Examining the relationship between social withdrawal motivations and symptoms of hikikomori.

Objective: This study aimed to examine the association between social withdrawal motivations (peer isolation, shyness, unsociability, low mood, and avoidance) and symptoms of hikikomori using both variable- and person-oriented analyses.Method: Adolescents (N = 212) participated in this cross-sectional study. Data were collected using the Social Withdrawal Motivations Scale and the Avoidance subscale of the Child Social Preference Scale-Revised, the 25-item Hikikomori Questionnaire, the Personality Inventory for the DSM-5 Brief Form, and the Interpersonal sensitivity subscale of the Brief Symptom Inventory.Results: Path analysis revealed that peer isolation, shyness, unsociability, and avoidance were associated with symptoms of hikikomori while covarying for age, sex, maladaptive personality, and interpersonal sensitivity. Cluster analysis based on social withdrawal motivations identified four subtypes of adolescents. The group with high social withdrawal motivations showed the highest level of overall personality dysfunction and interpersonal sensitivity. Additionally, the group with high social withdrawal motivations and the group with high avoidance demonstrated higher symptoms of hikikomori compared to the other two groups, after accounting for the effects of the covariates.Conclusions: The findings highlight that the evaluation of co-occurrent social withdrawal motivations may improve the ability to identify those adolescents most in need of support.

Trend in loneliness among Swiss university students during the first year of the COVID-19 pandemic.

BACKGROUND: The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. PARTICIPANTS AND PROCEDURE: This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. RESULTS: Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. CONCLUSIONS: Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students' loneliness and well-being.

Suicide Rates and Prescription of Antidepressants.

Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Method: The study protocol was pre-registered on the Open Science Framework (https://osf.io/978sk/). Publicly available data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and Medical Expenditure Panel Survey (MEPS) were used. Results: Overall, both the antidepressant prescription prevalence and the suicide rate were increasing from 1990 to 2020 in the United States. Positive trends for both outcomes were also evident when analyses were stratified according to sex and/or race/ethnicity. Pearson's correlation analyses consistently found positive associations between antidepressant prescription prevalence and suicide rates. Limitations: Trends and their associations were examined at the population level. The results cannot clarify the causal nature of the association observed. Conclusion: The results of our analysis consistently demonstrated positive trends for both antidepressant prescription prevalence and suicide rates over time as well as positive associations between them. These findings update those from previous studies and are at odds with the notion that, at a population level, more antidepressant prescriptions would lead to lower suicide rates. However, it needs to be acknowledged that ecological studies provide insufficient evidence to infer causality.

Antidepressants use in Italy: an ecological study of national and regional trends and associated factors.

The present study aimed to (1) provide an update on trends in AD consumption both at the national and regional unit of analysis for the period 2000-2020 in Italy and (2) analyze sociodemographic and healthcare system-related factors associated with AD prescribing at the regional-population level between 2000 and 2019. Data were extracted from reports of the Italian Medicines Agency and databases of the Italian National Institute of Statistics. Linear regression and mixed models were applied to analyze trends in AD use (DDD/1000/day) and ecological factors associated with AD prescribing. Between 2000 and 2010 AD prescription rates constantly increased. Thereafter they stabilized until 2017 when a positive trend began again. There was a positive ecological association between AD prescribing and rates of hospital discharge due to affective disorders, antibiotics prescribing, public non-drug healthcare spending per capita, and Northern regions compared to Southern regions. AD consumption increased massively during the 2000s, flattened during the 2010s but thereafter increased again until 2020. The ecological correlation between healthcare provision/spending and AD consumption suggests that health-economic factors may play an important role.

A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation.

BACKGROUND: Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. OBJECTIVE: We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia -Virtual Reality Rehabilitation System, for treatment purposes. METHODS: We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed and PubMed Central) for studies published until November 23, 2023. RESULTS: 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. CONCLUSION: After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis.

Factors associated with pharmacological treatment in children with attention-deficit/hyperactivity disorders: a retrospective study of a series of 77 cases in a single third-level reference Centre in Apulia region.

