Can Adolescent Psychiatric Day Care Incorporating Japanese Youth Culture Attract Adolescent Patients in Japan? A Novel Approach to Creating a Culturally Acceptable Clinical Environment.
Abstract
Background: Psychiatric day care is widely used in Japan, but adolescent-focused programs remain scarce, despite rising school absenteeism and suicide rates. Stigma toward mental illness and low continuity of care hinder engagement. Incorporating youth culture into therapeutic activities may improve participation. Objective: To describe an adolescent-oriented psychiatric day care program integrating youth culture and to examine attendance patterns, participant characteristics, and withdrawal reasons. Results: In February 2024, 88 adolescents (46 male, 42 female; mostly early to mid-teens) participated. Fourteen (15.9%) attended regularly for over one year. High-attendance programs included Social Skills Training and Psychodrama, Cognitive Behavioral Therapy, Analog Art, and Digital Art. Digital Art attracted younger users, including those with chronic school refusal but no diagnosis, while Analog Games were popular among participants with autism spectrum disorder, social anxiety disorder, or selective mutism. Lower-attendance programs included Acceptance and Commitment Therapy, Dance, Sports, Yoga, and Short Video Production. Reasons for withdrawal included relocation, return to school, transition to other services, symptom improvement, and loss of interest. Notably, some culturally relevant activities (Dance, Short Video Production) had low attendance, indicating that popularity alone does not ensure engagement. Conclusion: Integrating youth culture into adolescent psychiatric day care can enhance engagement, particularly when paired with structured therapeutic approaches. Program design should account for participants' cognitive, emotional, and practical needs to sustain involvement. Further research should evaluate long-term outcomes and adapt such models for diverse cultural and healthcare settings.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
2 of 18 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Adolescent-focused psychiatric day care programs remain scarce in Japan.
“adolescent-focused programs remain scarce”
- Also stated in: § Introduction · plain
“programs specifically for adolescents remain limited (Okazaki et al., 2024)”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Okazaki et al., 2024 source
The Materials and methods section says only a limited number of facilities treated patients under 15, and the Results report lower day-care use among younger age groups. These findings suggest limited access for some young patients, but the paper does not establish that adolescent-focused programs are scarce across Japan; it does not count such programs. (LLM, conf=0.78)
Experimental — accuracy not yet measured
- Also stated in: § Introduction · plain
- Findingown data
In February 2024, 88 adolescents participated in the adolescent-oriented psychiatric day care program.
“In February 2024, 88 adolescents (46 male, 42 female; mostly early to mid-teens) participated.”
- Also stated in: § Methods · plain
“In February 2024, data from 88 participants were collected”
Quote in the paperNot a substantial claim - Also stated in: § Methods · plain
- Findingreasoning
Nintendo Switch Sports had low participation.
“Nintendo Switch Sports had low Table 1.(Continued) participation, possibly due to controller use difficulty.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
- Findingown data
Twenty-six participants attended at least once in February 2024.
“Twenty-six attended at least once in February 2024”
Quote in the paperNot a substantial claim - Findingown data
Analog Games were well received by participants with autism spectrum disorder, social anxiety disorder, or selective mutism.
“Analog Games were well received by those with ASD, social anxiety disorder, or selective mutism.”
- Also stated in: § Abstract · plain
“Analog Games were popular among participants with autism spectrum disorder, social anxiety disorder, or selective mutism.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
- Rests on an assumption: The psychiatric diagnoses recorded in medical records are valid.
- Also stated in: § Abstract · plain
- Findingown data
Lower-attendance programs included Acceptance and Commitment Therapy, Dance, Sports, Yoga, and Short Video Production.
“Lower-attendance programs included ACT, Dance, Sports, Yoga, and Short Video Production.”
- Also stated in: § Abstract · plain
“Lower-attendance programs included Acceptance and Commitment Therapy, Dance, Sports, Yoga, and Short Video Production.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
- Also stated in: § Abstract · plain
- Findingown data
High-attendance programs included Social Skills Training and Psychodrama, Cognitive Behavioral Therapy, Analog Art, and Digital Art.
“High-attendance programs included SST and Psychodrama, CBT, Analog Art, and Digital Art.”
- Also stated in: § Abstract · plain
“High-attendance programs included Social Skills Training and Psychodrama, Cognitive Behavioral Therapy, Analog Art, and Digital Art.”
Quote in the paperSubstantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
- Also stated in: § Abstract · plain
- Findingown data
Digital Art attracted younger users, including those with chronic school refusal but no diagnosis.
“Digital Art attracted younger users, including those with chronic school refusal but no diagnosis.”
- Also stated in: § Abstract · plain
“Digital Art attracted younger users, including those with chronic school refusal but no diagnosis”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
- Also stated in: § Abstract · plain
- Findingown data
Most participants were early to mid-teens.
“Most were early to mid-teens.”
- Also stated in: § Abstract · plain
“mostly early to mid-teens”
Quote in the paperNot a substantial claim - Also stated in: § Abstract · plain
- Findingown data
Fourteen (15.9%) participants attended regularly for over one year.
“Fourteen (15.9%) attended regularly for over one year.”
- Also stated in: § Results · plain
“only 14 had regularly attended for over a year.”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Withdrawal reasons included relocation, return to school, transition to other services, symptom improvement, and loss of interest.
