feel "lonely and restless about not being connected to friends."

The survey also covered thoughts of suicide and feelings of alienation among students, with 19.5 percent of all respondents saying they "do not want to live anymore," and 22.7 percent of sophomores answering that way.

A total of 18.7 percent of all respondents said they felt "ostracized from everywhere," while 24.3 percent of second-year students said they felt that way.

Sophomores with fewer than five friends accounted for 35.1 percent, far more than 31.2 percent for freshmen and some 19 percent for juniors and seniors.

A total of 7.3 percent of second-year students had no friends, compared with 5.8 percent of freshmen.

As many as approximately 40 percent of the surveyed students answered that they want college operators to "create chances to build links with classmates within campus," "resume and promote after-school activities (of social circles and clubs)" and "offer opportunities to form connections with college superiors inside campus."

The questionnaire also came with a comment section where people could open up about their experiences with anxiety.

Opinions from sophomores included, "I tackled doing homework at midnight while sobbing in depression" and "I even think I should not have entered college."

"What relationships you can build differs greatly depending on whether one has in-person classes, and this forces people who do not often come (to campus) to be increasingly isolated," another second-year student pointed out.

One senior asked for "help because I just spend days in a small apartment to protect myself from the coronavirus so it is difficult to maintain my psychological health."

"I have no part-time shifts and therefore no money so I can't refresh myself by eating out," a junior wrote. "My assignments make it impossible for me to spend time with friends, so I'm always depressed and can't sleep soundly at night or wake up in the morning."

Shigeru Yamamoto, a specially appointed professor of support for young people at Taisho University, who is knowledgeable about measures to stop students from dropping out of school, called on university operators to take steps over the issue.

"Colleges should take advantage of the internet to hold online sessions in small groups with the main objective of helping people build connections with each other," Yamamoto said.

"To improve training programs for lecturers, i t's also important to pick up good examples, such as having teachers write comments on essays the students submit when they return them so students can improve," he added.

(This article was written by Hajime Ueno and Senior Staff Writer Fumio Masutani.)

The Asahi Shimbun

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Pandemic survey finds students in college cut off, alone, depressed | The Asahi Shimbun: Breaking News, Japan News and Analysis

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A large number of Japan's college students report having endured serious psychological health issues as a result of the prolonged pandemic, including depression, loneliness and decreased motivation, a new survey shows.

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Another newspaper published by NHK （Daichi）

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Another newspaper published by NHK （Daichi）

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https://www3.nhk.or.jp/news/html/20210602/k10013062981000.html
This media talks about the university students’ mental depression under covid-19. Because of it, all classes were conducted online, and it led to isolation and mental stress coming from anxiety of their future.
In addition, almost half of university students were stressed, and 20 percent of interviewed students had mental depression due to online classes and restriction of their activities. This restriction of activities still affects university students' life in a way that they possibly struggle with finding their places to belong to.

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新型コロナウイルスの感染拡大が続く中、若い世代の2割以上が気分が落ち込むなどの「治療が必要な抑うつ状態」と推定されるという調査結果がまとまりました。

この調査は徳島大学の山本哲也准教授のグループが今年2月、コロナ禍の心理面での影響などを調べようとインターネットを通じて、緊急事態宣言が発令されていた10の都府県のおよそ2万人を対象に行いました。

このうち18歳から29歳までのおよそ2100人について分析した結果、気分が落ち込むなど「治療が必要な抑うつ状態」と推定された人の割合は22.8％で、去年5月の緊急事態宣言の時に行った同様の調査と比べてわずかに減少していたものの、依然として高い水準となっていました。

また、今回の調査で「ストレス状態」と推定された割合も、46％と半数近くにのぼっていました。

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新型コロナ・影響・対応・支援

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若い世代2割以上「治療が必要な抑うつ状態」コロナ感染拡大で | NHKニュース

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新型コロナウイルスの感染拡大が続く中、若い世代の2割以上が気分が落ち込むなどの「治療が必要な抑うつ状態」と推定されるという調査結果がまとまりました。 この調査は徳島大学の山本哲也准教授のグループが今年2月、コロナ禍の心理面での影響などを調べようとインターネットを通じて、緊急事態宣言が発令されていた10の都府県のおよそ2万人を対象に行いました。 ...

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Japanese newspaper published by Asahi Shinbun （Daichi）

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Japanese newspaper published by Asahi Shinbun （Daichi）

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https://www.asahi.com/articles/ASL704WVNL70UBQU00N.html

This newspaper illustrates how isolation affects mental depression in Japan. It explains the two traits of Japanese culture. One of them is that Japanese people tend to maintain the relationship that they do not want in order to maintain the harmony within the group in which they belong to. As a result, they tend to make no effort to understand people from outside or different cultures and become poor at flat communication. This is how isolation can happen.
In addition, Japan is not very familiar with churches that meet regularly, civic organizations, and other activities. Japan ranks 101st out of 149 countries in terms of social capital, which refers to the level of human connections and trust. This is the lowest among developed countries. I fear that the recent trend to glorify solitude, saying that "being alone is enough" and "I don't need connections," will exacerbate the loneliness among Japanese people.

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「孤独」――。家族や学校、会社、 スマートフォン で人とつながっているのに、そう感じることが少なくない。そもそも孤独とは、私たちを自由にするものなのか、それとも病なのか。

「頼る人いない」対策急げ　岡本純子さん（オジサンの孤独研究家）

孤独は老若男女、日本のあらゆる年代に広がっています。誰にでも訪れる短期的な孤独には耐えることも必要でしょう。しかし、人とのつながりがなく、頼る人がいない恒常的・長期的な孤独を放置してはいけません。孤独は多くの人の精神と身体をむしばみ、社会問題にも関わる、深刻な病の一つなのです。

私は、これまでに約１千人の社長や企業幹部のコミュニケーションのコーチングをしてきました。その経験から、日本人、特にコミュニケーションが苦手なオジサンは、孤独に陥りやすいと感じてきました。その理由は、日本独自の文化や価値観にあります。

日本人は一つの会社に長く身を置く傾向があります。会社というムラ社会の内部で重視されるのは、上意下達のタテのコミュニケーション。しかも、内の人との和を大切にしすぎて、望まない人間関係も強いられ、人と関わることに疲れ切ってしまいます。その結果、外の人や異文化とわかり合う努力をしなくなり、フラットなコミュニケーションが苦手になります。

また、日本では、定期的に集まる教会、市民団体などでの活動などがあまり身近にありません。人と人とのつながりや信頼関係を意味する、ソーシャルキャピタルの充実度のランクは１４９カ国中１０１位。先進国で最低です。最近の「１人で十分」「つながりはいらない」という、孤独美化の風潮が、日本人の孤独化を悪化させることを危惧しています。

引きこもり、 介護 、貧困、いじめなどの社会問題は、誰ともつながらず、孤独であると深刻化します。様々な事件でも「周囲からの孤立」が背景にある場合が多いのです。

孤独の悪影響を証明した医学的研究は無数にあります。 心疾患リスクを２９％上げる。１日たばこを１５本吸うことに匹敵する。 アルツハイマーになるリスクが２・１倍になる。うつ病や アルコール依存症などの精神的な疾患にもつながります。米国の前 公衆衛生 局長官は、「病気になる人々の共通した病理は孤独だった」という論文を発表しました。英国は今年１月、孤独担当相を新たに設け、国家として孤独問題に取り組む姿勢を鮮明にしています。

日本も孤独対策を急がなければ、手遅れになります。教育で、読み書きだけではなく、人との対話の方法を学ぶことも対策の一つになるでしょう。同質の人だけでなく、異なる環境の人とわかり合うコミュニケーション力とコミュニティーを作る力という、二つの「コミュ力」が重要です。「孤独は自分の責任」「家族で責任を持て」ではなく、日本社会全体でこの問題を考えていかなければなりません。急がないと、「一億総引きこもり」の時代が来てしまいます。（聞き手・ 後藤太輔 ）

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６７年生まれ。新聞記者などを経て「コミュ力」支援会社社長。著書に「世界一孤独な日本のオジサン」。

ＳＮＳで変わる「ひとり」　南後由和さん（社会学者）

「孤独」は当人の気持ちや立場次第で、肯定的にも否定的にもとらえられる主観的状態です。私はより客観的な「ひとり」という言葉で、都市空間の中の「ひとり」のあり方を研究してきました。

