The Prevalence of and Inter-Relationship Between Subclinical Hikikomori and Internet Addiction in Health-Related University Students: A Network Analysis Perspective

BACKGROUND: Hikikomori, a form of pathological social withdrawal or isolation, is increasingly recognized particularly among young people. This study examined the prevalence of subclinical hikikomori and Internet addiction and assessed their interrelationships from the perspective of network analysis among health-related university students. METHODS: A cross-sectional study was conducted from September to December 2023 in China. Subclinical hikikomori and Internet addiction were assessed using the 1-month version of the 25-item Hikikomori Questionnaire (HQ-25M) and the Internet Addiction Test (IAT), respectively. Expected Influence (EI) and bridge EI were used as centrality indices to characterize the structure of the symptoms of both conditions. RESULTS: A total of 3,845 health-related university students were assessed. The prevalence of subclinical hikikomori and Internet addiction was 12.4% (95% confidence interval [CI] [11.4%, 13.4%]) and 26.4% (95% CI [25.0%, 27.8%]), respectively. The most central symptoms in this network model were "I avoid talking with other people" (HQ18), followed by "Request an extension for longer time" (IAT16) and "Academic efficiency declines" (IAT8). Additionally, "I spend most of my time alone" (HQ4), "Form new relationship" (IAT4) and "I do not like to be seen by others" (HQ11) were identified as bridge symptoms linking the communities of subclinical hikikomori and Internet addiction symptoms. CONCLUSION: Both subclinical hikikomori and Internet addiction were common among Chinese health-related university students. Interventions should target central and bridge symptoms of these conditions to reduce the comorbidity among at-risk university students.