Characteristics of and gender difference factors of hikikomori among the working-age population: A cross-sectional population study in rural Japan.

Objectives　This study aimed to assess the relevance of hikikomori to a variety of socio-demographic characteristics and socio-psychological conditions and examined these relationships by gender.Methods　The study employed a cross-sectional design. A questionnaire survey was conducted among 2,459 participants aged 15-64 years and living in Happo-cho, Akita. The outcome variable, hikikomori, was characterized by "not having participated in any social events nor interacted with others besides family members for more than six months." Exposure variables included sex, age, marital status, occupational status, outdoor frequencies, health, socio-psychological well-being, and availability of social support. Using Chi-square test of independence and multiple logistic regression, the results indicated the impact of the individual factors and the combined impact of all potential variables on the likelihood of being hikikomori in both participant groups: men and women.Results　The effective response rate was 54.5%. Those who socially withdrew for six months or more (n=164 (6.7%); 53.7% men, 46.2% women) were classified as being hikikomori; of these, 45.7% had been withdrawn for more than 10 years. Hikikomori men were more likely to have severe symptoms of mental illness, poorer overall self-rated health, feelings of distress, and passive suicidal ideation than non-hikikomori men, but not hikikomori women. Furthermore, after adjusting for all tested variables as possible confounding factors, being jobless and having fewer outdoor frequencies were associated with being a hikikomori man, and being a homemaker and having no social support were associated with being a hikikomori woman.Conclusion　Occupational status and outdoor frequencies are relevant factors for assessing the likelihood of being a hikikomori. Characteristics of hikikomori manifest differently in men and women. Having social support may help women avoid transitioning into a hikikomori. Incorporating emotional and mental health management into intervention programs may help better target potential beneficiaries among Japanese men.