Modern Type Depression Research Articles

Does childhood maltreatment affect hikikomori via traits of modern-type depression?

BackgroundIn the 1990s, the concepts of hikikomori and modern-type depression (MTD) emerged in Japan. Hikikomori is a condition of social avoidance or isolation, characterized by staying at home and being physically isolated for at least six months. MTD is characterized by depressive symptoms—mainly in stressful work or school situations during adolescence and early adulthood—which tend to rapidly reduce or disappear after leaving the stressful situation. We hypothesized that childhood maltreatment can form MTD traits that lead to hikikomori. MethodsAs a first step, we conducted a multigroup path analysis between childhood maltreatment, MTD traits, and physical isolation in the hikikomori group. This study utilized the nine-item Patient Health Questionnaire (PHQ-9), Home Environment Questionnaire (HEQ), 22-item Tarumi Modern-Type Depressive Trait Scale (TACS-22), 25-item Hikikomori Questionnaire (HQ-25), and Hamilton Depression Rating Scale (HDRS). The HQ-25 contains three factors: physical isolation, lack of socialization, and lack of emotional support. ResultsThe hikikomori group included 92 patients and the control group comprised 137 healthy individuals. All total and subscale scores of PHQ-9, HEQ, TACS-22, HQ-25, and HDRS were significantly higher in the hikikomori group than in the control group. The risk model of childhood maltreatment for physical isolation via MTD traits obtained good fit with a goodness-of-fit index of.982. LimitationsThe study's limitations were its sample selection bias, cross-sectional design, and use of self-report scales. ConclusionsOur findings support the hypothesis that childhood maltreatment is an important risk factor for hikikomori via MTD traits.

Could the Construct of Modern-Type Depression Predict Internet Gaming Disorder in Italian Video Gamers? A Case-Control Study.

A new postmodern depression type, named "Modern-Type Depression" (MTD), is emerging in Western countries. MTD is often underdiagnosed, mainly due to potentially higher comorbidity with technology-based addictions, including Internet Gaming Disorder (IGD). However, the definition of the relationship between MTD and IGD is still controversial, as few data have been published thus far. In particular, there are no data specifically investigating the prevalence of MTD within Italian young subjects with IGD, as well as their mutual association. Hence, within the SWATCH (Social Withdrawal and TeCno-mediated mental Health issues) project, our study aimed to identify the prevalence of MTD in a sample of Italian young adults who play video games by providing a clinical characterization of MTD within a group of IGD individuals (IGD+) versus a group without IGD (IGD-) who play video games. Our cross-sectional case-control study recruited a sample of 543 Italian young video-gaming players (aged 18-35) from the larger SWATCH database, stratified as IGD+ versus IGD-. Subjects were administered the 22-item Tarumi's Modern-Type Depression Trait Scale (TACS-22), the Motives for Online Gaming Questionnaire (MOGQ), and the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). Around 21.7% of the total sample was represented by MTD individuals, while within the IGD sample, around 34% of subjects had MTD. Within the MTD group, significantly higher scores at IGDS-9SF (p < 0.001), MOGQ "Escape from reality" (p < 0.001), "Fantasy" (p < 0.001), and MOGQ total score (p = 0.003) were found compared to MTD-. According to the multivariate regression model, controlled for sex and age, higher scores in the TACS-22 were positively predicted by the total score of IGDS9-SF (p = 0.003), the MOGQ "Escape from Reality" subscale (p = 0.014), and MOGQ "Fantasy" (p = 0.011), and negatively predicted by the MOGQ "Competition" subscale (p = 0.035) [F (4538) = 17.265; p < 0.001]. Our findings suggested that MTD displays a strong association with IGD. Video-gaming players who do not have IGD appear to be less prone to MTD; this suggests that further studies could be carried out to specifically investigate whether pathological use of video games could also be determined by the presence of MTD.

