Unmet Health Care Use Among Socially Withdrawn Youth (Hikikomori) in South Korea: Cross-Sectional Survey Study

Background Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth. Objective The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions. Methods Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses. Results The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force ( P for interaction <.05). Conclusions Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.