Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours

Background Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour. Aims To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students. Method A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status. Results Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22–3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45–3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses. Conclusions Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.

Spitz was right. A Moroccan validation of the Alarm Distress Baby (ADBB) scale A comparison of social withdrawal behaviour levels between infants raised in children’s home and infants raised by their own families and a validation of René Spitz’s hypothesis on the causes of ‘hospitalism’ and ‘anaclitic depression’

Social withdrawal behaviour in infants is a key indicator of child distress and a risk factor for later pathologies. The present study provides results from a Moroccan study of the ADBB scale applied to two populations that were very different in terms of early separation experiences: babies living in a children’s home (n=46) and babies raised by their families (n=56). These 102 infants were assessed using the ADBB scale during routine paediatric check-ups between the ages of 2 and 18 months. Social withdrawal behaviour was significantly more marked among infants raised in a children’s home than among infants raised by their family, and more so among boys than among girls. This study comprising a control group confirmed the validity of Spitz’s description, which placed social withdrawal at the centre of anaclitic depression and of the causes of hospitalism, and attributed this withdrawal to the infants’ early and prolonged separation from their caregivers. The use of the scale stay therefore be recommended for systematic detection during routine paediatric check-ups or for the follow-up of children at risk, to enable appropriate early interventions to take place.