{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:55:39Z","timestamp":1792688139022,"version":"4.5.0"},"reference-count":90,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    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 \u2013December 2003) and round 10 (September 2020 \u2013May 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\u201364 years). A complex sampling design to obtain weighted prevalence and results was used. The study protocol was preregistered online on the Open Science Framework (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/6a7br\/\" xlink:type=\"simple\">https:\/\/osf.io\/6a7br\/<\/jats:ext-link>\n                    ). 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.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0291341","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T13:23:51Z","timestamp":1694525031000},"page":"e0291341","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["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\u20132020)"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1950-4351","authenticated-orcid":true,"given":"Simone","family":"Amendola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Cerutti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6973-0277","authenticated-orcid":true,"given":"Agnes","family":"von Wyl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"pone.0291341.ref001","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1146\/annurev.psych.60.110707.163642","article-title":"Social Withdrawal in Childhood.","volume":"60","author":"KH Rubin","year":"2009","journal-title":"Annu Rev Psychol."},{"key":"pone.0291341.ref002","doi-asserted-by":"crossref","first-page":"651","DOI":"10.2307\/1129376","article-title":"Nonsocial Play in Preschoolers: Necessarily Evil?","volume":"53","author":"KH Rubin","year":"1982","journal-title":"Child Dev."},{"key":"pone.0291341.ref003","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/cdep.12417","article-title":"Perspectives on Social Withdrawal in Childhood: Past, Present, and Prospects.","volume":"15","author":"KH Rubin","year":"2021","journal-title":"Child Dev Perspect."},{"key":"pone.0291341.ref004","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.neubiorev.2018.09.012","article-title":"Social brain, social dysfunction and social withdrawal.","volume":"97","author":"S Porcelli","year":"2019","journal-title":"Neurosci Biobehav Rev."},{"key":"pone.0291341.ref005","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1007\/s00127-017-1446-1","article-title":"Social isolation in mental health: a conceptual and methodological review.","volume":"52","author":"J Wang","year":"2017","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"pone.0291341.ref006","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s41398-022-02178-4","article-title":"The effects of social isolation stress and discrimination on mental health.","volume":"12","author":"L Brandt","year":"2022","journal-title":"Transl Psychiatry"},{"key":"pone.0291341.ref007","doi-asserted-by":"crossref","first-page":"e2236676","DOI":"10.1001\/jamanetworkopen.2022.36676","article-title":"Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis","volume":"5","author":"P Hoang","year":"2022","journal-title":"JAMA Netw Open"},{"key":"pone.0291341.ref008","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.puhe.2017.07.035","article-title":"An overview of systematic reviews on the public health consequences of social isolation and loneliness.","volume":"152","author":"N Leigh-Hunt","year":"2017","journal-title":"Public Health"},{"key":"pone.0291341.ref009","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/pcn.12895","article-title":"Hikikomori: Multidimensional understanding, assessment, and future international perspectives.","volume":"73","author":"TA Kato","year":"2019","journal-title":"PSYCHIATRY Clin Neurosci"},{"key":"pone.0291341.ref010","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2023.1199359","article-title":"Chaos and confusion in Hikikomori research. Commentary on \u201cThe suitability of outing frequency as a definition of hikikomori (prolonged social withdrawal).\u201d","volume":"14","author":"S Amendola","year":"2023","journal-title":"Front Psychiatry."