そもそも都市は、単身者の流入と流出を繰り返し発展してきました。 江戸時代には 参勤交代 の藩士や上方の商人が江戸に集まり、ひとり向けの住居や飲食店が増えました。

戦後は進学や就職で上京し、単身になるパターンが定着。現在はカプセルホテルやひとりカラオケなど、ひとり向けの空間が膨大に存在します。都市は「ひとり」を集める機能があり、「ひとり空間」の集積は自然のことなのです。

都市に「ひとり」が多いのは当然なのですが、近年、「孤独」が解決すべき問題として注目され始めました。１９９５年の 阪神・淡路大震災、さらに２０１１年の 東日本大震災 で、隣人さえ知らない都市住民の孤立した生活ぶりや、地域コミュニティーの希薄さが明らかになったからです。「絆」や「みんな」が強調されるようになり、「孤独」が問題視されました。

その間も、都市の単身者は増え続けました。３０～４０代の独身女性が「 おひとりさま」という言葉で消費の主役とされる一方、単身高齢者の 孤独死 などで、「無縁社会」といった言葉も登場しました。

単身高齢者の増加は、解決すべき社会問題でしょう。私が現在滞在中の オランダ では、ある高齢者施設で若者を無料で入居させ、世代間の交流を促進しています。

こうしたなか、ＳＮＳで常につながるというテクノロジーの変化が、都市の若者の「ひとり」の意識に変化を与えつつあります。「ひとり」と「みんな」が正反対の状態ではなくなってきたのです。

例えば、「ぼっち」という言葉を使って学生は「いま、ぼっち授業」などとＳＮＳでよくつぶやきます。教室には大勢の学生がいるのに「ひとりぼっち」と感じるのです。

彼らはＳＮＳで常に誰かとつながり、一緒にいるのが普通の状態です。友達と一緒ではないと、集団の中でも「ひとり」と感じる。またコンセプトカフェなど一部の場所では、会話するでもなく、趣味を共有する人たちと、「みんな」で「ひとり」を楽しむことも人気を集めています。

スマートフォンによる「常時接続社会」で、他者とつながり続けたい気持ちと、他者から切り離されたい気持ちがせめぎ合っているのです。

いまは複数のＳＮＳのアカウントで、属する「みんな」を使い分ける人もいます。「ひとり」と「みんな」は簡単に切り替わり、その間にもグラデーション（濃淡）がある。「孤独」のありようは、ＳＮＳごとや個人ごとにさまざまな形を取り始めていると思います。（聞き手・中島鉄郎）

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７９年生まれ。 明治大学 准教授。専門は社会学、都市・建築論。著書に「ひとり空間の都市論」など。

深刻にならず、逃げ場だけは作っておく　田中慎弥さん（作家）

高校を卒業したあと１５年近く、３３歳で小説家デビューするまで 山口県下関市 の実家に引きこもり、ひたすら本を読んでいました。大学受験に失敗して進学はせず、就職もせず、外部との接触はほとんどありませんでした。

１人の生活は別にしんどくはありませんでした。その時のことをよく聞かれるんですよ。「孤独でつらかったですか？」とか。むしろ、しんどくなるのが嫌で、そういう生活をしていたんです。

高校の頃から、自分は他人とうまくやっていけない人間なんだな、と何となく分かっていました。人とのコミュニケーションにはかなりの覚悟が必要で苦労するな、と。「普通の生き方はできそうにない」と思い、二十歳過ぎから小説を書き始めました。

１人の効用は、人によって違うと思います。私は引きこもりの時、やりたいことは本を読むことしかなく、読書経験で多くの言葉を自分の中に蓄積できました。結果的にですが、小説を書くとき、この蓄積は意味がありました。

そもそも、ものを考えるって、１人じゃないと出来ないんじゃないでしょうか。いまは、立ち止まってじっくり考えることが出来にくい時代。常に誰かとつながっていないとダメというのは、奴隷のような状態ではないですか。

私は、ケータイもネットも使ったことがありません。自宅にあるのは、編集者とのやり取りなどに使うファクス付き固定電話だけです。ただ、ＳＮＳの弊害がよく言われますが、人が人とのコミュニケーションで傷つくというのは、ＳＮＳがない時代も、いくらでもありました。その時代のコミュニケーションのツールが違っているだけでは。

何か大きな事件を起こした犯人が「どんなヤツだったんだ？」と調べていくと、「１人ぼっちだった」という話はよくありますね。社会との接点が完全に断たれるのも危険です。しかし、他人とのコミュニケーションがないことを、深刻に考えすぎるのもよくない。双方のバランスをどう取るかは難しいですが、私は引きこもり時代も今も、特に悶々（もんもん）とせずノホホンとしていたので、危ない方には行かなかったんでしょう。

自分のことを「さみしいヤツ」と自覚するのは情けないことですが、健康に被害がない限り、孤独は「いけないこと」ではありません。

ただ、極端に孤独で過酷な環境にある人は、いざ何かが起こった時のため、どこかに「逃げ場」を求めて下さい。

私も小説家になった後、仕事がきつく、何度か命を絶とうとしたことがあります。そんな時は「時間をかけて待つ」ことが必要です。私の場合、歯止めになったのは、やはり本でした。ゲームでも何でもいい。逃げ場は作っておいて下さい。（聞き手・稲垣直人）

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７２年生まれ。「共喰（ぐ）い」で 芥川賞 受賞。著書に「燃える家」「宰相Ａ」など。昨年、エッセー「孤独論」を出版。

＜アピタル：オピニオン・メイン記事＞
http://www.asahi.com/apital/forum/opinion/

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孤独は病か、自由をもたらすものか：朝日新聞デジタル

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「孤独」――。家族や学校、会社、 スマートフォン で人とつながっているのに、そう感じることが少なくない。そもそも孤独とは、私たちを自由にするものなのか、それとも病なのか。 ...

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Photographs and stories of hikikomori people

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Photographs and stories of hikikomori people

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https://www.nationalgeographic.com/photography/article/japan-hikikomori-isolation-society
This article shows multiple photos of different hikikomori people and sheds some light on their stories. It shows the different ways that people may fall into this lifestyle and how they may get help. Some of these people have been in their rooms for up to seven years.

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In Japan, observes photographer Maika Elan, "there are always two sides that oppose one another. It is both modern and traditional, bustling and very lonely. Restaurants and bars are always full, but if you pay close attention, most are packed with customers eating alone. And in the streets, no matter the hour, you find exhausted office employees."

The counterpart to people living solitary lives in public might well be those who have chosen to shut themselves away. Known as hikikomori, these are people, mainly men, who haven't participated in society, or shown a desire to do so, for at least a year. They rely instead on their parents to take care of them. In 2016, the Japanese government census put the figure at 540,000 for people aged 15-39. But it could easily be double that number. Since many prefer to stay entirely hidden, they remain uncounted.

Elan, who is Vietnamese, first heard about the hikikomori while she was in Tokyo for a six-month artist residency. She connected with a Japanese woman named Oguri Ayako, who worked with New Start, a non-profit organization centered around drawing the hikikomori out of their seclusion.

At the parents' request-and at a cost of about $8,000 USD per year-women like Ayako regularly contact the recluse, starting with letters. The process takes months as he goes through the motion of opening them, writing back, chatting on the phone, talking through the door before finally allowing her in. Many more are required before he ventures out with her. The goal is to get him to go live in New Start's dorm and participate in its job-training program.

Ayako, whose role as a 'rental sister' might be best understood as that of a social worker, claims to have helped between forty and fifty of them out of their isolation in her decade-long career.

Elan shadowed Ayako on visits to eleven different hikikomori, and after five or six meetings was allowed to take pictures. "At first, I thought they were lazy and selfish," she admits, but over time as she got to know them, she learned not only how thoughtful and perceptive they can be. "There are so many people out there working themselves to the ground; the hikikomori, in a way draw Japan into balance."

The situation is not unique to Japan, though it is most acute here. Elan cites many reasons why this may be the case: an increasing number of families have only one son in which they put all their hopes and dreams, few of them have male role models since their fathers work day and night, persistent gender roles continue to ascribe much, if not all, the economic responsibilities to the household's patriarch, to name a few.

Yet another explanation could be found in the country's cultural shift from a collective-minded society to a more individualistic one, especially amongst the younger generations who are seeking ways to express their originality. "In Japan, where uniformity is still prized, and reputations and outward appearances are paramount, rebellion comes in muted forms, like hikikomori," she says.