BACKGROUND: The present study analysed data on children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) who were referred to the ADHD reference centre of Scientific Institute IRCCS E. Medea (Brindisi, Italy) for ADHD pharmacotherapy initiation and monitoring overtime. The main aim of the study was to examine differences in pharmacological treatment status (i.e., treatment continuation vs discontinuation) between patients. METHODS: Seventy-seven children and adolescents (mean age at pharmacotherapy initiation = 9.5, standard deviation = 2.6) with ADHD received drugs treatment for ADHD at the reference center between January, 2013 and May, 2022. Demographic and clinical data were obtained from the Italian Registry for ADHD and medical records. Child Behavior Checklist (CBCL) available data were used. RESULTS: Pharmacological treatment status was examined for patients (n = 63) with at least 12 months of follow-up after the first pharmacological treatment for ADHD. After starting pharmacotherapy treatment, 77.8% (n = 49) patients were still on treatment whereas 22.2% (n = 14) discontinued it. No between group difference were observed in demographic and clinical data except for the intelligence quotient/intellectual disability and rule-breaking behavior (n = 40). CONCLUSIONS: This study stressed the need of periodical assessments, monitoring difficulties with treatment and/or reasons for poor treatment compliance to provide individualized care.

Estimating the prevalence and characteristics of people in severe social isolation in 29 European countries: A secondary analysis of data from the European Social Survey round 9 (2018-2020).

The main aim of the present study was to estimate the prevalence of people in severe social isolation as a proxy for high risk of hikikomori using data from 29 European countries. The relationship between the presence/absence of severe social isolation and demographic and psychosocial variables was also investigated. Publicly available data from the European Social Survey (ESS) round 9 collected between August 2018 and January 2020 were used. Data from the ESS round 1 (September 2002 -December 2003) and round 10 (September 2020 -May 2022) were also examined to investigate changes in the prevalence of severe social isolation over time. Analyses were restricted to the working-age population (15-64 years). A complex sampling design to obtain weighted prevalence and results was used. The study protocol was preregistered online on the Open Science Framework (https://osf.io/6a7br/). The weighted prevalence of severe social isolation was 2.01% for the sample from the ESS 1, 1.77% for the sample from the ESS 9, and 1.71% for the sample from the ESS 10, indicating a decrease over time, mainly in males. Logistic regression models showed that different sociodemographic factors (e.g., being retired, being permanently sick or disabled, doing housework, living in Central and Eastern Europe, living uncomfortably on household income, having no income) were associated with severe social isolation. Further, feeling unsafe when walking alone in the neighbourhood after dark, low social trust, and support, decreased happiness and lack of future planning correlated with severe social isolation after adjustment for the effect of sociodemographic factors was made. In this study, the prevalence of severe social isolation as a proxy for hikikomori in European countries is in line with that found by previous representative studies conducted in Asian countries. The novelty of the findings as well as implications for hikikomori research are discussed according to recent scientific literature.

Observational studies of antidepressant use and suicide risk are selectively published in psychiatric journals.

OBJECTIVES: To investigate if observational studies showing favorable results for antidepressants on suicidal behavior (reduced risk) are preferably and more easily published in psychiatric journals and cited more often compared to studies with unfavorable results (increased risk). STUDY DESIGN AND SETTING: Prespecified secondary analysis, including 27 original studies selected through a systematic review of observational studies reporting associations between the use of newer antidepressant drugs and suicide risk. RESULTS: Independent of study quality, studies reporting favorable results were more frequently published in psychiatric than nonpsychiatric journals and were more often conducted by lead authors with financial conflicts of interest (fCOI). Within psychiatric journals, lead authors with fCOI published in journals with a higher impact factor (IF) and ranking. Within psychiatric journals, favorability of results also correlated with citation frequency, IF, and journal ranking, but these associations became weaker and inconclusive after adjusting for study quality. Results for ease of publishing were inconclusive. CONCLUSION: Studies reporting unfavorable results (increased suicide risk with antidepressant exposure) are less likely to be published in psychiatric journals. Lead authors with fCOI report more favorable results, and their studies are published in the most prestigious psychiatric journals. This may create a biased evidence base and an unbalanced dissemination and appraisal of findings within psychiatry.

Discussing evidence on the components model of addiction. A commentary on Fournier et al. (2023).

Fournier and colleagues have recently examined whether the components model of addiction includes peripheral features of addiction not indicative of a disorder. The authors conducted factor analyses and network analyses of responses (N = 4,256) to the Bergen Social Media Addiction Scale. Their results showed that a bidimensional solution best fitted the data and that two items examining salience and tolerance loaded on a factor not associated with symptoms of psychopathology signifying salience and tolerance as peripherical features of addiction to social media. A reanalysis of the data (focused on the internal structure of the scale) was believed necessary considering that previous studies consistently demonstrated the one-factor solution of the scale and that four independent samples were analysed as a single sample potentially limiting the results of the original study. Findings of the reanalyses of Fournier and colleagues' data provided additional support for a one-factor solution of the scale. Potential explanations of the findings and suggestions for future research were elaborated.

Symptoms of Prolonged Social Withdrawal, Problematic Internet Use, and Psychotic-Like Experiences in Emerging Adulthood: A Moderation Model.