Hikikomori: A Scientometric Review of 20 Years of Research

The Japanese term hikikomori was first used to describe prolonged social withdrawal in the 1990s. Since then, research across the world have reported similar prolonged social withdrawal in many countries outside Japan. This study systematically analyses the evolution of literature on hikikomori in the past 20 years to gain a better understanding of the development of the knowledge base on hikikomori since it garnered attention in Japan. Findings from the scientometric review indicate many perspectives on the etiology of hikikomori including cultural, attachment, family systems and sociological approaches. However, similarities with modern type depression, a novel psychiatric syndrome, have been proposed and there are signs of a recent paradigm shift of hikikomori as a society-bound syndrome rather than a cultural-bound syndrome unique to Japan. As research into hikikomori continues to grow, results from the review also highlight the need for a more universally shared definition of hikikomori in order to better consolidate cross-cultural research for meaningful and valid cross-cultural comparisons which can help to promote evidence-based therapeutic interventions for hikikomori.

Pathological social withdrawal in autism spectrum disorder: A case control study of hikikomori in Japan.

Hikikomori, a form of pathological social withdrawal, has been suggested to have comorbidity with autism spectrum disorder (ASD). This study aimed to clarify how characteristics of ASD are associated with hikikomori. Thirty-nine adult male patients with a diagnosis of ASD attending our outpatient clinic for neurodevelopmental disabilities were subjected to a structured interview regarding social withdrawal, various self-administered questionnaires, and blood tests. Through structured interviews, the subjects were divided into two groups: (Group 1) ASD with hikikomori condition and (Group 2) ASD without hikikomori condition. Sixteen subjects qualified as hikikomori and 23 subjects qualified as subjects without hikikomori. Age, sex, autism spectrum quotient (AQ), Autism Diagnostic Observation Schedule (ADOS), and FIQ were matched. Compared to non-hikikomori controls, hikikomori cases were likely to have stronger sensory symptoms, lower uric acid (UA) (p = 0.038), and higher rates of atopic dermatitis (p = 0.01). Cases showed more severe depressive and social anxiety symptoms based on self-rated scales: Patient Heath Questionnaire 9 (PHQ-9) (p < 0.001) and Liebowitz Social Anxiety Scale Japanese Version (LSAS-J) (p = 0.04). Tarumi's Modern-Type Depression Trait Scale (TACS-22), which measure traits of Modern-Type Depression (MTD), were significantly higher in cases (p = 0.003). The present study has suggested that ASD patients with hikikomori were more likely to have higher sensory abnormalities, comorbid atopic dermatitis, lower UA, stronger depressive, and anxiety tendency. Evaluating and approaching these aspects are important for appropriate interventions in ASD with hikikomori. Further investigations should be conducted to validate our pilot findings.

Psychopathological characterization of modern-type depression in subjects with Internet Gaming Disorder

IntroductionIn recent years, more evidence is emerging in favor of a new form of depression, aka “Modern-Type Depression” (MTD). It has also been theorized that MTD may have multiple relationships with other psychiatric disorders, including techno-addictions.ObjectivesOur study aims at clinically characterizing subjects with MTD in a sample of individuals affected with Internet Gaming Disorder (IGD).Methods1,157 subjects were recruited from a sample of Italian young people (aged 18-35), and selected only if they declared to be video game players (48.6%, n=542). Video game players filled out the 22-item Tarumi’s Modern-Type Depression Trait Scale (TACS-22), Motives for Online Gaming Questionnaire (MOGQ), Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Problematic Online Gaming Questionnaire (POGQ), Multidimensional State Boredom Scale (MSBS), Symptom Checklist-90 (SCL-90). Subjects were classified as IGD+/IGD- and MTD+/MTD-. Descriptive analysis, Mann-Whitney’s U-test for independent data and Chi-square tests were carried out.Results60.5% (n=328) of the sample were male. 21.7% (n=118) were positive to MTD. MTD subjects reported significantly higher scores at IGDS9-SF (p&lt;0.001), POGQ (p&lt;0.001), MOGQ (p=0.003), MSBS (p&lt;0.001). Significant higher scores were found at the MOGQ subscales “reality avoidance” (p&lt;0.001), “coping” (p=0.001), and “fantasy” (p&lt;0.001) and at the SCL-90 subscales “interpersonal sensitivity” (p&lt;0.001), “phobic anxiety” (p&lt;0.001), and “psychoticism” (p&lt;0.001).ConclusionsMTD displayed a strong association with technopathies, particularly IGD. Therefore, further studies should evaluate whether MTD could represent a predictor to IGD onset and/or maintenance and adequately address this aspect from a preventive and treatment perspective.Disclosure of InterestNone Declared

