Nonlinear Associations of Depression and Stigma With Subclinical Hikikomori in Cancer Survivors

Cancer survivors often experience depression and stigma associated with chronic diseases, which may increase the risk of subclinical hikikomori.

This study examined the prevalence of subclinical hikikomori and its nonlinear associations with depression and stigma among cancer patients.

A cross-sectional survey was conducted among 1951 cancer survivors. Depression and stigma associated with cancer were measured using the Patient Health Questionnaire-9 (PHQ-9) and Stigma Scale for Chronic Illnesses 8-Item Version (SSCI-8) scales, respectively, while subclinical hikikomori was assessed using the 1-month version of the validated 25-item Hikikomori Questionnaire (HQ-25M). Logistic regression and restricted cubic splines analysis were employed to explore the associations between depression, stigma, and subclinical hikikomori.

Of the 1951 cancer survivors, the prevalence of subclinical hikikomori was 21.6% (95% CI: 19.8%-23.5%). Both depression (OR = 1.06, 95% CI: 1.033-1.086, p < 0.001) and stigma (OR = 1.16, 95% CI: 1.132-1.182, p < 0.001) were significantly and positively associated with subclinical hikikomori. Nonlinear analyses revealed inflection points at PHQ-9 = 1.96 and SSCI = 9.41, beyond which the association between depression, stigma, and subclinical hikikomori significantly strengthened. Cancer survivors with chronic diseases, first-time cancer diagnoses, or a history of chemotherapy exhibited higher odds ratios of subclinical hikikomori across all measures.

Subclinical hikikomori was common among cancer survivors and was significantly associated with both depression and stigma. To prevent subclinical hikikomori, these findings underscore the importance of early intervention to address depression and stigma, especially for those with chronic health conditions, first-time cancer diagnoses, or prior chemotherapies.