Objective: Prolonged social withdrawal (PSW) or hikikomori and problematic internet use (PIU) have attracted the attention of mental health experts worldwide. The scientific literature suggests a complex relationship between these conditions and psychotic-like experiences (PLEs) or disorders. In the present cross-sectional study, we tested the role of PIU symptoms as a moderator of the relationship between symptoms of PSW and PLEs in a sample of 238 Italian emerging adults. Method: Data was collected using the 25-item Hikikomori Questionnaire, the Internet Disorder Scale, the Brief Prodromal Questionnaire, and the Brief Symptom Inventory. In addition, lifetime psychological disorders and drug and alcohol use during the last month were explored. No participant reported a lifetime episode of schizophrenia or other psychotic disorder. Results: Symptoms of PSW and PIU were significantly associated with PLEs total distress and PLEs total number of symptoms endorsed, after adjustment for age and symptoms of depression and anxiety. Further, PIU symptoms moderated the relationship between symptoms of PSW and PLEs total distress (b= 2.745, s.e.= 1.089, p= 0.012). However, PIU symptoms did not moderate the relationship between PSW and PLEs total symptoms (b= 0.615, s.e.= 0.349, p= 0.078). This study is limited because the participants were most likely university students and because of the cross-sectional design. Conclusions: Findings from this study partially support the role of high symptoms of PIU as a risk factor in the relationship between symptoms of PSW and PLEs. Future longitudinal research is needed to confirm our findings examining the temporal relationship between PSW, PIU, and PLEs using both dimensional and categorical approaches.

The serotonin theory of depression: a systematic umbrella review of the evidence.

The serotonin hypothesis of depression is still influential. We aimed to synthesise and evaluate evidence on whether depression is associated with lowered serotonin concentration or activity in a systematic umbrella review of the principal relevant areas of research. PubMed, EMBASE and PsycINFO were searched using terms appropriate to each area of research, from their inception until December 2020. Systematic reviews, meta-analyses and large data-set analyses in the following areas were identified: serotonin and serotonin metabolite, 5-HIAA, concentrations in body fluids; serotonin 5-HT1A receptor binding; serotonin transporter (SERT) levels measured by imaging or at post-mortem; tryptophan depletion studies; SERT gene associations and SERT gene-environment interactions. Studies of depression associated with physical conditions and specific subtypes of depression (e.g. bipolar depression) were excluded. Two independent reviewers extracted the data and assessed the quality of included studies using the AMSTAR-2, an adapted AMSTAR-2, or the STREGA for a large genetic study. The certainty of study results was assessed using a modified version of the GRADE. We did not synthesise results of individual meta-analyses because they included overlapping studies. The review was registered with PROSPERO (CRD42020207203). 17 studies were included: 12 systematic reviews and meta-analyses, 1 collaborative meta-analysis, 1 meta-analysis of large cohort studies, 1 systematic review and narrative synthesis, 1 genetic association study and 1 umbrella review. Quality of reviews was variable with some genetic studies of high quality. Two meta-analyses of overlapping studies examining the serotonin metabolite, 5-HIAA, showed no association with depression (largest n = 1002). One meta-analysis of cohort studies of plasma serotonin showed no relationship with depression, and evidence that lowered serotonin concentration was associated with antidepressant use (n = 1869). Two meta-analyses of overlapping studies examining the 5-HT1A receptor (largest n = 561), and three meta-analyses of overlapping studies examining SERT binding (largest n = 1845) showed weak and inconsistent evidence of reduced binding in some areas, which would be consistent with increased synaptic availability of serotonin in people with depression, if this was the original, causal abnormaly. However, effects of prior antidepressant use were not reliably excluded. One meta-analysis of tryptophan depletion studies found no effect in most healthy volunteers (n = 566), but weak evidence of an effect in those with a family history of depression (n = 75). Another systematic review (n = 342) and a sample of ten subsequent studies (n = 407) found no effect in volunteers. No systematic review of tryptophan depletion studies has been performed since 2007. The two largest and highest quality studies of the SERT gene, one genetic association study (n = 115,257) and one collaborative meta-analysis (n = 43,165), revealed no evidence of an association with depression, or of an interaction between genotype, stress and depression. The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.

Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire.

