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Cited by 86Psychological Treatments and DisordersMental Health and PsychiatryTreatment of Major Depression

Multidimensional anatomy of ‘modern type depression’ in J apan: A proposal for a different diagnostic approach to depression beyond the DSM‐5

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Kato, Takahiro A., Hashimoto, Ryota, Hayakawa, Kohei, Kubo, Hiroaki, Watabe, Motoki, Teo, Alan R., Kanba, Shigenobu·2016·Psychiatry and Clinical Neurosciences
DOI 10.1111/pcn.12360PMC PMC5560068
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Abstract

J apan's prototype of depression was traditionally a melancholic depression based on the premorbid personality known as shūchaku‐kishitsu proposed by M itsuzo S himoda in the 1930s. However, since around 2000, a novel form of depression has emerged among Japanese youth. Called ‘modern type depression (MTD)’ by the mass media, the term has quickly gained popularity among the general public, though it has not been regarded as an official medical term. Likewise, lack of consensus guidelines for its diagnosis and treatment, and a dearth of scientific literature on MTD has led to confusion when dealing with it in clinical practice in J apan. In this review article, we summarize and discuss the present situation and issues regarding MTD by focusing on historical, diagnostic, psychosocial, and cultural perspectives. We also draw on international perspectives that begin to suggest that MTD is a phenomenon that may exist not only in J apan but also in many other countries with different sociocultural and historical backgrounds. It is therefore of interest to establish whether MTD is a culture‐specific phenomenon in J apan or a syndrome that can be classified using international diagnostic criteria as contained in the ICD or the DSM. We propose a novel diagnostic approach for depression that addresses MTD in order to combat the current confusion about depression under the present diagnostic systems.

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  • In Japan, hikikomori is associated with paternal absence, close contact with the mother, and lack of independence.

    “In Japan, hikikomori is associated with paternal absence, close contact with the mother, and lack of independence [6, 50].”

    From Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents (2022) · cites this paper as [50]

    The “MTD and hikikomori based on amae” section says hikikomori may be indirectly promoted by parental acceptance of a child staying home and discusses young people’s economic dependence on parents. It does not identify paternal absence or close contact with the mother as associations, and its account of dependence is more tentative than the citing sentence. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • An absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children's independence have been repeatedly mentioned in previous studies as factors in the occurrence of hikikomori in Japan.

    “An absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children’s independence have been repeatedly mentioned in previous studies as factors in the occurrence of hikikomori in Japan”

    From Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents (2022) · cites this paper as [50]

    The “MTD and hikikomori based on amae” section (page not provided) suggests that parental acceptance of a child staying home may indirectly promote hikikomori and discusses dependence on parents. It does not identify an absent father, mother–child over-closeness or over-interference, or inhibited independence as factors repeatedly mentioned in previous studies. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Previous Japanese studies have reported an association of hikikomori with paternal absence, close contact with the mother, and lack of independence.

    “Previous Japanese studies have reported an association of hikikomori with paternal absence, close contact with the mother, and lack of independence”

    From Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents (2022) · cites this paper as [50]

    The “MTD and hikikomori based on amae” section (page unavailable) suggests that parental acceptance and continued dependence may contribute to hikikomori, which partly supports the lack-of-independence component. It does not report an association with paternal absence or specifically close contact with the mother, and presents the dependence link as a possibility rather than an established association. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 66