},{"key":"pone.0291341.ref011","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"},{"key":"pone.0291341.ref012","volume-title":"Hikikomori: Adolescence Without End (J. Angles, Trans.). First published in Japan in 1998 by PHP Institute, Inc. [As Shakaiteki hikikomori: Owaranai shishunki].","author":"T. Sait\u014d","year":"2013"},{"key":"pone.0291341.ref013","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":"pone.0291341.ref014","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1177\/00048674221085917","article-title":"Who are hikikomori? Demographic and clinical features of hikikomori (prolonged social withdrawal): A systematic review.","volume":"56","author":"S Nonaka","year":"2022","journal-title":"Aust N Z J Psychiatry"},{"key":"pone.0291341.ref015","first-page":"237","article-title":"Characteristics of and gender difference factors of hikikomori among the working-age population: A cross-sectional population study in rural Japan.","volume":"67","author":"RKF Yong","year":"2020","journal-title":"Nihon Koshu Eisei Zasshi Jpn J Public Health"},{"key":"pone.0291341.ref016","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2015.01117","article-title":"The NEET and Hikikomori spectrum: Assessing the risks and consequences of becoming culturally marginalized.","volume":"6","author":"Y Uchida","year":"2015","journal-title":"Front Psychol."},{"key":"pone.0291341.ref017","first-page":"106","article-title":"Hikikomori, problematic internet use and psychopathology: correlates in non-clinical and clinical samples of young adults in Italy.","volume":"27","author":"S Amendola","year":"2021","journal-title":"J Psychopathol"},{"key":"pone.0291341.ref018","doi-asserted-by":"crossref","first-page":"10408","DOI":"10.3390\/ijerph191610408","article-title":"Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire for Adolescents.","volume":"19","author":"S Amendola","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0291341.ref019","doi-asserted-by":"crossref","first-page":"13552","DOI":"10.3390\/ijerph192013552","article-title":"Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire.","volume":"19","author":"S Amendola","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0291341.ref020","article-title":"Examining the hikikomori syndrome in a French sample of hospitalized adolescents with severe social withdrawal and school refusal behavior.","author":"X Benarous","year":"2022","journal-title":"Transcult Psychiatry."},{"key":"pone.0291341.ref021","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0020764017704474","article-title":"Characteristics of socially withdrawn youth in France: A retrospective study.","volume":"63","author":"N Chauliac","year":"2017","journal-title":"Int J Soc Psychiatry"},{"key":"pone.0291341.ref022","doi-asserted-by":"crossref","first-page":"558","DOI":"10.3389\/fpsyt.2019.00558","article-title":"Similar but Different: Psychological and Psychopathological Features of Primary and Secondary Hikikomori.","volume":"10","author":"I. Frankova","year":"2019","journal-title":"Front Psychiatry."},{"key":"pone.0291341.ref023","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1186\/s12888-022-04116-6","article-title":"Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents.","volume":"22","author":"Y Hamasaki","year":"2022","journal-title":"BMC Psychiatry"},{"key":"pone.0291341.ref024","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.psychres.2018.03.060","article-title":"A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal.","volume":"270","author":"\u00c1 Malag\u00f3n-Amor","year":"2018","journal-title":"Psychiatry Res."},{"key":"pone.0291341.ref025","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.psychres.2015.04.033","article-title":"Psychopathology associated with social withdrawal: Idiopathic and comorbid presentations.","volume":"228","author":"AR Teo","year":"2015","journal-title":"Psychiatry Res."},{"key":"pone.0291341.ref026","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/j.1440-1819.2011.02292.x","article-title":"Association of childhood family environments with the risk of social withdrawal (\u2019hikikomori\u2019) in the community population in Japan.","volume":"66","author":"World Mental Health Japan Survey Group 2002\u20132006","year":"2012","journal-title":"Psychiatry Clin Neurosci."},{"key":"pone.0291341.ref027","first-page":"5017","article-title":"Hikikomori: The Japanese Cabinet Office\u2019s 2016 Survey of Acute Social Withdrawal.","volume":"15","author":"N Tajan","year":"2017","journal-title":"Asia-Pac J."