3-day intervention program for family members of hikikomori sufferers: A pilot randomized controlled trial

Hiroaki Kubo; Hiromi Urata; Motohiro Sakai; Shunsuke Nonaka; Junji Kishimoto; Kazuhiko Saito; Masaru Tateno; Keiji Kobara; Daisuke Fujisawa; Naoki Hashimoto; Yuriko Suzuki; Yoko Honda; Tomohiro Nakao; Kotaro Otsuka; Shigenobu Kanba; Toshihide Kuroki; Takahiro A Kato

doi:10.3389/fpsyt.2022.1029653

3-day intervention program for family members of hikikomori sufferers: A pilot randomized controlled trial

Front Psychiatry. 2023 Jan 9:13:1029653. doi: 10.3389/fpsyt.2022.1029653. eCollection 2022.

Authors

Hiroaki Kubo^{1

2}, Hiromi Urata¹, Motohiro Sakai³, Shunsuke Nonaka⁴, Junji Kishimoto⁵, Kazuhiko Saito⁶, Masaru Tateno⁷, Keiji Kobara⁸, Daisuke Fujisawa⁹, Naoki Hashimoto¹⁰, Yuriko Suzuki¹¹, Yoko Honda¹², Tomohiro Nakao¹, Kotaro Otsuka¹³, Shigenobu Kanba¹, Toshihide Kuroki¹⁴, Takahiro A Kato¹

Affiliations

¹ Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Psychiatry, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
³ Faculty of Education, University of Miyazaki, Miyazaki, Japan.
⁴ School of Child Psychology, Tokyo Future University, Tokyo, Japan.
⁵ Center for Clinical and Translational Research, Kyushu University, Fukuoka, Japan.
⁶ Aiiku Research Institute, Imperial Gift Foundation Boshi-Aiiku-Kai, Tokyo, Japan.
⁷ Department of Neuropsychiatry, Sapporo Medical University, Sapporo, Japan.
⁸ Shimane Prefectural Counseling Center for Physical and Mental Health, Shimane, Japan.
⁹ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
¹⁰ Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
¹¹ Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
¹² Fukuoka City Mental Health and Welfare Center, Fukuoka, Japan.
¹³ Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Iwate, Japan.
¹⁴ Department of Clinical Psychology Practice, Graduate School of Human-Environment Studies, Kyushu University, Fukuoka, Japan.

Abstract

Backgrounds: Hikikomori, pathological social withdrawal, is becoming a crucial mental health issue in Japan and worldwide. We have developed a 3-day family intervention program for hikikomori sufferers based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). This study aims to confirm the effectiveness of the 3-day program by a randomized controlled trial.

Methods: This study was registered on the UMIN Clinical Trials Registry (UMIN000037289). Fifteen parents were assigned to the treat as usual (TAU) group (TAU only; Age Mean, 65.6; SD, 7.8), and 14 to the Program group (program + TAU; Age Mean, 67.9; SD, 8.6). This study was discontinued due to the COVID-19 pandemic; the recruitment rate was 36.3% of our target sample size of 80.

Results: Perceived skills improved temporally and stigma temporally worsened in the TAU group. Confidence decreased and attitude showed no change in both groups. Aggressive behaviors of hikikomori sufferers were significantly worsened in the Program group; however, no serious domestic violence was reported. In the TAU group, Avoidance and irregular life patterns were improved. Activity levels were worsened in both groups. Two participants (16.7%) in the Program group and one participant (7.7%) in the TAU group reported actual behavioral changes (e.g., utilizing support).

Conclusion: We could not draw general conclusions on the effectiveness of the program due to the study discontinuation. Nevertheless, this study indicates the necessity for revision of the program to improve family members' confidence in engaging with hikikomori sufferers, with safer approaching by families.

Keywords: RCT (randomized controlled trial); community reinforcement and family training (CRAFT); family intervention; mental health first aid (MHFA); pathological social withdrawal (hikikomori).

Grants and funding

This study was supported in part by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI grant Numbers: JP16H06403, JP18H04042, JP19K21591, JP20H01773, and JP22H00494) and the Japan Agency for Medical Research and Development (AMED: JP19dk0307073, JP18dk0307075, and JP21wm0425010).