"The longer the hikikomori remain apart from society, the more aware they become of their social failure," explains Elan. "They lose whatever self-esteem and confidence they had, and the prospect of leaving home becomes ever more terrifying. Locking themselves in their room makes them feel 'safe'."

Elan plans on continuing this project by focusing more on the rental sisters. These women who are strangers to the hikikomori yet may be the solution to their malaise. Case in point, Elan just learned that one of the hikikomori she photographed, Ikuo Nakamura, has fallen in love with his rental sister, Oguri Ayako, and the two are planning to get married. He now wants to become a rental brother, helping others like him.
See more of Maika Elan's work on her website.
Editor's Note, March 19, 2018: A previous version of this article stated that Oguri Ayako and Ikuo Nakamura had gotten married. While they are planning to get married soon, this has not happened yet. In addition, the photograph of Ayako slipping a letter under the door misidentified the name of the hikikomori she was visiting. It is Kobayashi Haruto.

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Pictures of Life in Isolation: Japan's Hikikomori

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In Japan, observes photographer Maika Elan, "there are always two sides that oppose one another. It is both modern and traditional, bustling and very lonely. Restaurants and bars are always full, but if you pay close attention, most are packed with customers eating alone.

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A documentary about hikikomori culture in Japan

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A documentary about hikikomori culture in Japan

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https://www.youtube.com/watch?v=SORthIsoLP0
ABC news created a short documentary that explored hikikomori culture in Japan

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Living Lonely and Loveless in Japan | Foreign Correspondent

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comment to Aletana's resources by Daichi 

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comment to Aletana's resources by Daichi 

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About the source of ability of Internet, I strongly agree with the ability of the Internet to connect people. This source can be used to explain the practicality and significance of our app.

In terms of isolation associated with the covid-19, it is clear that covid-19 deteriorated the social issue of isolation which was one of the main factors causing mental depression.
The resources I found also insisted that half of uni students in Japan felt stressed and 20 percent of them had mental depression.
This idea is helpful for the app ideas: connecting uni students who lost or have no places to belong to due to the aftermath of covid-19.

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https://edition.cnn.com/2023/04/06/asia/japan-hikikomori-study-covid-intl-hnk/index.html#:~:text=Across%20Japan%2C%20nearly%201.5%20million,for%20at%20least%20six%20months.
Prior to COVID-19, Japan was already struggling with a "loneliness epidemic" but as expected, this was exacerbated by the global pandemic. Approximately, 1.5 million people in Japan have withdrawn from society. Some manage to complete necessary tasks such as going to the grocery store but others are completely confined to their rooms and rely on delivery/online shopping for survival

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Across Japan, nearly 1.5 million people have withdrawn from society, leading reclusive lives largely confined within the walls of their home, according to a new government survey.

These are Japan's hikikomori, or shut-ins, defined by the government as people who have been isolated for at least six months. Some only go out to buy groceries or for occasional activities, while others don't even leave their bedrooms.

The phrase was coined as early as the 1980s, and authorities have expressed increasing concern about the issue for the past decade - but Covid-19 has made things worse, according to a survey conducted last November by the government's Children and Families Agency.

The nationwide survey found that among 12,249 respondents, roughly 2% of people aged 15 to 64 identified as hikikomori, with a slight increase among those aged 15 to 39. With that percentage applied to Japan's total population, there are an estimated 1.46 million social recluses in the country, according to a spokesperson from the agency.

Common reasons cited for social isolation were pregnancy, job loss, illness, retirement and having poor interpersonal relationships -but a top reason was Covid-19, with more than a fifth of respondents citing the pandemic as a significant factor in their reclusive lifestyle.

No further details were given about the impact of Covid-19 on respondents.

Japan, like many countries in East Asia, maintained stringentpandemic restrictions well into 2022 even as other places embraced "living with Covid." It only reopened its borders to overseas visitors last October, ending one of the world's strictest border controls, more than two years after the pandemic began.

But the toll of the last few years continues to be deeply felt.

"Due to Covid-19, opportunities for contact with other people have decreased," said a separate paper published February in Japan's National Diet Library.

It added that the pandemic could have worsened existing social problems like loneliness, isolation and financial hardship, pointing to a rise in reported suicides, and child and domestic abuse.

Experts have previously told CNN that hikikomori is often thought to stem from psychological issues such as depression and anxiety, though societal factors play a role too, such as Japan's patriarchal norms and demanding work culture.

Japan's aging population

But hikikomori had been around long before the pandemic, tied to Japan's other looming problem: its population crisis.

Japan's population has been in steady decline since its economic boom of the 1980s, with the fertility rate and annual number of births falling to new record lows several years in a row.

All the while, the elderly population is swelling as people age out of the workforce and into retirement, spelling trouble for an already stagnant economy. Things are so dire the prime minister warned this year that the country was "on the brink of not being able to maintain social functions."

For families with hikikomori members, this poses a double challenge, dubbed the "8050 problem" - referring to social recluses in their 50s who rely on parents in their 80s.

Authorities have cited other factors, too, like the rising number of single adults as the appeal of dating and marriage wane, and weakening real-life ties as people move their communities online.

In 2018, Japan's Ministry of Health, Labor and Welfare established a hikikomori regional support body to help those impacted by the phenomenon.

"We believe that it is important to restore ties with society while providing detailed support for those who have withdrawn by attending to their individual situations," said Takumi Nemoto, then-head of the ministry, in 2019.

He added that local and national authorities had launched various services such as consultations and home visits to those affected by hikikomori, housing support for middle-aged and older people, and other community outreach efforts for "households that have difficulty reporting an SOS on their own."

But these efforts were dwarfed by the challenges brought during the pandemic, prompting the government to carry out nationwide surveys on loneliness starting 2021, and to release a more intensive plan of countermeasures in December 2022.

Some measures include pushing public awareness and suicide prevention campaigns through social media; assigning more school counselors and social workers; and continuing a 24/7 phone consultation service for those with "weak social ties."

There are also programs geared toward single-parent households such as meal plans for their children, housing loans, and planning services for those going through divorce.

Though the pandemic may have caused greater loneliness in society, it may also have simply shed light on long-existing problems that usually go overlooked, said the government in the plan.

"As the number of single-person households and elderly single-person households is expected to increase in the future, there is concern that the problem of loneliness and isolation will become more serious," it said.

"Therefore, even if the spread of Covid-19 is brought under control in the future, it will be necessary for the government to ... deal with the problems of loneliness and isolation inherent in Japanese society."

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Japan was already grappling with isolation and loneliness. The pandemic made it worse | CNN

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Across Japan, nearly 1.5 million people have withdrawn from society, leading reclusive lives largely confined within the walls of their home, according to a new government survey. These are Japan's hikikomori, or shut-ins, defined by the government as people who have been isolated for at least six months.

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The internet as a cause and/or effect of isolation

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The internet as a cause and/or effect of isolation

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https://www.bbc.com/future/article/20190129-the-plight-of-japans-modern-hermits
This article suggests that modern technology and internet addictions have the ability to encourage a culture of solitude and isolation. However, this article also suggests that the internet can be the solution and be used to bring people together and assist with isolation. One example of this was a remote counselling service

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(This article is illustrated with a series of portraits by photographer Maika Elan.)
In today's connected world it can feel difficult to disengage. An endless stream of emails, posts, tweets, likes, comments and pictures keeps us constantly plugged into modern life.

But in Japan half a million people live as modern-day hermits. They are known as hikikomori - recluses who withdraw from all social contact and often don't leave their houses for years at a time. A government survey found roughly 541,000 (1.57% of the population) but many experts believe the total is much higher as it can take years before they seek help.

The condition was initially thought to be unique to Japan, but in recent years cases have appeared across the world. In neighbouring South Korea, a 2005 analysis estimated there were 33,000 socially withdrawn adolescents (0.3% of the population) and in Hong Kong a 2014 survey pegged the figure at 1.9%. It's not just in Asia, cases are appearing in the US, Spain, Italy, France and elsewhere.

Whether due to increased awareness or a growing problem remains unclear, but concern around social isolation is on the rise globally. Last January the UK appointed its first minister for loneliness and recent Office of National Statistics data found nearly 10% of 16 to 24-year-olds reported feeling "always or often" lonely.
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A controversial but common theme in hikikomori research is the isolating influence of modern technology. Any potential links are far from settled, but there's concern Japan's lost generation could be a canary in the coal mine for our increasingly disconnected societies. At the same time there's hope technology could help bring people back from the brink.