},{"key":"pone.0291341.ref028","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1177\/0020764014543711","article-title":"The prevalence and correlates of severe social withdrawal (hikikomori) in Hong Kong: A cross-sectional telephone-based survey study.","volume":"61","author":"PWC Wong","year":"2015","journal-title":"Int J Soc Psychiatry"},{"key":"pone.0291341.ref029","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.1192\/bjo.2021.47","article-title":"Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours","volume":"7","author":"S Zhu","year":"2021","journal-title":"BJPsych Open"},{"key":"pone.0291341.ref030","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/00221325.2019.1633618","article-title":"Severe Social Withdrawal: Cultural Variation in Past Hikikomori Experiences of University Students in Nigeria, Singapore, and the United States","volume":"180","author":"JC Bowker","year":"2019","journal-title":"J Genet Psychol"},{"key":"pone.0291341.ref031","unstructured":"European Social Survey European Research Infrastructure (ESS ERIC). ESS9\u2014integrated file, edition 3.1 [Data set]. Sikt\u2014Norwegian Agency for Shared Services in Education and Research; 2021. Available: https:\/\/doi.org\/10.21338\/ESS9E03_1."},{"key":"pone.0291341.ref032","unstructured":"European Social Survey European Research Infrastructure (ESS ERIC). ESS9 Data Documentation. Sikt\u2014Norwegian Agency for Shared Services in Education and Research; 2021. Available: https:\/\/doi.org\/10.21338\/NSD-ESS9-2018."},{"key":"pone.0291341.ref033","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/pcn.12043","article-title":"Home visitation program for detecting, evaluating and treating socially withdrawn youth in Korea.","volume":"67","author":"YS Lee","year":"2013","journal-title":"Psychiatry Clin Neurosci"},{"key":"pone.0291341.ref034","article-title":"Social Trust Scale (ESS).","author":"B. Breyer","year":"2015","journal-title":"ZIS\u2014Collect Items Scales Soc Sci"},{"key":"pone.0291341.ref035","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2298\/SOC2102419B","article-title":"Measuring the trust in the European values study and the European social survey.","volume":"63","author":"M. Besic","year":"2021","journal-title":"Sociologija"},{"key":"pone.0291341.ref036","article-title":"Guide to Using Weights and Sample Design.","author":"O. Kaminska","year":"2020","journal-title":"Indicators with ESS Data."},{"key":"pone.0291341.ref037","unstructured":"Lumley T. survey: analysis of complex survey samples. 2020. Available: https:\/\/cran.r-project.org\/web\/packages\/survey\/index.html."},{"key":"pone.0291341.ref038","first-page":"6","article-title":"The \u201chikikomori\u201d syndrome: Prevalence in the general and the psychiatric population. A systematic review and meta-analysis [La sindrome \u201chikikomori\u201d: Prevalenza nella popolazione generale e psichiatrica. Una systematic review con meta-analisi].","volume":"13","author":"A Pozza","year":"2019","journal-title":"Rassegna Ital Criminol."},{"key":"pone.0291341.ref039","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/pcn.13112","article-title":"Forced social isolation due to COVID-19 and consequent mental health problems: Lessons from hikikomori.","volume":"74","author":"TA Kato","year":"2020","journal-title":"Psychiatry Clin Neurosci"},{"key":"pone.0291341.ref040","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/wps.20804","article-title":"Hikikomori: a hidden mental health need following the COVID \u201019 pandemic.","volume":"19","author":"M Rooksby","year":"2020","journal-title":"World Psychiatry"},{"key":"pone.0291341.ref041","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1590\/1516-4446-2020-1145","article-title":"Hikikomori and the covid-19 pandemic: Not leaving behind the socially withdrawn.","volume":"43","author":"TH Roza","year":"2021","journal-title":"Braz J Psychiatry."},{"key":"pone.0291341.ref042","doi-asserted-by":"crossref","first-page":"102288","DOI":"10.1016\/j.ajp.2020.102288","article-title":"Potential changes to the hikikimori phenomenon in the wake of the Covid-19 pandemic.","volume":"54","author":"PWC Wong","year":"2020","journal-title":"Asian J Psychiatry"},{"key":"pone.0291341.ref043","doi-asserted-by":"crossref","first-page":"101331","DOI":"10.1016\/j.ssmph.2022.101331","article-title":"US trends in social isolation, social engagement, and companionship \u23af nationally and by age, sex, race\/ethnicity, family income, and work hours, 2003\u20132020.","volume":"21","author":"VD Kannan","year":"2023","journal-title":"SSM\u2014Popul Health"},{"key":"pone.0291341.ref044","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/geronb\/gby037","article-title":"The Epidemiology of Social Isolation: National Health and Aging Trends Study","volume":"75","author":"TKM Cudjoe","year":"2020","journal-title":"J Gerontol Ser B"},{"key":"pone.0291341.ref045","first-page":"114204","article-title":"The isolation paradox: A comparative study of social support and health across migrant generations in the U.S. Soc Sci Med.","volume":"283","author":"B Bilecen","year":"2021"},{"key":"pone.0291341.ref046","volume-title":"Loneliness and Social Isolation: An Unequally Shared Burden in Europe.","author":"B d\u2019Hombres","year":"2021"},{"key":"pone.0291341.ref047","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1017\/S0144686X1000139X","article-title":"Age and loneliness in 25 European nations.","volume":"31","author":"K Yang","year":"2011","journal-title":"Ageing Soc."