Are Japan's hikikomori and depression in young people spreading abroad?

Hikikomori, or severe social withdrawal, in Japan's young people has been a prominent public mental health concern since around 2000.1 Another, more recent, concern is a syndrome dubbed “modern-type depression”. This catchy name has quickly and widely spread to the public via Japan's mass media and internet-related media, yet there is no consensus guideline for its diagnosis and treatment, which has led to confusion when dealing with the disorder in clinical practice.

Modern-type depression is characterised by a shift in values from collectivism to individualism; distress and reluctance to accept prevailing social norms; a vague sense of omnipotence; and avoidance of effort and strenuous work.2 It seems to mainly affect those who were born after 1970—ie, the generation growing up with home video games in the era of Japan's high economic growth. Young people with modern-type depression tend to feel depressed only when they are at work; at other times, they enjoy the virtual world of the internet, video games, and pachinko (similar to pinball). Therefore, people with modern-type depression have difficulties in adapting to work or school and participating in the labour market, similarly to those with hikikomori.

An epidemiological study of hikikomori indicated a lifetime prevalence of more than 1% in adults in Japan.3 However, the question arises: do these syndromes represent no more than a general response to Japan's modernisation? In fact, several hikikomori-like cases have been reported from Korea, Oman, and Spain, leading to debate as to whether hikikomori is a culture-bound syndrome specific to Japan or a new form of maladjustment or psychiatric disorder.4

We did an international survey to investigate whether these syndromes exist beyond Japan.2, 5 Psychiatrists’ responses to vignettes indicated that both hikikomori and modern-type depression are seen in various countries, and are more prevalent in urban areas, which might suggest that modernisation has an important role in the occurrence of these phenomena. Many respondents suggested that hikikomori and modern-type depression might not fit into current international diagnostic categories, and some felt that hikikomori could be seen as a form of internet addiction.

These reports provide a rational basis for epidemiological and ethnographic studies of hikikomori and modern-type depression in clinical and community populations in different countries. They might not simply be Japanese cultural phenomena; rather, they might be indicators of a pandemic of psychological problems that the global internet-connected society will have to face in the near future.

We declare that we have no conflicts of interest.