The term hikikomori, often used interchangeably for the condition and its sufferers, was coined by Japanese psychologist Tamaki Saitō in his 1998 book Social Withdrawal - Adolescence Without End. Today the most common criteria is a combination of physical isolation, social avoidance and psychological distress that lasts six months or longer.

The condition was originally considered "culture-bound" and there are reasons to think Japanese society is particularly vulnerable, says Takahiro Kato, an associate professor of psychiatry at Kyushu University in Fukuoka, who both studies and treats hikikomori.

"In Japanese there's a very famous saying, 'A protruding nail will be hammered down'," says Kato. Only half-jokingly, the 6ft 2in doctor adds that's why he walks around with a slight hunch so he's not seen as arrogant. Rigid social norms, high expectations from parents and a culture of shame make Japanese society a fertile breeding ground for feelings of inadequacy and a desire to keep one's head below the parapet, Kato says.

After quitting his job in 2015, Tomoki, 29, tells me he was determined to get back into work and regularly visited the job centre. He also attended a religious group almost daily, but the group's leader started publicly criticising his attitude and inability to get back into work. When he stopped attending the leader called him several times a week and the pressure, combined with that from his family, eventually caused him to withdraw completely. (The names of all hikikomori have been changed to protect their identity.)

"I blamed myself," he said. "I didn't want to see anyone, I didn't want to go outside."

At Fukuoka city's hikikomori support centre the Yokayoka Room - "take it easy" room in the local dialect - one by one the group describes the pressure they felt to conform. "School is a monoculture, everyone has to have the same opinion," says one of the visitors, Haru, 34. "If someone says something they're out of the group."

Living up to the expectations of Japanese society has also got harder. Economic stagnation and globalisation is bringing Japan's collectivist and hierarchical traditions into conflict with a more individualistic and competitive Western worldview, says Kato. And while British parents might give short shrift to a child refusing to leave their room, Japanese parents feel a strong obligation to support children no matter what and shame often prevents them from seeking help, says Kato.

But the increasing number of cases outside Japan is leading people to question the culture-bound nature of the condition. In a 2015 study, Kato and collaborators in the US, South Korea and India found cases matching the clinical criteria in all four countries.

Lead author Alan Teo, an associate professor of psychiatry at Oregon Health and Science University in the US, says he is regularly contacted by Americans self-identifying with the condition.

"People have this underlying assumption it must be most common in Japan," he says. "If you formally measured how common it is we might come up with some surprising information."

Spanish psychiatrist Angeles Malagon-Amor, at Hospital del Mar in Barcelona, stumbled across the problem during a home treatment program in Barcelona. Malagon-Amor and colleagues frequently found patients with extended periods of social withdrawal, which led her to the literature on Japan's hikikomori. Between 2008 and 2014 they came across 190 cases - the most recent data they hold - but that was before the program was expanded and she's sure it's the tip of the iceberg.

"At the time, we were two psychiatrists and two nurses for a population of more than one million," she says. "I think there must be a lot more cases."

Establishing a broader explanation is fraught with difficulties though.

Multiple studies have found that hikikomori typically have co-occurring psychiatric or developmental disorders, which can vary in type and severity. Triggers can also be diverse from work stress to dysfunctional family dynamics.

"One of the reasons hikikomori is fascinating is that there's not one explanation," says Teo. "It's a lot of factors coming together."

One factor regularly discussed is the role of technology like the Internet, social media and videogames - already the source of contentious debate in mental health research. Many hikikomori I spoke to were prolific internet and videogame users and multiple studies have noted high levels of technology use, but it's far from universal and the nature of the relationship is still unclear.

In South Korea, anyone who remains isolated for at least three months is termed " oiettolie", the link is more established. A 2013 study of 43 oiettolie found that nearly one in ten were already considered to be addicted to the internet, and more than 50% were thought to be at high-risk of internet addiction.

TaeYoung Choi, a psychiatrist and researcher at the Catholic University of Daegu who worked on the study, doesn't think technology necessarily causes withdrawal, but he thinks it can support and deepen it. "Some people can get more isolated by using technology, which makes that isolation more rigid and more severe," he says.

In a 2018 study of hikikomori cases In Barcelona, Malagon-Amor said they found only 30% exhibited internet addiction. But they found that group tended to be younger - the average age across all 190 cases was 39 but it was just 24 for those addicted to the internet.

"For what we've seen now, it's not that big an issue," she says. "But I think this is going to be much bigger in the next few years in those cases of social isolation in young people with Internet addiction."

The effect of technology could also be more subtle, says Kato. Computer games have rewritten the nature of play, he says, with children spending ever more time in controlled virtual environments rather than the unpredictable real world. At the same time the internet, smartphones and social media have made indirect rather than face-to-face contact much more common.

"Now society has no risk, no direct communication," says Kato. "It's easy to hit the reset button and reverse and there's low experience of failure." He thinks that's detrimental to children's development, making them less resilient and less adept at interpersonal relationships. Just like you need to be exposed to dirt to develop immunity to diseases you need to be exposed to risk and failure to develop resilience and independence, he adds.

At the Yokayoka Room patients said they say they feel more able to speak freely on the Internet. When I ask why they say it's the anonymity it provides. Ichika, 27, adds that he likes the ability to always interact on his own terms.

There is some recognition of the limitations of this kind of communication. Hinata, 32, worries about the superficial nature of online dialogue and the ease with which you can avoid conflict. "We always try to make friends with the people who have the same opinion where we can feel more comfortable to comment," he says.

"Technology itself can't be 100% behind the aggravation of hikikomori as a world phenomenon," says Choi. But he thinks our increasing ability to shop, play and socialise without real-world interactions could be exacerbating social isolation.

There's simply not enough research to draw any conclusive links yet, says Teo. But he says it does chime with his gut feeling, which is based partly on research outside the hikikomori field. In multiple studies his lab has found face-to-face contact either in person or on video-chat corresponds to lower risk of depression, compared with contact by phone, email and social media.

"If interactions online become a substitute for face-to-face interactions, I think the research that I've done and other folks have done indicate that that's problematic," he says.
Lines of communication
It's important not to demonise technology though, says Teo. Social media or email are not the underlying causes of mental health problems, they are vehicles for communication that can be used both positively and negatively.

In particular, the internet provides a window into the isolated lives of hikikomori. Last year Teo and researchers in China used social media apps like WeChat and Weibo to survey socially withdrawn teenagers. It cost just $7.27 (£5.53) per participant to reach 137 people, one-fifth of whom were experiencing some level of social withdrawal, suggesting it could be a cost-effective method for reaching hidden cases.

The growing interconnectedness of online and offline worlds could also offer ways to ease hikikomori back into everyday life. In 2016 Kato published a case report on a patient who suddenly started going out daily after downloading Nintendo's hit smartphone game Pokemon Go.

The game uses augmented reality to overlay digital creatures onto the real-world that players have to roam about collecting. Kato thinks this kind of bridge between real and virtual worlds could help encourage hikikomori out of their homes and even make it easier for health workers to make first contact, particularly if it can be tailored to their needs. For example, says Kato, this kind of game could be tweaked so valuable items appear at hikikomori support centres.

He's also started working with a Japanese company to create a robot that could reintroduce hikikomori to social contact in a controllable way. Researchers in Hong Kong have successfully used dogs for a similar purpose, which he thinks could serve as a template. "But Japanese like robots!" he adds.

There may also be less hi-tech ways to exploit hikikomori's relationship with technology. Shinichiro Matsuguma, a PhD student at Keio University School of Medicine in Tokyo who specializes in positive psychology, has set up a non-profit to rehabilitate hikikomori called the Strength Association. He's provided coaching to 32 patients using principles from positive psychology, which focuses on strengths rather than flaws. The majority of his clients play videogames so this typically involves discussing playing styles and motivations to identify strengths like teamwork, strategy or leadership.

"Many people, even their parents, see hikikomori as not doing anything," he says. "But from my perspective, they're developing their strengths through the video games. And I always tell them while you're playing video games you are developing strengths that can be applicable to different life domains."

Establishing these strengths improves self-esteem, he says, but can also guide patients on the best path to re-entering society. The approach has yet to be scientifically evaluated, but he says almost 80% have taken a first step towards reintegration like going back to school, university or vocational training.
Remote counselling
Experts agree though that there's no substitute for direct social contact and intensive therapy. Yoko Honda, a clinical psychiatrist who manages the Fukuoka City Mental Health and Welfare Centre, says the national government has been pushing them to use social media to provide remote counselling to hikikomori, but they've resisted.