},{"key":"pone.0291341.ref048","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s10433-012-0248-2","article-title":"Loneliness in old age in Eastern and Western European societies: theoretical perspectives.","volume":"9","author":"J de Jong Gierveld","year":"2012","journal-title":"Eur J Ageing."},{"key":"pone.0291341.ref049","doi-asserted-by":"crossref","first-page":"e067068","DOI":"10.1136\/bmj-2021-067068","article-title":"The prevalence of loneliness across 113 countries: systematic review and meta-analysis","volume":"376","author":"DL Surkalim","year":"2022","journal-title":"BMJ"},{"key":"pone.0291341.ref050","first-page":"173","article-title":"The macroeconomic determinants of NEET: a panel data analysis for fragile five countries and Russia.","volume":"18","author":"U Bing\u00f6l","year":"2020","journal-title":"J Manag Econ Res"},{"key":"pone.0291341.ref051","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s11205-020-02270-6","article-title":"Being NEET in Europe Before and After the Economic Crisis: An Analysis of the Micro and Macro Determinants.","volume":"149","author":"FE Caroleo","year":"2020","journal-title":"Soc Indic Res."},{"key":"pone.0291341.ref052","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1057\/ces.2014.27","article-title":"The Rise of NEET and Youth Unemployment in EU Regions after the Crisis.","volume":"56","author":"GSF Bruno","year":"2014","journal-title":"Comp Econ Stud."},{"key":"pone.0291341.ref053","doi-asserted-by":"crossref","first-page":"115122","DOI":"10.1016\/j.socscimed.2022.115122","article-title":"Economic gradients in loneliness, social isolation and social support: Evidence from the UK Biobank.","volume":"306","author":"CSJ Kung","year":"2022","journal-title":"Soc Sci Med."},{"key":"pone.0291341.ref054","doi-asserted-by":"crossref","first-page":"384","DOI":"10.3390\/youth2030028","article-title":"Macro-Determinants of NEET: An Ecological Study at the Country Level of Analysis for the Period 1997\u20132020.","volume":"2","author":"S. Amendola","year":"2022","journal-title":"Youth"},{"key":"pone.0291341.ref055","doi-asserted-by":"crossref","first-page":"e0274518","DOI":"10.1371\/journal.pone.0274518","article-title":"Income inequality and its relationship with loneliness prevalence: A cross-sectional study among older adults in the US and 16 European countries.","volume":"17","author":"T Tapia-Mu\u00f1oz","year":"2022","journal-title":"PLOS ONE"},{"key":"pone.0291341.ref056","doi-asserted-by":"crossref","first-page":"100965","DOI":"10.1016\/j.dhjo.2020.100965","article-title":"Loneliness, social support, social isolation and wellbeing among working age adults with and without disability: Cross-sectional study.","volume":"14","author":"E Emerson","year":"2021","journal-title":"Disabil Health J"},{"key":"pone.0291341.ref057","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/ageing\/afaa271","article-title":"Social isolation, loneliness and functional disability in Chinese older women and men: a longitudinal study.","volume":"50","author":"L Guo","year":"2021","journal-title":"Age Ageing"},{"key":"pone.0291341.ref058","doi-asserted-by":"crossref","first-page":"e80655","DOI":"10.1371\/journal.pone.0080655","article-title":"Does social isolation and low societal participation predict disability pension? A population based study.","volume":"8","author":"K Gustafsson","year":"2013","journal-title":"PloS One"},{"key":"pone.0291341.ref059","article-title":"Impact of technology on social isolation: Longitudinal analysis from the National Health Aging Trends Study.","author":"ME Umoh","year":"2022","journal-title":"J Am Geriatr Soc."