A serious form of social withdrawal, initially described within Japan as hikikomori, has received increasing attention from the international scientific community during the last decade. The 25-item Hikikomori Questionnaire (HQ-25) was initially developed and validated in Japan. To date, data on its psychometric properties in other populations where cases of hikikomori have been described are still scarce. Thus, the aims of this study were to (1) translate, adapt, and validate the Italian version of the HQ-25 analyzing its psychometric properties; and (2) verify the association between hikikomori and personality functioning, social support, and problematic Internet use. A sample of 372 Italian adults aged 18 to 50 years completed the HQ-25 and measures of psychoticism, personality dysfunction, social support, and problematic Internet use were employed to test the convergent validity of the HQ-25. The data showed a satisfactory fit for a three-factor model, significantly better than a one-factor model. The three factors (socialization, isolation, and emotional support, as in the original study on the HQ-25) correlated positively with psychoticism, personality dysfunction, and problematic Internet use, and correlated negatively with social support. A lifetime history of hikikomori was present in 1.1% of the sample (n = 4). This is the first study to use the Italian validated version of the HQ-25 with an adult population. The findings from this study provide evidence of the satisfactory psychometric properties of the Italian version of the HQ-25 and support further investigation of the HQ-25 as an instrument to help screen for and investigate the presence of hikikomori.

Responding to the COVID-19 public health emergency: The usefulness of an online brief psychological intervention with Italian university students.

The COVID-19 pandemic has brought about new stressors on university students, with a negative impact on their mental health and well-being. The purpose of this study was to examine the usefulness of a brief psychodynamically oriented intervention on general functioning by investigating changes in symptoms of depression, anxiety, hopelessness, and burnout. The sample was comprised of 67 university students (22.4% males), with a mean age of 23.27 (standard deviation (SD) = 3.27), who asked for psychological help at a psychological university service. Pre- and posttreatment data showed a significant improvement in general functioning and symptom reduction due to the psychological intervention. The mean change was very high for depression (d = 1.11) and high for general functioning (d = 0.70) and anxiety (d = 0.69). Our findings showed the importance of considering university students a vulnerable population that requires specific services within the university context and underlined the fact that mental-health-promotion policies should be extensively implemented.

Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire for Adolescents.

Hikikomori is a form of social withdrawal that is commonly described as having an onset during adolescence, a life stage when other psychiatric problems can also emerge. This study aimed to adapt the 25-item Hikikomori Questionnaire (HQ-25) for the Italian adolescent population, examining its psychometric properties; associations between hikikomori and psychoticism, depression, anxiety, problematic internet use (PIU), psychotic-like experiences (PLEs), to confirm convergent validity of the HQ-25; and the interaction effect between symptoms of hikikomori and PIU in predicting PLEs. Two-hundred and twenty-one adolescents participated in the study. Measures included the HQ-25, the Psychoticism subscale of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, the Depression and Anxiety subscales of the Brief Symptom Inventory, the Internet Disorder Scale, and the Brief Prodromal Questionnaire. Data showed a satisfactory fit for a three-factor model for the HQ-25 that is consistent with the original study on the HQ-25. Three factors (socialization, isolation, and emotional support) were associated with psychopathology measures. Six participants reported lifetime history of hikikomori. Symptoms of hikikomori and PIU did not interact in predicting PLEs. This is the first study to validate the HQ-25 in a population of adolescents. Findings provide initial evidence of the adequate psychometric properties of the Italian version of the HQ-25 for adolescents.

Change in Alcohol Consumption and Binge Drinking in University Students During the Early COVID-19 Pandemic.

Objectives: Young adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods. Methods: A prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change). Results: Overall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking. Conclusions: A substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

Burden of mental health and substance use disorders among Italian young people aged 10-24 years: results from the Global Burden of Disease 2019 Study.

PURPOSE: The burden of mental health and substance use disorders among Italian young people have not yet been presented in detail, despite adolescents and young adults aged between 10 and 24 years constitute 14.5% of the Italian population. Therefore, the aim of this study was to provide data on the health burden of mental health and substance use disorders among young people (10-24 years) in Italy between 1990 and 2019. METHODS: Ecological study design using data from the Global Burden of Disease Study 2019. Age- and sex-specific prevalence and years lived with disability (YLDs) of mental health and substance use disorders with the uncertainty intervals were reported as well as their percentual changes between 1990 and 2019. RESULTS: Prevalence and YLDs rates of mental health and substance use disorders showed negative trends overall between 1990 and 2019. However, diagnoses of attention-deficit/hyperactivity, autism spectrum, conduct and eating (among males) disorders increased as well as cocaine use disorder. The highest levels of disability in terms of YLDs were due to anxiety, depressive, conduct and eating disorders and alcohol use, amphetamine use and opioid use disorders. The disease burden was higher in middle-late adolescence and young adulthood than early adolescence, among females than males for mental health disorders and among males compared to females for substance use disorders. CONCLUSION: Findings of the study highlighted disorder-specific patterns of prevalence and YLDs rates and were discussed considering previous research. The public health system should continuously sustain mental health promotion and prevention efforts in young people.