The prevalence and interrelationship between subclinical hikikomori and fear of COVID-19 among college students: the findings of a multicentre study from a network perspective

Subclinical hikikomori is a mild-moderate form of social withdrawal that does not meet the criteria for long-term isolation. Despite the widespread fear of COVID-19, the association with subclinical hikikomori has not been adequately studied. This study examined the prevalence of subclinical hikikomori and COVID-19 fear among college students and explored their interrelationships through network analysis. This multicenter study was conducted across four universities in China. The one-month version of the 25-item Hikikomori Questionnaire (HQ-25M) and the Fear of COVID-19 Scale were used to assess subclinical hikikomori and fear of COVID-19, respectively. Network analysis was conducted to examine the interconnections between symptoms of subclinical hikikomori and COVID-19 fear, identifying central and bridge symptoms using Expected Influence (EI) centrality and bridge EI indices. Of 6,514 students, 12.6% (824) exhibited subclinical hikikomori, and 44.6% (2,909) reported fear of COVID-19. Network analysis identified "I avoid talking with other people" (HQ18, EI=1.12) as the most central symptom, followed by “Palpitation when thinking about COVID-19” (FOC7, EI=1.09) and “There are few people I can discuss important issues with” (HQ14, EI=1.02). The key bridge symptoms were “Nervous when watching news about COVID-19” (FOC5, bridge EI=0.08), “Afraid of COVID-19” (FOC1, bridge EI=0.06), and “Uncomfortable to think about COVID-19” (FOC2, bridge EI=0.05). Both subclinical hikikomori and fear of COVID-19 were prevalent among Chinese college students. Identifying influential central and bridge symptoms could guide the development of targeted interventions to better treat and prevent comorbidities, ultimately informing future mental health strategies in the post-pandemic era.