},{"key":"pone.0291341.ref060","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jad.2022.05.057","article-title":"A network analysis on the relationship between loneliness and schizotypy","volume":"311","author":"AKC Chau","year":"2022","journal-title":"J Affect Disord"},{"key":"pone.0291341.ref061","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/0091415019871201","article-title":"Beyond the Individual: Evidence Linking Neighborhood Trust and Social Isolation Among Community-Dwelling Older Adults.","volume":"92","author":"J Yang","year":"2021","journal-title":"Int J Aging Hum Dev."},{"key":"pone.0291341.ref062","first-page":"1","article-title":"The Importance of Different Forms of Social Capital for Happiness in Europe: A Multilevel Structural Equation Model (GSEM).","author":"L G\u00f3mez-Balc\u00e1cer","year":"2022","journal-title":"Appl Res Qual Life."},{"key":"pone.0291341.ref063","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1080\/15298868.2020.1779119","article-title":"Social exclusion reduces happiness by creating expectations of future rejection.","volume":"20","author":"H Sj\u00e5stad","year":"2021","journal-title":"Self Identity"},{"key":"pone.0291341.ref064","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.paid.2015.03.006","article-title":"Relationships between general self-efficacy, planning for the future, and life satisfaction.","volume":"82","author":"N Azizli","year":"2015","journal-title":"Personal Individ Differ"},{"key":"pone.0291341.ref065","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1037\/0882-7974.16.2.206","article-title":"Planning for the future: A life management strategy for increasing control and life satisfaction in adulthood.","volume":"16","author":"KM Prenda","year":"2001","journal-title":"Psychol Aging."},{"key":"pone.0291341.ref066","volume-title":"Mental Health and Social Withdrawal in Contemporary Japan: Beyond the Hikikomori Spectrum","author":"N. Tajan","year":"2022"},{"key":"pone.0291341.ref067","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013","edition":"5"},{"key":"pone.0291341.ref068","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jad.2012.07.004","article-title":"Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research","volume":"145","author":"O Friborg","year":"2013","journal-title":"J Affect Disord"},{"key":"pone.0291341.ref069","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1177\/1039856215592319","article-title":"Social anxiety disorders in clinical practice: differentiating social phobia from avoidant personality disorder.","volume":"23","author":"L. Lampe","year":"2015","journal-title":"Australas Psychiatry"},{"key":"pone.0291341.ref070","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0005-7967(97)00022-3","article-title":"A cognitive-behavioral model of anxiety in social phobia.","volume":"35","author":"RM Rapee","year":"1997","journal-title":"Behav Res Ther"},{"key":"pone.0291341.ref071","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S0924-9338(00)00240-6","article-title":"The relationship of social phobia to avoidant personality disorder: a proposal to reclassify avoidant personality disorder based on clinical empirical findings.","volume":"15","author":"J. Reich","year":"2000","journal-title":"Eur Psychiatry"},{"key":"pone.0291341.ref072","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11920-009-0014-0","article-title":"Avoidant Personality Disorder and Its Relationship to Social Phobia.","volume":"11","author":"J. Reich","year":"2009","journal-title":"Curr Psychiatry Rep."},{"key":"pone.0291341.ref073","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/08039480410005530","article-title":"Social phobia and avoidant personality disorder: One spectrum disorder?","volume":"58","author":"M Tillfors","year":"2004","journal-title":"Nord J Psychiatry"},{"key":"pone.0291341.ref074","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0887-6185(00)00030-X","article-title":"Generalized social phobia versus avoidant personality disorder: differences in psychopathology, personality traits, and social and occupational functioning.","volume":"14","author":"CJ van Velzen","year":"2000","journal-title":"J Anxiety Disord"},{"key":"pone.0291341.ref075","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1600-0447.1996.tb10626.x","article-title":"Avoidant personality disorder and taijin kyoufu: Sociocultural implications of the WHO\/ADAMHA International Study of Personality Disorders in Japan.","volume":"93","author":"Y Ono","year":"1996","journal-title":"Acta Psychiatr Scand"},{"key":"pone.0291341.ref076","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1037\/abn0000124","article-title":"Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study.","volume":"125","author":"FA Torvik","year":"2016","journal-title":"J