  1. Hamilton M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 1960; 23: 56-62.
  2. Furukawa TA, Streiner DL, Azuma H et al. Cross-cultural equivalence in depression assessment: Japan-Europe- North American study. Acta Psychiatr. Scand. 2005; 112: 279-285.
  3. Kato TA, Shinfuku N, Fujisawa D et al. Introducing the concept of modern depression in Japan: An international case vignette survey. J. Affect. Disord. 2011; 135: 66-76.
  4. Tarumi S, Kanba S. Sociocultural approach toward depres- sion -Dysthymic type depression. Jpn Bull. Soc. Psychiatr. 2005; 13: 129-136 (in Japanese).
  5. Tarumi S. The 'new' variant of depression: The dysthymic type. Jpn J. Clin. Psychiatr. 2005; 34: 687-694 (in Japanese).
  6. Benazzi F. Testing atypical depression definitions. Int. J. Methods Psychiatr. Res. 2005; 14: 82-91.
  7. Akiskal HS, Akiskal KK, Perugi G, Toni C, Ruffolo G, Tusini G. Bipolar II and anxious reactive 'comorbidity': Toward better phenotypic characterization suitable for genotyping. J. Affect. Disord. 2006; 96: 239-247.
  8. Shimoda M. On the treatment of involutional depression in my department. Taiwan Igaku Zasshi 1932; 31: 113-115 (in Japanese).
  9. Tellenbach H. Melancholie. Springer, Berlin, 1961.
  10. Kasahara Y, Kimura B. Utsu-byo no rinshoteki-bunrui ni kansuru kenkyu. Seishin Shinkeigaku Zasshi 1975; 77: 715- 735 (in Japanese).
  11. Hirose T. Tohi-gata utsu-byo ni tsuite. In: Miyamoto T (ed.). Sou-utsu-byo no seishin-byori 2 [Psychopathology of Manic-Depressive Illness 2]. Kobundo, Tokyo, 1977; 61-86.
  12. Matsunami K, Yamashita Y. Syakai-hendo to utsu-byo [Social changes and depression]. Jpn Bull. Soc. Psychiatr. 1991; 14: 193-200 (in Japanese).
  13. Abe T, Otsuka K, Nagano M, Kato S, Miyamoto T. A con- sideration on 'Immature Type of Depression': Premorbid personalities and clinical pictures of depression from the structural-dynamic viewpoint (W. Janzarik). Jpn Clin. Psychopathol. 1995; 16: 239-248 (in Japanese).
  14. Klein DF, Liebowitz MR. Hysteroid dysphoria. Am. J. Psy- chiatry 1982; 139: 1520-1521.
  15. Kato TA, Shinfuku N, Sartorius N, Kanba S. Are Japan's hikikomori and depression in young people spreading abroad? Lancet 2011; 378: 1070.
  16. Shimoda M. Shuchaku-kishitsu ni tsuite. Yonago Igaku Zasshi 1950; 2: 1-2 (in Japanese).
  17. Kanba S. Modern interpretation of Shimoda's shuchaku- kishitsu. Kyushu Neuro-Psychiatry 2006; 52: 79-88 (in Japa- nese).
  18. Ohmae S. The modern concept of atypical depression: Four definitions. Seishin Shinkeigaku Zasshi 2010; 112: 3-22 (in Japanese).
  19. Akiskal HS. Dysthymic disorder: Psychopathology of pro- posed chronic depressive subtypes. Am. J. Psychiatry 1983; 140: 11-20.
  20. Hirose T. Depression of avoidant type compared with depression of dysthymic type. Jpn J. Clin. Psychiatr. 2008; 37: 1179-1182 (in Japanese).
  21. Abe T. Depression from the viewpoint of life stage: Diag- nosis and treatment. Jpn J. Psychosom. Med. 2009; 49: 987- 993 (in Japanese).
  22. Furukawa T, Nakanishi M, Hamanaka T. Typus melancholicus is not the premorbid personality trait of unipolar (endogenous) depression. Psychiatry Clin. Neurosci. 1997; 51: 197-202.
  23. Kanba S, Kano R, Eguchi S, Utsumi T, Abe T. Has the prototype of depression been shifted? Jpn J. Clin. Psychiatr. 2008; 37: 1091-1109 (in Japanese).
  24. Kotov R, Gamez W, Schmidt F, Watson D. Linking 'big' personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychol. Bull. 2010; 136: 768- 821.
  25. Watson D, Clark LA. Depression and the melancholic tem- perament. Eur. J. Pers. 1995; 9: 351-366.
  26. Tseng WS. Handbook of Cultural Psychiatry. Academic Press, San Diego, CA, 2001.
  27. Ogata Y, Izumi Y, Kitaike T. Mobile-phone e-mail use, social networks, and loneliness among Japanese high school students. Nippon Koshu Eisei Zasshi 2006; 53: 480- 492 (in Japanese).
  28. Kim SY, Kim MH, Kawachi I, Cho Y. Comparative epide- miology of suicide sin South Korea and Japan: Effects of age, gender and suicide methods. Crisis 2011; 32: 5-14.
  29. Kato TA, Tateno M, Shinfuku N et al. Does the 'hikikomori' syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc. Psy- chiatry Psychiatr. Epidemiol. 2012; 47: 1061-1075.
  30. Niiya Y, Ellsworth PC, Yamaguchi S. Amae in Japan and the United States: An exploration of a 'culturally unique' emotion. Emotion 2006; 6: 279-295.
  31. Teo AR, Stufflebam K, Saha S et al. Psychopathology asso- ciated with social withdrawal: Idiopathic and comorbid presentations. Psychiatry Res. 2015; 228: 182-183.
  32. Yamagishi T. Trust -The Evolutionary Game of Mind and Society. Springer Tokyo, Tokyo, 2011.
  33. Yamagishi T, Cook KS, Watabe M. Uncertainty, trust, and commitment formation in the United States and Japan. Am. J. Sociol. 1998; 104: 165-194.
  34. Cross SE, Hardin EE, Gercek-Swing B. The what, how, why, and where of self-construal. Pers. Soc. Psychol. Rev. 2011; 15: 142-179.
  35. Markus HR, Kitayama S. Culture and the self: Implications for cognition, emotion, and motivation. Psychol. Rev. 1991; 98: 224-253.
