From Invisible to Visible: Identifying, Understanding and Helping Socially Withdrawn Youth

This dissertation, "From Invisible to Visible: Identifying, Understanding and Helping Socially Withdrawn Youth" by Man-ho, Li, 李汶浩, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Typical characteristics of socially withdrawn youths include seclusion at home, absence from school or work, and minimal social contact. This phenomenon, called hikikomori in Japan or youth social withdrawal in other countries, has raised concern in technologically advanced high-income societies. Unfortunately, socially withdrawn youths are difficult to identify and their risks can be 'invisible' because of their withdrawn nature. Study 1 in this thesis presents a systematic review of the available scientific information on youth social withdrawal in the academic databases: ProQuest, ScienceDirect, Web of Science and PubMed. 42 articles published in English and academic peer-reviewed journals were reviewed and synthesized into the following categories: definitions of youth social withdrawal, developmental theories, factors associated with youth social withdrawal and interventions for socially withdrawn youths. A theoretical framework depicting youth social withdrawal as a result of the interplay between psychological, social, and behavioral factors was proposed; and different interventions for different trajectories of youth social withdrawal were suggested. Study 2 was a cross-sectional telephone-based survey which explored the youth social withdrawal phenomenon in Hong Kong. Socially withdrawn youths were categorized according to the (1) proposed duration criterion used internationally (withdrawn for more than six months); and (2) locally (withdrawn for less than six months); and (3) self-perception as non-problematic. The prevalence of youth social withdrawal in Hong Kong (1.9%) was comparable to that in Japan. The correlates of social withdrawal among the three groups were examined using multinomial and ordinal logistic regression. The change of withdrawal behaviors in the framework was examined. Study 3 was a qualitative study which aimed to fill the research gap about the engagement of socially withdrawn youths. Thirty interviews of socially withdrawn youths in Hong Kong were conducted. By thematic analysis and grounded theory, their perspectives on withdrawal were conceptualized into withdrawal as suspension of experience, withdrawal as a defriending spiral and withdrawal as a private status. Their motivation to come out was conceptualized into desire to move forward, reconnection with tuned-in people and compromise between self and reality. The findings further established the framework. Study 4 was an interventional study which adopted a pre-post design to evaluate a pilot multicomponent program (n = 56) for enhancing self-esteem, employability, and reducing interaction anxiety of socially withdrawn youths in Hong Kong. A repeated measures ANOVA was conducted for each scale to compare mean scores over time (within-subjects factor) and between intervention groups (animal-assisted therapy vs. other interventional components) and withdrawal groups (the more than and less than three months' group without mental disorder, and social withdrawal group with mental disorder; between-subjects factor). The study provided empirical evidence for the matching between withdrawal behaviors and types of intervention in the framework. Through these four studies, a framework was proposed, validated and established to advance knowledge and interventions for youth social withdrawal in high-income countries. This thesis forms the basic foundation of scienti