{"title":"Unmet Health Care Use Among Socially Withdrawn Youth (Hikikomori) in South Korea: Cross-Sectional Survey Study.","authors":"Eunjeong Choi, Seoyeong Choi, Sukyong Jang","doi":"10.2196/79043","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth.</p><p><strong>Objective: </strong>The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions.</p><p><strong>Methods: </strong>Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses.</p><p><strong>Results: </strong>The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force (P for interaction <.05).</p><p><strong>Conclusions: </strong>Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.</p>","PeriodicalId":14765,"journal":{"name":"JMIR Public Health and Surveillance","volume":"11 ","pages":"e79043"},"PeriodicalIF":3.9000,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490772/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JMIR Public Health and Surveillance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2196/79043","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth.
Objective: The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions.
Methods: Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses.
Results: The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force (P for interaction <.05).
Conclusions: Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.
背景：“隐蔽青年”是一种严重的社交退缩症，是一个以长期孤立为特征的全球性公共卫生问题。尽管越来越普遍，但人们对孤僻青年的保健需求和使用模式知之甚少。目的：本研究旨在探讨“隐蔽青年”状态与未得到满足的卫生保健使用之间的关系，为有针对性的干预措施提供信息。方法：数据来自2022年韩国青年生活条件调查，这是一项具有全国代表性的横断面调查，共有14966名年龄在19岁至34岁之间的参与者。采用调查权重来解释抽样设计。根据自我报告的戒断行为对“隐蔽青年”状态进行分类，按严重程度和持续时间分层。对身心健康方面未得到满足的卫生保健使用情况进行了评估。采用广义估计方程模型估计95% ci的校正患病率（aPRs），并应用logistic回归进行亚组分析。结果：对心理健康服务感知需求的加权患病率在隐蔽青年群体中为63.9%，而在非隐蔽青年群体中为50.5% （aPR 1.27, 95% CI 1.15-1.41）。未满足的医疗保健使用在身体保健（aPR 3.33, 95% CI 2.16-5.13）和精神保健（aPR 4.46, 95% CI 2.92-6.81）方面较高。相关性随着严重程度和持续时间的延长而增强：对于未满足的精神卫生保健使用，第一阶段的aPRs为4.14 (95% CI 2.64-6.49)，第二阶段的aPRs为9.52 (95% CI 3.67-24.65)；按持续时间划分，前隐蔽青年期的apr为2.57 (95% CI 1.11-5.96)，而隐蔽青年期的apr为5.44 （95% CI 3.44-8.58）。结论：“隐蔽青年”与未得到满足的医疗保健使用密切相关，特别是在心理健康方面，其风险随着严重程度和持续时间的增加而放大。迫切需要有针对性的政策，包括社区外展和远程保健干预措施，以解决这些差距。
期刊介绍：
JMIR Public Health & Surveillance (JPHS) is a renowned scholarly journal indexed on PubMed. It follows a rigorous peer-review process and covers a wide range of disciplines. The journal distinguishes itself by its unique focus on the intersection of technology and innovation in the field of public health. JPHS delves into diverse topics such as public health informatics, surveillance systems, rapid reports, participatory epidemiology, infodemiology, infoveillance, digital disease detection, digital epidemiology, electronic public health interventions, mass media and social media campaigns, health communication, and emerging population health analysis systems and tools.
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