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

Shimin Zhu, Paul H. Lee, Paul W.C. Wong

Research output: Journal article publicationJournal articleAcademic researchpeer-review

14 Citations (Scopus)


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.

Original languageEnglish
Article numbere90
JournalBJPsych Open
Issue number3
Publication statusPublished - 30 Apr 2021


  • China
  • hikikomori
  • prolonged social withdrawal behaviour
  • Self-harm
  • suicidal behaviour

ASJC Scopus subject areas

  • Psychiatry and Mental health


Dive into the research topics of 'Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours'. Together they form a unique fingerprint.

Cite this