"Just one tweet is not enough for expressing our anxiety or emotions," she says, though she agrees it might be useful for reaching new patients.

Asides from psychotherapy and medication to treat any underlying psychiatric disorders, a central plank of their strategy is family training to fix dysfunctional home environments. The Yokayoka Room also provides a safe haven for those on the path to recovery to meet others like them and relearn atrophied social skills. But she says the varied nature of cases makes treating them tough.

"We hope to give tailormade support to all these hikikomori," she says. "But we always need a lot of labour, a lot of time."

That's something Malagon-Amor found in her 12-month study of Barcelona's hikikomori. Those who received more intensive therapy either at home or in hospital reacted best. Less intensive outpatient services were linked to higher abandonment of treatment and often worsening isolation. "They're very fragile patients," she says.

Whether or not the West should be gearing up for a tsunami of such patients is still unclear. But social isolation can be a feature of other conditions, from depression to PTSD, so Malagon-Amor thinks the West can learn a lot from the Japanese experience.

And regardless of the scale of the phenomenon, Teo hopes hikikomori research will broaden our understanding of the importance of social connections to our mental and physical health.

"When I talk to parents of someone with hikikomori it's very clear to me that the social isolation is causing huge negative impacts - it ripples through the individual, to their family, to others," he says.

"So that social impairment, problems with social connections, we haven't paid enough attention to that in medicine. And I think now with hikikomori, with more attention to loneliness we are finally starting to look at these issues as health issues. And that's good."

--
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# data[].attributes.attachment_link.description
(This article is illustrated with a series of portraits by photographer Maika Elan.) In today's connected world it can feel difficult to disengage. An endless stream of emails, posts, tweets, likes, comments and pictures keeps us constantly plugged into modern life. But in Japan half a million people live as modern-day hermits.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912003/#:~:text=A%20form%20of%20severe%20social,school%20for%20months%20or%20years.
There is a phenomena amongst young people in Japan called hikikomori, this is when people become socially isolated and withdrawn from the rest of society. Essentially, they are modern-day hermits. As one can imagine, this can have adverse effects on an individual's mental health. This can be a predictor and/or cause of poor mental health

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Journal List

HHS Author Manuscripts

PMC4912003

Author manuscript; available in PMC 2016 Jun 17.

Published in final edited form as:

PMCID: PMC4912003

NIHMSID: NIHMS792352

Abstract

A form of severe social withdrawal, called hikikomori, has been frequently described in Japan and is characterized by adolescents and young adults who become recluses in their parents’ homes, unable to work or go to school for months or years. The aim of this study was to review the evidence for hikikomori as a new psychiatric disorder. Electronic and manual literatures searches were used to gather information on social withdrawal and hikikomori, including studies examining case definitions, epidemiology, and diagnosis. A number of recent empiric studies have emerged from Japan. The majority of such cases of hikikomori are classifiable as a variety of existing DSM-IV-TR (or ICD-10) psychiatric disorders. However, a notable subset of cases with substantial psychopathology do not meet criteria for any existing psychiatric disorder. We suggest hikikomori may be considered a culture-bound syndrome and merits further international research into whether it meets accepted criteria as a new psychiatric disorder. Research diagnostic criteria for the condition are proposed.

Keywords: hikikomori, social withdrawal, diagnosis, culture-bound syndrome

INTRODUCTION

Case Report

The patient is a 14-year-old Japanese boy who complains of not wanting to attend school. He had no significant problems or difficulties during elementary school, but suddenly and without any apparent trigger, ceased attending school during the last quarter of the first year of middle school. He likewise stopped any attempts at studying. His parents became concerned and sought psychiatric evaluation. At the time of initial evaluation, the patient was noted to have normal hygiene and grooming. He greeted the clinician and responded appropriately to questioning, but stated “I just don’t want to go to school.”

The patient has no medical history of note. Developmental history is notable for mild language delay. His first words were late compared to peers, and he did not use grammatical structures including particles like “to” until age six. Family history is notable only for the patient’s 48-year-old mother who has panic disorder and is treated by a psychiatrist. The patient’s father, also age 48, and his older brother, age 16, are both healthy. Routine laboratory testing (including complete blood count, basic chemistry panel, liver enzymes, and urinalysis) were within normal limits. On neuropsychiatric testing, the patient’s total IQ was 88, divided further into 75 and 106 on verbal and performance subscales, respectively, on the Wechsler Intelligence Scale Third for Children Third Edition (WISC-III).

The patient presented for follow-up once, but thereafter remained at home. His father and mother returned for follow-up every two to four weeks for family therapy, providing updates on the state of their son and receiving advice from the psychiatrist. In particular, the psychiatrist provided suggestions on how to interact with their son. The parents proactively followed these suggestions, changing their style of interaction with their son from one of reprimanding and ordering him to one of patiently waiting for the patient to initiate conversation or actions. They also arranged for the patient’s homeroom teacher to regularly visit the patient at home as he refused to attend school. During home visits, the teacher also waited until the patient would initiate conversation. The boy never directly received treatment from a mental health professional. The patient would only leave home once a week on Sunday’s with his father to rent DVDs at a local video store. This living situation continued for two years. Then, at the time of entrance into high school, the patient suddenly reported that he wanted to return to school. He entered a vocational school specializing in design and since then has regularly attended classes.

Per the psychiatrist providing family therapy, though the patient’s decision superficially appeared sudden, it actually developed gradually in stages. Over the two-year period of social withdrawal, the patient reportedly spent much time deliberating his future, ambitions, and unsustainability of his isolation. Though he rarely shared his decision-making process, he ultimately developed the capacity to express his wishes to his parents.

Historical Background

Cases such as the above have been described as hikikomori in Japan for the last two decades. However, related phenomena have been described even prior to the emergence of the term hikikomori. In 1978, Kasahara described cases of “withdrawal neurosis” or taikyaku shinkeishou.(Kasahara, 1978) In the 1980s, Lock described several cases of what she aptly termed “school refusal syndrome.”(Lock, 1986) Both bear a resemblance to contemporary hikikomori. However, in neither case were they followed by substantial literature examining them. In contrast, attention to hikikomori built to a crescendo in the 1990s and now appears to have stabilized. At first, Japanese psychiatrists(Saito, 1998) described hikikomori. Mainstream media, in Japan and internationally, cast further light upon the shadowy hikikomori.(Jones, 2006; Murakami, 2000) Later, Western academics provided in-depth review and analysis, and their works provided more detailed background.(Borovoy, 2008; Furlong; Teo, 2009)

METHOD

Electronic and manual literatures searches were used to gather information on the existence of social withdrawal and hikikomori. As the aim was to evaluate the evidence for hikikomori as a unique and new psychiatric condition, studies examined included those addressing case definitions, epidemiology, and diagnosis of hikikomori. PubMed was searched up to 13 October 2009 using the following search string: hikikomori OR (social withdrawal AND Japan) OR (social isolation AND Japan). No language restriction was placed. An analogous search strategy was employed for PsycINFO and searched up to 22 October 2009. The Japanese electronic database Ichushi for medical literature was searched using the term hikikomori up to 18 November 2008. The reference lists of all relevant papers were checked. This search was supplemented with contact with an expert in the field who furnished additional manuscripts.

RESULTS

Definition

A consensus definition of hikikomori has not been reached. The word, now part of the everyday lexicon in Japanese, can refer to either the afflicted (i.e., the person or people) or the phenomenon (i.e., the symptom of withdrawal). More specific and operationalized definitions have been developed by Japanese psychiatrists and are presented here.