The Relationship between the Tendencies of Interpersonal Sensitivity, Privileged Self and Perspective-Taking in University Students

“Interpersonal sensitivity” and “privileged self” are personality traits related to modern-type depression. Individuals with these traits tend to have difficulty establishing positive relationships with others. Perspective-taking has a positive effect on interpersonal relationships, and we predict that privileged self suppresses it. We examined the relationship between interpersonal sensitivity, privileged self, and perspective-taking tendency through a questionnaire survey of 102 university students. Our results indicate a significant partial correlation between perspective-taking tendency and privileged self, controlled by interpersonal sensitivity, and that privileged self interferes with self-perspective.

Predominant affective temperaments in modern-type depression and hikikomori syndrome

Predominant affective temperaments in modern-type depression and hikikomori syndrome

Exploring the Reasons behind Perceived Severity of Modern and Traditional Types of Depression in an American Undergraduate Sample

Aim: A subtype of depression called Modern-type depression (MTD) is typically viewed as less severe compared to the Traditional-type depression (TTD). The purpose of this study was to explore the reasons behind the differences of perceptions when assessing the severity of MTD and TTD. Methods: After reading two vignettes describing an individual who is experiencing symptoms of MTD or TTD, participants (N = 300, Mage= 20.36) were asked to rate the severity of the depression for each and rank, in order of importance, a set of sentences in each vignette that served as reasons why they chose that rating. Results: Overall, TTD was more likely to be rated as severe than MTD. Those who perceived high severity in TTD relied on the information of the individual experiencing mental and physical consequences a high workload. Those who perceived high severity in MTD also relied on the same information of X suffering a high workload; however, those who perceived low severity in MTD relied more on the information of the individual complaining about the workload. Conclusion: These results indicate that perceptions of each disorder may in part come from which information people pay attention to. Future studies should explore the possibility of other factors, such as familiarity with mental health disorders or certain trauma experiences that could lead some individuals to process circumstances and situations within each depression to reduce stigma of mental disorders.

Risk factors of hikikomori among office workers during the COVID-19 pandemic: A prospective online survey

The global pandemic of COVID-19 has forced people to restrict their outings. In Japan, self-restraint behavior (SRB) has been requested by the government, and some of those decreasing their outings may shift to pathological social withdrawal; hikikomori. The purpose of this study was to examine the risk factors of hikikomori conducting an online prospective survey. An online survey was conducted in June 2020 and December 2020; (1) SRB-related indicators (degree of SRB, motivation for SRB, stigma and self-stigma toward COVID-19, anxiety and depressive feelings toward COVID-19) and (2) general mental health (hikikomori tendency, depressive symptoms, modern type depression (MTD) tendency, internet addiction) were collected. A cross-lagged effects model was performed to examine the association between these variables. Lack of emotional support and lack of socialization in June 2020 increased isolation in December 2020. Besides, MTD and hikikomori interacted with each other. Interestingly, although hikikomori tendency increased depressive tendencies, SRB itself did not have a significant path on any mental health-related variables. Poor interpersonal relationships, rather than SRB per se, are suggested to be a risk factor for increased isolation among office workers in the COVID-19 pandemic. Appropriate early interventions such as interpersonal or emotional support may prevent the transition to pathological hikikomori. The association between MTD and hikikomori seems to reveal the interesting possibility that MTD is a gateway to increased risk of hikikomori, and that hikikomori is a gateway to MTD as well. Future research is required to elucidate the relationship between hikikomori and MTD.

Hikikomori and modern-type depression in Italy: A new phenotypical trans-cultural characterization?