  36. Oyserman D, Coon HM, Kemmelmeier M. Rethinking individualism and collectivism: Evaluation of theoretical assumptions and meta-analyses. Psychol. Bull. 2002; 128: 3-72.
  37. Matsumoto D. Culture and self: An empirical assessment of Markus and Kitayama's theory of independent and interdependent self-construals. Asian J. Soc. Psychol. 1999; 2: 289-310.
  38. Levine TR, Bresnahan MJ, Park HS et al. Self-construal scales lack validity. Hum. Commun. Res. 2003; 29: 210- 252.
  39. Hashimoto H, Yamagishi T. Two faces of interdependence: Harmony seeking and rejection avoidance. Asian J. Soc. Psychol. 2013; 16: 142-151.
  40. Holsboer F. The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology 2000; 23: 477- 501.
  41. Hori H, Teraishi T, Sasayama D et al. Relationship of tem- perament and character with cortisol reactivity to the com- bined dexamethasone/CRH test in depressed outpatients. J. Affect. Disord. 2013; 147: 128-136.
  42. Hori H, Teraishi T, Ozeki Y et al. Schizotypal personality in healthy adults is related to blunted cortisol responses to the combined dexamethasone/corticotropin-releasing hormone test. Neuropsychobiology 2011; 63: 232-241.
  43. Tyrka AR, Wier LM, Price LH et al. Cortisol and ACTH responses to the Dex/CRH test: Influence of temperament. Horm. Behav. 2008; 53: 518-525.
  44. Gold PW, Chrousos GP. The endocrinology of melan- cholic and atypical depression: Relation to neurocircuitry and somatic consequences. Proc. Assoc. Am. Physicians 1999; 111: 22-34.
  45. Kunugi H, Hori H, Ogawa S. Biochemical markers subtyping major depressive disorder. Psychiatry Clin. Neurosci. 2015; 69: 597-608.
  46. Takeuchi T, Nakao M, Kachi Y, Yano E. Association of metabolic syndrome with atypical features of depression in Japanese people. Psychiatry Clin. Neurosci. 2013; 67: 532-539.
  47. Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444: 860-867.
  48. Horikawa H, Kato TA, Mizoguchi Y et al. Inhibitory effects of SSRIs on IFN-gamma induced microglial activation through the regulation of intracellular calcium. Prog. Neuropsychopharmacol Biol. Psychiatry 2010; 34: 1306- 1316.
  49. Kato TA, Monji A, Mizoguchi Y et al. Anti-inflammatory properties of antipsychotics via microglia modulations: Are antipsychotics a 'fire extinguisher' in the brain of schizophrenia? Mini Rev. Med. Chem. 2011; 11: 565-574.
  50. Kato TA, Yamauchi Y, Horikawa H et al. Neurotransmit- ters, psychotropic drugs and microglia: Clinical implica- tions for psychiatry. Curr. Med. Chem. 2013; 20: 331- 344.
  51. Mizoguchi Y, Kato TA, Seki Y et al. Brain-derived neuro- trophic factor (BDNF) induces sustained intracellular Ca2+ elevation through the up-regulation of surface tran- sient receptor potential 3 (TRPC3) channels in rodent microglia. J. Biol. Chem. 2014; 289: 18549-18555.
  52. Monji A, Kato T, Kanba S. Cytokines and schizophrenia: Microglia hypothesis of schizophrenia. Psychiatry Clin. Neurosci. 2009; 63: 257-265.
  53. Healy D. The Antidepressant Era. Harvard University Press, Cambridge, MA, 1997.
  54. Parker G. Is depression overdiagnosed? Yes. BMJ 2007; 335: 328.
  55. Hashimoto R, Yasuda Y, Yamamori H et al. Is it possible to make a diagnosis of major depression based solely on the medical interview of the patient? Seishinka 2013; 22: 243- 249.
  56. Zhang HJ, Sun D, Lee TM. Impaired social decision making in patients with major depressive disorder. Brain Behav. 2012; 2: 415-423.
  57. Brendan Clark C, Thorne CB, Hardy S, Cropsey KL. Coop- eration and depressive symptoms. J. Affect. Disord. 2013; 150: 1184-1187.
  58. King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science 2008; 321: 806- 810.
  59. Berg J, Dickhaut J, McCabe K. Trust, reciprocity, and social history. Games Econ. Behav. 1995; 10: 122-142.
  60. Chiu PH, Kayali MA, Kishida KT et al. Self responses along cingulate cortex reveal quantitative neural phenotype for high-functioning autism. Neuron 2008; 57: 463-473.
  61. Kato TA, Watabe M, Tsuboi S et al. Minocycline modulates human social decision-making: Possible impact of microglia on personality-oriented social behaviors. PLoS ONE 2012; 7: e40461.
  62. Watabe M, Kato TA, Monji A, Horikawa H, Kanba S. Does minocycline, an antibiotic with inhibitory effects on microglial activation, sharpen a sense of trust in social interaction? Psychopharmacology 2012; 220: 551-557.
  63. Watabe M, Kato TA, Teo AR et al. Relationship between trusting behaviors and psychometrics associated with social network and depression among young generation: A pilot study. PLoS ONE 2015; 10: e0120183.
  64. Nakano M. How supervisors deal with subordinates who have characteristics of 'new-type depression'. Rinsho- Shinrigaku 2014; 14: 235-243.
  65. Tsujii H, Natsuhori K, Uozumi E. Nursing care for an adolescent hikikomori case with domestic violence: A case report. Nihon Seishinka Kangogaku Kaishi 2010; 52: 72-76.
  66. Nakagama H. Integration of individual and family con- joint interview: A case study of a social withdrawal ado- lescent and his family members. Kazoku-Shinrigaku-Kenkyu 2008; 22: 28-41.

