Hikikomori and the COVID-19 pandemic: not leaving behind the socially withdrawn.

dated in Portuguese for the Brazilian cultural context, as well as the impossibility of objectively identifying and measuring tokophobia, make adequate therapeutic guidance difficult. A systematic review and meta-analysis was performed of the risk factors. The perception of tokophobia was assessed among pregnant women and prenatal health care professionals to identify the peculiarities of tokophobia in the Brazilian socio-cultural and clinical-obstetric context. The conceptual and psychometric analysis process allowed the development and validation of the Tokophobia Assessment Questionnaire (Questionário de Avaliação da Partofobia) in Brazilian Portuguese, available from the authors upon request. This research project was approved by the Universidade do Sul de Santa Catarina research ethics committee (protocol 87312818.0.0000.5369). The Tokophobia Assessment Questionnaire has been validated; its reliability was measured with the Pearson correlation coefficient (0.766) and the intraclass correlation coefficient (0.856). Bland-Altman analysis showed a central tendency between the difference and mean of the two Tokophobia Assessment Questionnaire applications in almost the entire sample. The general Cronbach’s alpha was 0.935 (Table 1). The Kappa index was 0.444 and the Pearson correlation coefficient between the first application of the Tokophobia Assessment Questionnaire and the Depression, Anxiety and Stress Scale was 0.607. Exploratory factor analysis identified six factors categorized into conceptual groups: physical repercussions (factor 1); feeling of panic (factor 2); social involvement (factor 3); interference in daily habits (factor 4); pregnancy avoidance (factor 5); self-perception of tokophobia (factor 6) (Table 1). Use of the item response theory demonstrated the suitability of all items (Figure 1). Therefore, the 25-item Tokophobia Assessment Questionnaire is reliable and valid and is the first instrument for assessing the clinical, emotional and psychiatric manifestations of tokophobia. Although developed for the Brazilian population, the instrument may have worldwide applicability.