Hikikomori is a Japanese term etymologically derived from 'hiku' (i.e. 'to pull back') and 'komoru' (i.e. 'seclude oneself'), which identifies those subjects who deliberately withdraw themselves by social life, remaining confined into their own home/room. The phenomenon is widely diffused in Japan, even though it is currently spread outside the Japanese culture. However, a universally shared and cross-cultural adaptation of Hikikomori definition, phenomenological and psychopathological characterization is still missing. An expert-guided opinion paper was here provided to clinical characterize the Hikikomori-like social withdrawal in the Italian context, by considering the transformation from a family-based society to a 'fluid' digital-structured culture, also discussing the concept of modern-type depression. This was provided deepening the principal current studies available in literature and giving an interpretation based on clinical experience in the Italian society. The work was supervised through a consensus by the most international expert of Japanese Hikikomori syndrome. Current individual, family and social trajectories may potentially act as a mediator in favouring the occurrence of Hikikomori-like social withdrawal also in western countries, including Italy. Despite the differences between Japanese and Italian society and culture, the recent shaping of family structure and intra-familial dynamics, typical of the current post-modern society, may potentially influence the emergence of psychopathologies not typical of Italian culture. Unemployment and 'Not in Employment Education or Training' (NEET) conditions may represent another potential risk factor for economical/social marginalization of youngsters, together with the recent dramatic emergence of web-based psychopathologies. A diagnostic culturally-adapted flow-chart is proposed for clinical characterizing Hikikomori in Italian context, which may help in proposing preventive strategies, ensuring early identification and prompt therapeutic interventions, particularly among youngsters.

Boredom, loneliness and modern type depression in a cohort of Italian university students

IntroductionCOVID-19-related physical isolation, fear and anxiety determined de novo mental illnesses, by potentially facilitating the emergence of Hikikomori traits (i.e., a severe social withdrawal condition).ObjectivesThe present study aims at screening a cohort of university students for the Hikikomori traits and assessing a set of psychopathological determinants associated with Hikikomori, particularly boredom and loneliness dimensions.MethodsA cross-sectional web-based survey was carried out by administering Hikikomori Questionnaire (HQ-11), Italian Loneliness Scale (ILS), Multidimensional State Boredom Scale (MSBS), Depression Anxiety Stress Scale (DASS-21) and Toronto Alexithymia Scale (TAS-20).Results1,148 respondents (767 women and 374 men, mean age: 23.2±SD=2.8 years old) were recruited. 70.7% declared to have experienced psychological distress. HQ-11 average total score was 18.4±SD=7.5 with statistically significant higher values in the males (p=0.017) and amongst students studying Informatics, Mathematics/Physics/Chemistry, Science of Communication and Engineering. The HQ-11 positively correlated with ILS (r=0.609), MSBS (r=0.415), TAS-20 (r=0.482) and DASS-21 (r=0.434).ConclusionsThis study represents the first screening of the Hikikomori phenomenon in Italian university students. Hikikomori traits appear to be particularly represented in the Italian youth population and should be carefully investigated in future studies.DisclosureNo significant relationships.

Modern-type depression and web-based psychopathology in a cohort of Italian university students

IntroductionHikikomori represents the severe social withdrawal condition of the so-called ‘modern type-depression” (MTD). Digital addictions, including Internet addiction (IA), Internet gaming disorder (IGD) and smartphone addiction, have been associated with MTD and Hikikomori.ObjectivesThis is a post-hoc study aimed at assessing digital addictions in a cohort of university students with a positive screening for MTD and Hikikomori.MethodsA cross-sectional web-based survey was conducted by administering the Hikikomori Questionnaire (HQ-11), Internet Addiction Test (IAT), Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) and the Smartphone addiction scale-Short Version (SAS-SV).ResultsAmong 1,148 respondents, a significant association was found between the HQ-11 scale and the DASS-21 total score (r=0.434). The HQ-11 positively correlated with IAT, IGDS9-SF and SAS-SV (r=0.329; r=0.292 and r=0.205 respectively).ConclusionsDigital addictions appear to be widely diffuse among university students positive to the Hikikomori and MTD screening. Further longitudinal studies are needed to weight and balance the potential consequences of digital tools in Hikikomori subjects.DisclosureNo significant relationships.