First, in 2003, the Japanese Ministry of Health, Labor, and Welfare established the following criteria for hikikomori: 1) a lifestyle centered at home; 2) no interest or willingness to attend school or work; 3) symptom duration of at least six months; 4) schizophrenia, mental retardation or other mental disorders have been excluded; 5) among those with no interest or willingness to attend school or work, those who maintain personal relationships (e.g., friendships) have been excluded.(Ministry of Health Labor and Welfare) Second, a national research taskforce further condensed this definition into the following description: “the state of avoiding social engagement (e.g., education, employment, and friendships) with generally persistent withdrawal into one’s residence for at least six months as a result of various factors.”(Saito, 2008)

Epidemiology

Very limited reliable data exist on the epidemiology of hikikomori. The strongest data come from a review that summarized three population-based studies involving a total of 12 cities and 3,951 people. Using a standardized definition, it showed between 0.9% and 3.8% had a history of hikikomori.(Kiyota et al, 2008) Another survey by Okinawan researchers of over 1,600 families in 2002 found 14 cases, which, if extrapolated to the entire nation, would be 410,000 cases.(Furlong, 2008) Though undoubtedly a vast underestimation due to selected sample sites, incidence has been examined by a government study of consultations (mostly by parents) regarding hikikomori at all official mental health and welfare centers across Japan, which showed over 14,000 in a one-year period.(Ministry of Health Labor and Welfare, 2003) Symptom onset typically occurs during adolescence,(Kondo, 1997; Takahata, 2003) while age at first presentation is usually in the 20s.(Kondo et al, 2008; Ministry of Health Labor and Welfare, 2003; Saito, 1998; Takahata, 2003)

Differential Diagnosis

The core feature of hikikomori is social withdrawal or isolation. This, in and of itself, of course has a wide differential diagnosis: psychotic illness such as schizophrenia; anxiety disorders such as posttraumatic stress disorder or social anxiety disorder; major depressive disorder or other mood disorders; and personality disorders, such as schizoid personality disorder or avoidant personality disorder, are among the many considerations.

Recently, some mental health professionals have begun attempting to classify hikikomori according to accepted diagnostic categories. A relatively large three-month prospective study conducted by Japanese child psychiatrists examined 463 cases of youth less than 21 years old with a current or past history of the research taskforce definition hikikomori. According to DSM-IV-TR criteria, the top six diagnoses (with multiple diagnoses possible) were: pervasive development disorder (31%), generalized anxiety disorder (10%), dysthymia disorder (10%), adjustment disorder (9%), obsessive-compulsive disorder (9%), and schizophrenia (9%).(Watabe et al, 2008)

A multicenter study examining somewhat older cases of hikikomori found somewhat similar diagnostic heterogeneity but also included undiagnosable cases.(Kondo et al, 2008) To be included patients had to be aged 16–35 with onset of social isolation before age 30 and meet a clear definition of at least six months of social and occupational withdrawal. Of the 181 cases that met these criteria, 97 (54%) were cases in which the patient actually presented. (Getting hikikomori to present to a health care provider, let alone psychiatrist, is challenging due to the very nature of the primary symptom.) Diagnosis was made according to DSM-IV-TR criteria during a “diagnostic conference” attended by at least one psychiatrist and three other allied mental health professionals. Patients could have more than one Axis I or II condition. Results indicated that: 8/97 (8%) had schizophrenia; 25/97 (26%) had an anxiety disorder (including 11 with social phobia, 6 with obsessive-compulsive disorder, and 3 with generalized anxiety disorder); 8/97 (8%) had a mood disorder; 7/97 (7%) had an adjustment disorder; 22/97 (23%) had a personality disorder (including 6 with avoidant personality disorder, 6 with schizoid personality disorder, and 4 with obsessive-compulsive personality disorder); 27/97 (28%) had a disorder usually first diagnosed in infancy, childhood, or adolescence (including 10 with mental retardation, 7 with autism, 5 with Asperger syndrome, 3 with pervasive developmental disorder); and 6/97 (6%) had other conditions (e.g., dissociative disorder, eating disorder).

Two studies have examined diagnosis using an ICD-10 model. One unique retrospective study was conducted at a single large Japanese acute psychiatric facility.(Nakajima et al, 2008) Researchers conducted a chart review of all patients under 30 years of age who presented to their center in 2006. Of the 308 eligible patients, 68 reported social withdrawal/isolation. Using ICD-10 diagnostic guidelines, the three most common diagnostic categories were: neurotic, stress, and somatoform disorders (27%); schizophrenia-spectrum and delusional disorders (24%); and developmental disorders (22%). This study was unique in that it only included those who actually presented and could therefore be assessed in-person for diagnosis. Weaknesses of the study, though, included lack of a reported definition of hikikomori and lack of specific diagnoses (beyond diagnostic categories). Only one patient (1/68) did not fall into one of the nine major ICD-10 mental health diagnostic categories, and this patient was not described. Another smaller study of 52 outpatients categorized all patients as having an ICD-10 diagnosis. The top six diagnoses were as follows: 35% had phobic anxiety disorders; 19% had reaction to severe stress, and adjustment disorders; 12% had mood (affective) disorders; 10% had somatoform disorders; 6% had disorders of psychological development; and 6% had behavioral and emotional disorders with onset usually occurring in childhood or adolescence.(Tsujimoto et al, 2007) There were several key limitations of this study. The authors offered no description of the method for diagnosis, the sample was a convenience sample increasing the likelihood of a nonrepresentative sample, and all diagnoses were made by a single psychiatrist based on a single visit.

DISCUSSION

The irony of the term hikikomori is that it has achieved such popularity in use and recognition that it may now be unwittingly obfuscating diagnosis. Both the general public and mental health providers commonly use the term hikikomori in conversation and writing. Such broad use of a term can ultimately led to its demise amongst clinicians, as happened with the term neurasthenia in the early 20th century.(Schuster, 2003)

In a society where it is highly stigmatizing to use words like clinical depression (utsubyou), let alone schizophrenia (tougou shicchoushou), the term hikikomori has broad appeal as a socially acceptable term. The public may use the term hikikomori not so much as camouflage for another disorder, as much as an uneducated substitution for the “proper” terminology of the mental disorder it is symptomatic of. Mental health professionals may use the term with patients and their families as a softer, gentler proxy for an underlying mental disorder. Borovoy, an anthropologist and expert on Japan, posits that there is a “web of ideas and institutions that mitigate against pathologizing the individual…” and that Japanese doctors “avoid diagnosing major psychopathology to the extent that it is possible.”(Borovoy, 2008) Public surveys likewise have found Japanese averse to using psychiatric labels.(Jorm et al, 2005) Such use of a ‘disguised diagnosis’ has been described before in Japan.(Munakata, 1986) In short, we suspect that hikikomori, as a term, has flourished in no small part because it is less stigmatizing than other terms for mental illness.

Herein, we make three arguments about hikikomori and psychiatric diagnosis:

1. Cases of hikikomori are often, but not always, classifiable as a variety of existing DSM-IV-TR (or ICD-10) psychiatric disorders.

2. Hikikomori may be considered a culture-bound syndrome.

3. Hikikomori merits further consideration and research into whether it is a new psychiatric disorder.

It should be noted that at least one Western sociologist has suggested that hikikomori is not a psychological or psychiatric condition at all; rather it is fundamentally a transient phenomenon caused by social factors.(Furlong, 2008) We do not endorse this view and exploration of it is beyond the scope of this article.

Argument 1: Cases of hikikomori are often, but not always, classifiable as a variety of existing DSM-IV-TR (or ICD-10) psychiatric disorders

We argue that the majority of hikikomori indeed suffer from some form of established Axis I or II disorder. As has been noted in past debate over the validity of various culture-bound syndromes, it is crucial to determine whether hikikomori represents a superficially-atypical variant of conventional psychiatric diagnosis.(Alarcon et al, 2002) If the dramatic and severe withdrawal is merely a Japanese-specific emphasis on the quality of withdrawal—a symptom that may be part of an underlying anxiety, mood, developmental, or other disorder—then one way to classify them would be as a more pervasive, existing clinical entity with social withdrawal as a clinical feature. Such cases exhibit hikikomori-like states but are not true hikikomori as described herein. Beyond these theoretical justifications, the empirical studies described above(Kondo et al, 2008; Nakajima et al, 2008; Watabe et al, 2008) are strong enough to persuasively argue that the majority of hikikomori manifest some form of psychiatric disorder.

