key: cord-0889634-eycq2j3f authors: Kato, Takahiro A.; Sartorius, Norman; Shinfuku, Naotaka title: Forced social isolation due to COVID‐19 and consequent mental health problems: Lessons from hikikomori date: 2020-07-27 journal: Psychiatry Clin Neurosci DOI: 10.1111/pcn.13112 sha: 51ff45842961afc7badb40bd0b4cd30d9cdea858 doc_id: 889634 cord_uid: eycq2j3f nan on Internet communication, social isolation, and mental health problems, including Internet addiction, 8 and that therefore social isolation and the reliance on the simple virtual tools widely used during the current crisis elevate the risk of Internet addiction and other disturbances of mental health. It is possible that the introduction of 'face-to-face'-like communication systems with innovative technologies, such as virtual reality and humanoid robotics, would prevent or reduce COVID-19-induced mental health problems. Even though no statistical data exist, there are anecdotal examples of people in Japan and perhaps elsewhere who fear that their COVID-19-positive status might become known in their community and this makes them hesitate to take a polymerase chain reaction testa behavior similar to that of individuals with hikikomori and their family members, who avoid contact with psychiatrists in order to avoid being given a psychiatric diagnosis. In Japan and some Asian countries, both fears are probably deeply rooted in traditional-culture-based shame (haji) and social ostracism (murahachibu), which have, during past epidemics and economic crises, often led those sick or financially ruined to commit suicide. 3, 9 Recent reports of COVID-19-related suicides might support this hypothesis. 9 Action against COVID-19 must therefore include a component addressing the prevention of stigmatization of the disease to avoid covert spread of the disease and other consequences of stigma related to the disease, such as depression and suicide. Generally, hikikomori support programs are designed to change avoidance behaviors of persons with hikikomori. 5 We have recently developed a family-based educational program to reduce the stigma toward psychiatric disorders and the risk of family violence, suicide, and other mental disturbances due to hikikomori, using lectures and role-play sessions. 10 This program is based on the Mental Health First Aid, which aids in the detection of early signs of mental health problems before onset, and the Community Reinforcement and Family Training that was originally developed for family members of individuals with addiction disorders. 10 We believe that these hikikomori support programs especially using online educational systems might be useful in the effort to make social isolation more tolerable and prevent its negative consequences. COVID-19 may be changing global society in fundamental ways, hastening the online revolution as virtual spaces and environments supersede traditional boundaries, such as the urban and rural. To overcome this current chaos, psychiatric specialists along with experts from a wideranging number of fields, such as psychology, engineering, sociology, and politics, must take action to provide for the new reality of global mental health. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts Hikikomori: Experience in Japan and international relevance Hikikomori: Multidimensional understanding, assessment, and future international perspectives Are Japan's hikikomori and depression in young people spreading abroad? Guideline of hikikomori for their evaluation and support Defining pathological social withdrawal: Proposed diagnostic criteria for hikikomori Understanding, compliance and psychological impact of the SARS quarantine experience Internet society, internet addiction, and pathological social withdrawal: The chicken and egg dilemma for internet addiction and hikikomori First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies Development of 5-day hikikomori intervention program for family members: A single-arm pilot trial This work was partially supported by a Grant-in-Aid for Scientific Research on (i) Innovative Areas 'Will-Dynamics' of the Ministry of Education, Culture, Sports, Science, and Technology, Japan (JP16H06403 to T.A.K.); and (ii) the Japan Agency for Medical Research and Development (Syogaisya-Taisaku-Sogo-Kenkyu-Kaihatsu-Jigyo to T.A.K.; JP19dk0307073 and JP19dk0307075). All authors declare that they have no conflicts of interest.