Abnorm Psychol"},{"key":"pone.0291341.ref077","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1521\/pedi_2018_32_341","article-title":"Relationships Among Avoidant Personality Disorder, Social Anxiety Disorder, and Normative Personality Traits: A Twin Study.","volume":"33","author":"A Welander-Vatn","year":"2019","journal-title":"J Personal Disord"},{"key":"pone.0291341.ref078","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/papt.12214","article-title":"Social anxiety disorder and avoidant personality disorder from an interpersonal perspective.","volume":"93","author":"FW Frandsen","year":"2020","journal-title":"Psychol Psychother Theory Res Pract"},{"key":"pone.0291341.ref079","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1017\/S0033291714002116","article-title":"Population-based, multi-generational family clustering study of social anxiety disorder and avoidant personality disorder","volume":"45","author":"K Isomura","year":"2015","journal-title":"Psychol Med"},{"key":"pone.0291341.ref080","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.janxdis.2012.05.004","article-title":"Avoidant personality disorder in individuals with generalized social anxiety disorder: What does it add?","volume":"26","author":"L Marques","year":"2012","journal-title":"J Anxiety Disord."},{"key":"pone.0291341.ref081","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/0020764011423184","article-title":"Comorbid social withdrawal (hikikomori) in outpatients with social anxiety disorder: Clinical characteristics and treatment response in a case series","volume":"59","author":"T Nagata","year":"2013","journal-title":"Int J Soc Psychiatry"},{"key":"pone.0291341.ref082","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/da.20475","article-title":"The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey.","volume":"26","author":"BJ Cox","year":"2009","journal-title":"Depress Anxiety"},{"key":"pone.0291341.ref083","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1002\/wps.20705","article-title":"Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori.","volume":"19","author":"TA Kato","year":"2020","journal-title":"World Psychiatry"},{"key":"pone.0291341.ref084","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1038\/s41598-018-21260-w","article-title":"Blood biomarkers of Hikikomori, a severe social withdrawal syndrome.","volume":"8","author":"K Hayakawa","year":"2018","journal-title":"Sci Rep."},{"key":"pone.0291341.ref085","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/0010-440X(91)90022-5","article-title":"Social breakdown in the elderly, II. Sociodemographic data and psychopathology.","volume":"32","author":"GS Ungvari","year":"1991","journal-title":"Compr Psychiatry."},{"key":"pone.0291341.ref086","article-title":"Commentary on \u201cOne month version of Hikikomori Questionnaire-25 (HQ-25M): Development and initial validation.\u201d","author":"S Amendola","year":"2023","journal-title":"OSF Preprints"},{"key":"pone.0291341.ref087","volume-title":"Hikikomori: indagine sul ritiro sociale volontario dei giovani italiani. Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche di Pisa (CNR-IFC), Gruppo Abele","author":"S Cerrai","year":"2023"},{"key":"pone.0291341.ref088","first-page":"129","article-title":"Hikikomori: la sofferenza silenziosa dei giovani [Hikikomori: the silent suffering among young people].","volume":"56","author":"R Cerutti","year":"2021","journal-title":"Riv Psichiatr"},{"key":"pone.0291341.ref089","unstructured":"Ufficio Scolastico Regionale per l\u2019Emilia-Romagna. Adolescenti \u201cEremiti Sociali\u201d. Rilevazione nelle scuole dell\u2019Emilia-Romagna degli alunni che non frequentano, \u201critirati\u201d in casa, per motivi psicologici. Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca; 2018. Available: https:\/\/bit.ly\/3rC7KtJ."},{"key":"pone.0291341.ref090","volume-title":"Vite in disparte. Prima indagine sul ritiro sociale volontario nella popolazione scolastica italiana. Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche di Pisa (CNR-IFC), Gruppo Abele","author":"S Cerrai","year":"2023"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T13:24:36Z","timestamp":1694525076000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291341"}},"subtitle":[],"editor":[{"given":"Srebrenka","family":"Letina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,9,12]]},"references-count":90,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0291341","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,12]]}}}