{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:59:53Z","timestamp":1785347993990,"version":"3.55.0"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006785","name":"Google","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006785","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>\n                    Video-games could help players deal with\n                    <jats:italic>hikikomori<\/jats:italic>\n                    \u2013 extreme social withdrawal. However, it is still unclear what game elements are preferred by this audience, and thus it is difficult to design game-based interventions for them. To address this gap, we investigated the gaming preferences of hikikomori players through a survey (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009529). To focus on those at higher risk of becoming hikikomori, participants were categorized into High and Low Hikikomori Risk (H-NHR and L-NHR) using the NEET-Hikikomori Risk (NHR) scale. Open-ended questions were asked about participants\u2019 opinions towards favourite games, single-player, multiplayer, and online games. We quantitatively compared favourite game genres and hikikomori risk tendencies, finding no significant relationship between the two groups. Inductive thematic analysis showed that H-NHR players reported experiencing more negative player interactions, preferring cooperative over competitive gameplay. These resonate with the heightened social anxiety and sensitivity to social rejection that have been known to exacerbate the hikikomori condition. Moreover, there were several positive mentions of action, adventure, narrative, and strategic gameplay elements from the H-NHR group. From our findings, we summarise game design features that could be used in future game-based interventions to help hikikomori players overcome their social withdrawal without worsening their conditions, such as short play sessions, simple mechanics, involving narratives and location-based elements.\n                  <\/jats:p>","DOI":"10.1371\/journal.pmen.0000517","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:21:10Z","timestamp":1785345670000},"page":"e0000517","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extreme social isolation risk is associated with story-driven, strategic and cooperative-first gameplay preferences"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8650-6006","authenticated-orcid":true,"given":"Brian","family":"Confessor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0486-1743","authenticated-orcid":true,"given":"Monica","family":"Perusqu\u00eda-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kongmeng","family":"Liew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panote","family":"Siriaraya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoriko","family":"Matsuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Hirao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6119-1184","authenticated-orcid":true,"given":"Hideaki","family":"Uchiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2260-1707","authenticated-orcid":true,"given":"Kiyoshi","family":"Kiyokawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"issue":"6","key":"pmen.0000517.ref001","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/NMD.0b013e3181e086b1","article-title":"Hikikomori, a Japanese culture-bound syndrome of social withdrawal?: A proposal for DSM-5","volume":"198","author":"AR Teo","year":"2010","journal-title":"J Nerv Ment Dis"},{"key":"pmen.0000517.ref002","volume-title":"Hikikomori: Adolescence without end","author":"S Tamaki","year":"2013"},{"issue":"1","key":"pmen.0000517.ref003","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.psychres.2008.10.019","article-title":"Lifetime prevalence, psychiatric comorbidity and demographic correlates of \u201chikikomori\u201d in a community population in Japan","volume":"176","author":"A Koyama","year":"2010","journal-title":"Psychiatry Res"},{"issue":"7","key":"pmen.0000517.ref004","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s00127-011-0411-7","article-title":"Does the \u201chikikomori\u201d syndrome of social withdrawal exist outside Japan? 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