Argument 2: Hikikomori may be considered a culture-bound syndrome

For the remaining subset of hikikomori cases that do not fall into an existing Axis I or II disorder, we believe the data on hikikomori are sufficiently strong to designate hikikomori a culture-bound syndrome. Also termed culture-specific disorder or culture-related specific psychiatric syndrome, it is a “recurrent, locality specific patterns of aberrant behavior and troubling experience”(American Psychiatric Association, 2000) best understood and managed primarily from the cultural perspective from which it originates. Gaw further clarified the definition for culture-bound syndrome by stipulating four requisite characteristics: 1) the disorder must be a discrete, well-define syndrome; 2) it must be recognized as a specific illness in the culture with which it is primarily associated; 3) the disorder must be expected, recognized, and to some degree sanctioned as a response to certain precipitants in the particular culture; and 4) a higher incidence or prevalence of the disorder must exist in societies in which the disorder is culturally recognized, compared with other societies.(Gaw, 2001)

Hikikomori easily meets three of the four culture-bound syndrome criteria–and arguably all four. First, the Japanese government and research taskforce definitions described above fulfill the first criterion. Second, cultural characteristics within Japan that promote the formation of social withdrawal behavior have been explored at length in prior reviews of hikikomori, fulfilling the third criterion.(Furlong, 2008; Kawanishi, 2004; Teo, 2009) Third, as far as the fourth criterion, the vast majority of reported cases are in Japan, with only two cases of hikikomori reported elsewhere.(Garcia-Campayo et al, 2007; Sakamoto et al, 2005) And though anecdotally many psychiatrists would agree with having seen cases similar to the one described at the outset of this article, prevalence figures for Japan like those described above(Kiyota et al, 2008) are surely distinctly higher than other countries.

Whether hikikomori fulfills the fourth criterion of culture-bound syndromes—that hikikomori be recognized as a specific illness in Japan—is somewhat controversial. Certainly, the vast majority of Japanese experts agree that hikikomori is a disabling condition worthy of clinical attention. However, the government experts who provided one of the definitions of hikikomori were quick to insist that hikikomori was not a psychiatric diagnosis per se. But they offered no alternative as to what it might be and even acknowledged that in many cases presenting to health centers, the behavior cannot be attributed to any known medical or psychiatric pathology.(Ministry of Health Labor and Welfare, 2003) Furthermore, the research taskforce case definition uses the conspicuously vague description (“as a result of various factors”) to describe etiology of hikikomori. This suggests ambivalence—if not outright confusion—as to how to reconcile hikikomori with psychiatric disorder. Indeed, one informal survey of 103 Japanese child and adult psychiatrists conducted in 1992 found that 57% thought traditional diagnostic categories do not completely capture the notion of hikikomori, and 22% felt a new diagnostic category was warranted.(Saito, 1998)

A proposal for hikikomori as a culture-bound syndrome is reminiscent of the psychiatric literature’s discussion of taijin kyofusho in prior decades. A well-established Japanese psychiatric diagnosis, taijin kyofusho is also entombed in the DSM-IV TR appendix of culture-bound syndromes.(American Psychiatric Association, 2000) Epidemiologically, the two conditions are strikingly similar. Taijin kyofusho is known to predominate among the same youthful age group, have symptoms often regressing after age 30, and have the same bias towards males.(Russell, 1989) One psychiatrist reporting a case series of 24 consecutive taijin kyofusho treated on an inpatient unit described seven (29%) of the patients as fitting what he deemed a “hikikomori subtype” of the disorder.(Nakamura et al, 1997) However, taijin kyofusho’s core feature is fear of offending or hurting others through awkward social interaction or due to perceived physical defect.(Kirmayer, 1991) Body odor, blushing, and eye-to-eye contact are among the most common fears. Therefore, neither the core feature nor most common clinical manifestations are typical of hikikomori. Kirmayer described taijin kyofusho as a “pathological amplification of culture-specific concerns about the social presentation of self and the impact of improper conduct on the well-being of others.”(Kirmayer, 1991) In contrast, hikikomori may be an amplification of Japanese-specific concerns about the quality and quantity of one’s social interactions.

What is similar between these two conditions is that some cases, when viewed through the nosological lens of the DSM, meet criteria for other psychiatric disorders. Severe cases of taijin kyofusho, for instance, often turn out be major mental illnesses like psychotic disorders.(Russell, 1989) A study of DSM diagnosis of taijin kyofusho by American mental health practitioners’ revealed a tendency to apply a range of personality, anxiety, and psychotic diagnostic labels.(Tanaka-Matsumi, 1979) Perhaps, then, these findings are akin to results in the hikikomori diagnostic studies cited above in the Differential Diagnosis section.

In summary, a reasonable number of Japanese experts endorse a new diagnostic category for hikikomori, epidemiologic data show widespread cases limited to Japan, and a clear, succinct case definition of hikikomori is available. Hikikomori is distinct from taijin kyofusho, but deserves its place in the company of its culture-bound syndrome cousin. Despite the debate regarding the historical legacy of culture-bound syndromes as “foreign” and “exotic,” the reasonable criticism of the entire notion of culture-bound syndromes(Sumathipala et al, 2004), and the unclear future of them in DSM-V, we believe hikikomori would fit well in the category of culture-bound syndromes.

Argument 3: Hikikomori merits further consideration and research into whether it is a new psychiatric disorder

We suggest that a small but notable subset of hikikomori suffer from persistent and disabling social isolation but lack other notable psychopathology. Recall, for instance, the care report described at the start of this article. This case illustrates some features typical of hikikomori that distinguish it from other disorders on the differential diagnosis. The patient’s behavior was ego-syntonic, he did not recognizes his disinclination to go outside as unreasonable or excessive, and did not fear he would act in a way that will be humiliating or embarrassing, distinguishing it from social anxiety disorder. The patient’s symptoms, though lasting over two years, were not lifelong, thus ruling out schizoid, avoidant or other personality disorders, as well as autistic or pervasive developmental disorders. Though some hikikomori do go on to develop a primary psychotic illness, again in this illustrative case vignette, the patient recovered with no residual symptoms, ruling out schizophrenia spectrum illness. An exhaustive examination of a differential diagnosis is beyond the scope of this article, but further discussion of differential diagnosis in hikikomori has been considered elsewhere.(Teo, 2009)

Studies that have examined diagnosis among hikikomori have come to the same result: a small portion of hikikomori do not fit classification within a traditional psychiatric disorder. For instance, in one of the best-designed prospective studies of youth with social isolation of at least six months’ duration and onset before age 30, fully 20% (19/97) of patients examined were undiagnosable with any existing Axis I or II disorders.(Kondo et al, 2008; Suwa et al, 2002) Another small study classified two out of 14 (14%) cases of young adults meeting criteria for hikikomori but not fulfilling full diagnostic criteria for any disorder (though they were noted to have schizoid, avoidant, and narcissistic personality traits).(Suwa et al, 2002) Twenty-seven patients with hikikomori undergoing group psychotherapy at a community mental health center were diagnosed based solely on extensive collateral information gathered from patients’ parents. While acknowledging the limitation of this approach, the authors’ provisionally diagnosed ten out of 27 as not meeting criteria for any DSM IV disorder and therefore having “primary social withdrawal.”(Suwa et al, 2003) Without saying so, Japanese government experts’ data can be construed as suggesting this too; they acknowledged many cases presenting to health centers cannot be attributed to any known medical or psychiatric pathology.(Ministry of Health Labor and Welfare, 2003) Taken together, this suggests the existence of a “pure” form of hikikomori—that is social withdrawal with substantial psychopathology but no other apparent etiology—which was first introduced as ichijisei hikikomori in Japanese(Kinugasa, 1998) and may be called primary social withdrawal.

We believe that it would be premature to propose that hikikomori is a disorder that should be included in DSM-V. First, the results show heterogeneity of DSM-IV TR and ICD-10 diagnoses with widely varying prevalence figures. Only a few studies document person-to-person interviews, and standardized tools such as the Structured Clinical Interview for DSM Disorders (SCID) were not described in studies, leading one to surmise that other psychopathology may have be missed in some of the “pure” hikikomori cases. Longer followup of cases of primary social withdrawal might have led to discovery of illnesses like schizophrenia with prodromal periods. Second, hikikomori does not yet meet the high threshold for labeling as a disease or disorder. An appropriate analogy here might be the ongoing debate on “internet addiction.” Like hikikomori in Japan, internet addiction has been widely studied in South Korea, and the country considers it one of its most serious public health issues.(Block, 2008) Yet, as one commentator argues, internet addiction cannot be considered a bona fide disorder—a “specific disease entity”—until at least one of the following conditions is established:

1. A pattern of genetic transmission.

2. A reasonably well-understood etiology, pathophysiology, and/or pathologic anatomy.

3. A relatively predictable and consistent course, prognosis, stability, and response to treatment across many different populations.(Pies, 2009)

Quite simply, there is insufficient robust evidence for hikikomori meeting any of these criteria. However, rejecting hikikomori at this point due to lack of data would be the statistical equivalent of a type II error. That is, it very well might meet one or more of these criteria and further prospective research to clarify this issue warranted. Additionally, more systematically collected clinical data across populations, including developmental and social history, familial interactions, and risk factors associated with this phenomenon are essential. To fill this knowledge gap, multi-year longitudinal prospective population-based studies applying consistent methodologies are needed. To aid in further investigation, we propose research-oriented diagnostic criteria for hikikomori. Table 1 contains our proposed research definition of hikikomori. Figure 1 provides a diagnostic algorithm for classifying cases that present with marked social withdrawal as a method for isolating hikikomori from other conditions. Any suggestion of new culture-bound syndrome and the possibility of a new psychiatric disorder is an open invitation to a healthy dose of skepticism and vigorous critique. Nonetheless, we suggest that the combination of the large scale of hikikomori described in Japan, the persistence of such reports across multiple decades, and recent empirical data supporting undiagnosable cases are persuasive evidence for the existence of a culture-bound syndrome of hikikomori and potentially a new psychiatric disorder that can be admitted into DSM and ICD nosology.

