Abstract
BACKGROUND: Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth. OBJECTIVE: The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions. METHODS: Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses. RESULTS: The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force (P for interaction <.05). CONCLUSIONS: Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.