Psychological Traits of Patients With Depression Comorbid With Chronic Pain: Are Complaint and Competitive Tendency Related to Pain?

BackgroundModern-Type Depression (MTD) is a category of depression that has been studied mainly in Japan; however, no study has attempted to determine its relation to chronic pain.AimTo determine possible associations between psychological traits related to MTD and the chronic pain of patients at psychiatric clinics.MethodTwo hundred and twenty-one first time patients who visited the psychiatric clinic at a Japanese university medical center or an associated clinic were enrolled. The Hamilton Depression Rating Scale was used to measure depressive symptoms. The 22-item Tarumi's Modern-Type Depression Trait Scale (TACS-22), Achievement Motive, and 20-item Toronto Alexithymia Scale were used to assess psychological traits related to depression and chronic pain. The clinical diagnosis of each patient was confirmed by use of the Structured Clinical Interview for DSM-IV Axis I Disorders, administered by experienced specialists. The medians of the psychological traits identified were compared between patients with or without chronic pain. Analysis was also done of patients with Major Depressive Disorder (MDD).ResultOf the 221 patients, 139 had chronic pain. Patients with chronic pain had more severe depressive symptoms, Alexithymia, and high scores for the complaint trait of MTD. Seventy-three of the 221 patients met the criteria for MDD (53 had chronic pain). Patients with MDD comorbid with chronic pain had a higher competitive achievement score, severe depression, and difficulty identifying feelings.ConclusionComplaint and competitive traits were shown to be related to chronic pain in psychiatric settings. Further study will allow us to design multidimensional approach for patients suffering from depression.

Modern-type depression and web-based psychopathology in a cohort of Italian university students

Modern-type depression and web-based psychopathology in a cohort of Italian university students

Impressions and Attitudes toward the Employee with “Modern-Type Depression” by Supervisors and Coworkers: A Case Vignette Survey among Japanese Managerial and Non-managerial Employees.

Impressions and Attitudes toward the Employee with “Modern-Type Depression” by Supervisors and Coworkers: A Case Vignette Survey among Japanese Managerial and Non-managerial Employees.

Social withdrawal in major depressive disorder: a case-control study of hikikomori in japan

BackgroundSocial withdrawal is a feature of a number of psychiatric disorders including major depressive disorder (MDD), yet research examining social withdrawal as a feature of MDD is rare. MethodsThis was a retrospective case-control study. Participants (N = 67) were recruited through an outpatient clinic at an academic medical center in Japan. Major depressive disorder (MDD) and social withdrawal were established with the Structured Clinical Interview for DSM-IV Axis I Disorders and a semi-structured psychiatric interview, respectively. Participants also completed self-report measures. ResultsWe classified 24 participants as cases (MDD with social withdrawal) and 43 participants as controls (MDD without social withdrawal). Cases, on average, were more likely to have lower education level, prior episodes of depression, and higher suicidal ideation at baseline than controls. In unadjusted regression models, cases had significantly less social connection, less reward dependence, less self-directedness, and higher scores on scales of modern-type depression and hikikomori. In adjusted regression models, associations between social withdrawal and hikikomori (p<0.01) and reward dependence (p = 0.03) remained significant. LimitationsThe sample was limited in size and drawn from a single site. ConclusionsIn patients with MDD, social withdrawal may have subtle associations with clinical symptoms, social connection, and personality traits. Developing a better understanding of social withdrawal's phenotype in depression requires more in-depth examination.

Social status and modern-type depression: A review.