Decision tree for hikikomori

Table 1

Proposed Research Diagnostic Criteria for Hikikomori

The essential feature of this disorder is protracted social withdrawal. The person spends most of the day and nearly every day confined to a single room, typically his or her bedroom. There is marked avoidance of social situations and interpersonal relationships. The person may leave his or her room only at night when unlikely to be noticed by others and often spends time using the internet, reading, or playing video games. The person must meet each of the following six criteria:

1. The person spends most of the day and nearly every day confined to home.

2. Marked and persistent avoidance of social situations (e.g., attending school, working) and social relationships (e.g., friendships, contact with family members).

3. The social withdrawal and avoidance interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships.

4. The person perceives the withdrawal as ego-syntonic.

5. In individuals under age 18 years, the duration is at least 6 months.

6. The social withdrawal and avoidance are not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Major Depressive Disorder (e.g., avoidance of social situations as a reflection of neurovegetative symptoms), Schizophrenia (e.g., isolation due to negative symptoms of psychosis), or Avoidant Personality Disorder (e.g., isolation due to fears of criticism or rejection).

Acknowledgments

This article could not have been completed without the generous assistance of others, though the responsibility for any disagreements with content rest wholly with the author. We extend our appreciation to Naoji Kondo, MD, for supplying numerous Japanese articles on hikikomori and to Shizuo Takamiya, MD, for providing the case report.

Footnotes

Portions of this manuscript were presented as part of the John P. Spiegel Memorial Fellowship Lecture at the Society for the Study of Psychiatry and Culture 2009 Annual Meeting.

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Hikikomori, A Japanese Culture-Bound Syndrome of Social Withdrawal? A Proposal for DSM-V

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A form of severe social withdrawal, called hikikomori, has been frequently described in Japan and is characterized by adolescents and young adults who become recluses in their parents’ homes, unable to work or go to school for months or years. ...

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mental depression of university Japanese students, and isolation of students in Japan under covid 　（Daichi)

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mental depression of university Japanese students, and isolation of students in Japan under covid 　（Daichi)

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Uematsu, Akiko., Nakamura, Maya., Hashimoto, Kazuyuki., and Komuro, Yasuhiro. "Daigakusei wo taisho to shita mental helath tyousa hokoku: gakuseisoudanshitsukatsudo no tennkaiwo saguru tameni [Mental health of students in Japanese University: Implications for the University Mental Support Center]". The Bulletin of Ryukokuji University, no. 7 (2016), 71-81

Ida Akihito., Mizuno, Kunpei., Irie, Tomonari., Nishimura Takayuki., Kawasaki, Naoki., Saito, Mika. "Shingata korona uirusu kansenkakudai ga daigakusei ni oyobosu eikyou (daiippo) ~Hokkaido naino daigaku heno tyousakekka kara ~ [Effects of the Spread of COVID-19 On College students (Part 1) ~ Results from a Survey of Universities in Hokkaido~". Bulletin of Hokkaido School University School of Lifelong Sport, no. 12 (2021), 147-158.

According to Uematsu et al, (2016), one of the reasons making university students refrain from asking help from the counsellors is that asking professional mental advise is representation of the weakness and no ability to control oneself (p. 73).
In addition, he also states that loneliness and isolation are more likely to happen among freshmen because they can struggle with finding opportunities to connect with other people (p. 77-78). And, this led to mental depression among them.

According to Ida et al (2021), half of the university students felt stressed due to the isolation caused by COVID-19, and 20 percent of them were mentally depressed.
Because almost all classes were conducted via zoom in 2020 and 2021, some university students went back to their home city to live with their family, which led to the loss of social connection with other students (negatively affected their social activity even after they came back to university.)

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Association between isolation and mental depression in Japan (Daichi)

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Association between isolation and mental depression in Japan (Daichi)

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Koyama, Asuka., Miyake, Yuko., Kawakami, Norito., Tsuchiya, Masao., Tachimori, Hisateru., Takeshima, Takashi., and World Mental Health Japan Survey Group, 2002-2006. "Lifetime prevalence, psychiatric comorbidity and demographic correlates of "hikikomori" in a community population in Japan." Psychiatry research, 176, no. 1 (2010), 69–74.

This research paper reported social isolation called hikikomori, which can be seen in younger generations more often, was associated with psychiatric disorder. Also, they found that isolated people have 6 times higher risk to have mental depression.
Onset of hikikomori in the age of 30s or 40s is caused by their loss of jobs, and this phenomenon has been caused in Japan whose society is very competitive and gives social pressure making them think that losers cannot be accepted.
Among teenagers, the fear and anxiety of Japanese competitive society develops their isolation, which led to mental depression.

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1, Kondo, Naoki, and Juhwan Oh. “Suicide and Karoshi (Death from Overwork) during the Recent Economic Crises in Japan: The Impacts, Mechanisms and Political Responses.” Journal of Epidemiology and Community Health (1979-) 64, no. 8 (2010): 649–50. http://www.jstor.org/stable/40794056.

This article explains that Japanese working conditions have resulted in mental depression.
For example, precarious employment in Japan has increased, and their income is about half of regular employment despite of their high workload. In addition, overtime which is not paid sufficiently leads to high rate of mental depression and suicide.
However, that mental depression includes not only deteriorated working conditions but also Japanese cultural mattes, such as strong sense of responsibility to their co-workers and companies.

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The main issue is that people refrain from getting advise from professional counselling due to stigma and cost.

This app encourages users to overcome the stigma that prevents users to ask the professional ideas. This app shows how important to take the medical treatment for mental depression. Also, the counselling is held for free.
The app has the closed-ended question to identify what kind of therapy the users need to deal with the mental depression, and the details of the question goes to professional counsellor prior to opening counselling.

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The main issue that I want to look at is isolation and loneliness. Various research suggests that some people in Japan feel lonely and this is a significant contributing factor to their mental health. Research proves that strong social networks act as a protective barrier for mental health.

An app that uses an algorithm to find you weekly/fortnightly events to attend, based on your demographic information and personal interests. The app will be sponsored by a mental health provider and these are the people that will run the events. The events will be a chance for people to connect with other locals that have similar backgrounds and interests, while finding ways to positively impact their mental health. The goal of the app is to fight isolation and loneliness by building community

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This application should be a tool for users to meet proper counselling, and this app should also include the closed-ended questions, like asking age, gender, and so on.

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This is an interesting topic in a way getting pregnant and having baby is something only people who are biologically women can do. This is very complicated in a way, it contradicts to gender diversity concept

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Japan's gender appreciation is very behind other countries.
application that can help people who don't belong to their expected gender to reveal ?
App that can change how people think about those problems

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40s-year-old men, especially unemployed, are likely to have mental depression.

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The descriptions of mental illness symptoms are unique in Japan 

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The descriptions of mental illness symptoms are unique in Japan 

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The way that Japanese people may describe symptoms of mental illness does not always align with the DSM-5. Using a diagnostic tool that may not translate across non-Western cultures means that it is possible that people are misdiagnosed or undiagnosed

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online forum
just like when you get an advice about human relationship online
make a poll about how people dealt with that problem
professional advice

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There is a lot of stigma about mental illness in Japan because it is seen as a personal weakness. This stigma can be what stops people from seeking treatment or reaching out for help. People have a tendency to either downplay their mental health or keep it to themselves

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Depression is treated as a primarily physical illness, not a physical and psychological illness. Japanese culture is typically collectivistic and this means that people may not want to "burden" their family or friends with their mental health

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Mental depression involves suicide.
In Japan, men are more likely to be exposed to this risk, but women are, as well.