Cited by

Sorted by citations

Authors
Kato, T. A., Hashimoto, R., Hayakawa, K., Kubo, H., Watabe, M., Teo, A. R., & Kanba, S.
Affiliations
  • Kyushu University (JP)
  • Molecular Research Center for Children's Mental Development (JP)
  • Monash University Malaysia (MY)
  • Oregon Health & Science University (US)
Corresponding author
Kato, Takahiro A.
ORCID
Venue
Psychiatry and Clinical Neurosciences
Publisher
Wiley
Published
2015-10-09
Volume
70
Issue
1
Pages
7-23
ISSN
  • 1323-1316 (ISSN-L)
  • 1440-1819
DOI
10.1111/pcn.12360
PMC
PMC5560068
OpenAlex
W1940436591
Cited by
86
References
10
Citations by year
2026: 11 · 2025: 8 · 2024: 6 · 2023: 7 · 2022: 9 · 2021: 6 · 2020: 9 · 2019: 8 · 2018: 12 · 2017: 6 · 2016: 4
FWCI
9.11
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Psychiatry and Clinical Neurosciences (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Japanese Ministry of Education, Culture, Sports, Science, and Technology (26713039, 24650227, 15K15431, 25117011)
  • JSPS Bilateral Joint Research Project between USA-Japan
  • Japan Agency for Medical Research and Development (AMED) - The Japanese Ministry of Health, Labour and Welfare
  • SENSHIN Medical Research Foundation
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
endogenous depression, adolescent depression, Japanese youth, depression diagnosis, DSM-5, ICD classification, psychosocial factors, sociocultural factors
MeSH terms
Culture, Depression, Humans, Japan, Male, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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