BackgroundsSocial hierarchy is one of the most influential social structures employed by social species. While dominants in such hierarchies can preferentially access rich resources, subordinates are forced into lower social statuses and lifestyles with inferior resources. Previous studies have indicated that the social rank regulates social behaviors and emotion in a variety of species, whereby individual organisms live within the framework of their ranks. However, in human societies, people, particularly young men, who cannot accept their own social status may show social withdrawal behaviors such as hikikomori to avoid confronting their circumstances.MethodsThis article reviews the neural mechanisms underlying social status identified in animal studies with rodents and primates, and assesses how social rank affects animal's social behaviors and emotion which may be relevant to modern type depression.ResultsSeveral brain regions such as medial prefrontal cortex are implicated in the formation of animal's social status, which leads to the differences in vulnerability and resilience to social stress.ConclusionOn the basis of these findings, we propose that physical interventions such as voluntary exercise, diet, transcranial direct current stimulation, and psychotherapy, rather than psychotropic drugs, may be useful therapeutic approaches for modern type depression, which is a typical example of social status conflict and a phenotype of adjustment disorder to the traditional hierarchical social order.

Psychological understanding of modern type depression: The role of interpersonal sensitivity and privileged self

Psychological understanding of modern type depression: The role of interpersonal sensitivity and privileged self

Development and validation of the 22-item Tarumi's Modern-Type Depression Trait Scale: Avoidance of Social Roles, Complaint, and Low Self-Esteem (TACS-22).

AimUnderstanding premorbid personality is important, especially when considering treatment selection. Historically, the premorbid personality of patients with major depression in Japan was described as Shuchaku‐kishitsu [similar to Typus melancholicus], as proposed by Shimoda in the 1930s. Since around 2000, there have been increased reports in Japan of young adults with depression who have had premorbid personality differing from the traditional type. In 2005, Tarumi termed this novel condition ‘dysthymic‐type depression,’ and more recently the condition has been called Shin‐gata/Gendai‐gata Utsu‐byo [modern‐type depression (MTD)]. We recently developed a semi‐structured diagnostic interview to evaluate MTD. Development of a tool that enables understanding of premorbid personality in a short time, especially at the early stage of treatment, is desirable. The object of this study was to develop a self‐report scale to evaluate the traits of MTD, and to assess the scale's psychometric properties, diagnostic accuracy, and biological validity.MethodsA sample of 340 participants from clinical and community settings completed measures. Psychometric properties were assessed with factor analysis. Diagnostic accuracy of the MTD traits was compared against a semi‐structured interview.ResultsThe questionnaire contained 22 items across three subscales, thus we termed it the 22‐item Tarumi's Modern‐Type Depression Trait Scale: Avoidance of Social Roles, Complaint, and Low Self‐Esteem (TACS‐22). Internal consistency, test–retest reliability, and convergent validity were all satisfactory. Among patients with major depression, the area under the curve was 0.757 (sensitivity of 63.1% and specificity of 82.9%) and the score was positively correlated with plasma tryptophan.ConclusionThe TACS‐22 possessed adequate psychometric properties and diagnostic accuracy in an initial sample of Japanese adults. Additional research on its ability to support clinical assessment of MTD is warranted.

Perceptions of traditional and modern types of depression: A cross-cultural vignette survey comparing Japanese and American undergraduate students.

Depression is a heterogeneous disorder that has various subtypes. In Japan, however, a prevailing misunderstanding is that the term utsu-byo (clinical depression) indicates only the melancholic type. Consequently, a subtype called 'modern-type depression' (MTD), which has contrasting features to those of melancholic or traditional-type depression (TTD), is severely stigmatized in Japan these days. The present study conducted a cross-cultural comparison of perceptions of TTD and MTD between Japan and the USA to examine how the Japanese collectivistic culture contributes to negative biases toward MTD. Undergraduate students in Japan (N = 303) and the Midwestern USA (N = 272) completed the survey. They read two vignettes that described the conditions of fictional individuals with either TTD or MTD, and then reported their perceptions of each vignette. Mixed analyses of variance revealed significant interactions between nation (Japan or the USA) and vignette (TTD or MTD) on most perception items. These interactions and subsequent analyses with Bonferroni corrections mainly indicate the following: (i) Japanese are more likely to suppose that conditions of MTD are milder compared with TTD; and (ii) Japanese are more likely to hold stronger aversive attitudes and weaker willingness to provide support toward people with MTD than toward those with TTD. These results indicate that people with MTD are more likely to be accepted in the US independent culture than in the Japanese collectivistic culture. Discussion highlights that cultural diversity education potentially reduces stigma of MTD in Japan.