“Reasons for withdrawal included relocation, return to school, transition to other services, symptom improvement, and loss of interest.”
Quote in the paperNot a substantial claim- Rests on an assumption: Withdrawal reasons inferred from medical records are accurate and complete.
- Interpretationreasoning
Program-specific factors likely explain the observed attendance trends.
“Program-specific factors likely explain these trends.”
Quote in the paperSubstantial claim - Premisecitation
Adolescents often show lower continuity of care than other age groups.
“Adolescents often show lower continuity of care than other age groups (Edlund et al., 2002).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Edlund et al., 2002 source
- Premisecitation
In the U.S., culturally sensitive healthcare has reduced dropout rates among Latino youth.
“In the U.S., culturally sensitive healthcare has reduced dropout rates among Latino youth (Kapke et al., 2016).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kapke et al., 2016 source
- Interpretationown data
Integrating youth culture into adolescent psychiatric day care can enhance engagement.
“Integrating youth culture into adolescent psychiatric day care can enhance engagement, particularly when paired with structured therapeutic approaches.”
- Also stated in: § Discussion · hedged
“Programs incorporating youth culture appear effective in engaging adolescents.”
Quote in the paperSubstantial claim- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
- Rests on an assumption: The high attendance of youth-culture programs reflects the youth-culture content rather than other factors such as staff, novelty, or schedule.
- Also stated in: § Discussion · hedged
- Premisecitation
A national survey reported high youth engagement with visual and media art in Japan.
“A national survey reported high youth engagement with visual and media art (Agency for Cultural Affairs, Japan, n.d.), supporting the appeal of such content.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Agency for Cultural Affairs, Japan, n.d.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- May combine two claims. 19
- Classified as probably not a substantial claim. 14
May combine two claims.
PremisecitationPrejudice against mental illness remains prevalent among Japanese adolescents, and it is still difficult to encourage help-seeking behavior.
“prejudice against mental illness remains prevalent among Japanese adolescents, and it is still difficult to encourage help-seeking behavior (Ando et al., 2013;Nakane & Mine, 2013;Ojio et al., 2021).”
Quote in the paperSubstantial claim1 of 3 sources checked- cites Ando et al., 2013 source
Section 2 (p. 477) reports negative attitudes and prejudice toward mental illness among the Japanese general public, but does not establish their prevalence among adolescents specifically. The same section says people tend to seek help from counselors or family and friends rather than psychiatrists; it does not say that encouraging help-seeking behavior among adolescents remains difficult. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites Nakane & Mine, 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Ojio et al., 2021 source
May combine two claims.
Findingown dataParticipants had varied psychiatric diagnoses, with some experiencing school refusal without diagnosis.
“Participants had varied psychiatric diagnoses, with some experiencing school refusal without diagnosis.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCBT and Dance had no long-term users.
“CBT and Dance had no long-term users.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
May combine two claims.
Findingown dataBoard Games and Chatting and Analog Games also saw strong participation.
“Board Games and Chatting and Analog Games also saw strong participation.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataOf the 88 February 2024 participants, 46 were male and 42 were female.
“Of 88 participants, 46 were male and 42 female.”
- Also stated in: § Abstract · plain
“88 adolescents (46 male, 42 female; mostly early to mid-teens) participated.”
Quote in the paperNot a substantial claim- Also stated in: § Abstract · plain
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataGender distribution was nearly even overall, but more females attended CBT, Yoga, Sports, and Digital Art.
“Gender distribution was nearly even overall, but more females attended CBT, Yoga, Sports, and Digital Art.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataAnalog Art drew slightly older participants.
“Analog Art drew slightly older participants.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
May combine two claims.
Findingown dataYoga had several older and long-term users despite lower attendance.
“Yoga, while less attended, had several older and longterm users.”
Quote in the paperNot a substantial claim- Rests on an assumption: The selected days used for attendance assessment are representative of overall attendance patterns.
May combine two claims.
Findingnone givenSome participants withdrew due to positive life changes; others lost interest or had difficulty completing activities.
“Some participants withdrew due to positive life changes; others lost interest or had difficulty completing activities.”
Quote in the paperNot a substantial claim- Rests on an assumption: Withdrawal reasons inferred from medical records are accurate and complete.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationSchool absenteeism and suicide rates among Japanese students continue to grow.
“School absenteeism and suicide rates continue to grow, with 514 student suicides recorded in 2022-the highest since 1980.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Ministry of Education, Culture, Sports, Science and Technology, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites National Policy Agency, 2024
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn Japan, psychiatric day care is widely used.
“Psychiatric day care is widely used in Japan”
- Also stated in: § Introduction · plain
“Psychiatric day care is a common outpatient treatment in Japan”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites The Japanese Society for Day Care Treatment, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § Introduction · plain
May combine two claims.
PremisecitationOnly 6.1% of hospital-based and 16.4% of clinic-based psychiatric day care programs in Japan serve adolescents.
“Only 6.1% of hospital-based and 16.4% of clinicbased programs serve this age group (Study Group on Future Mental Health and Medical Welfare, 2009).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Study Group on Future Mental Health and Medical Welfare, 2009
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation514 student suicides were recorded in Japan in 2022, the highest since 1980.
“School absenteeism and suicide rates continue to grow, with 514 student suicides recorded in 2022-the highest since 1980.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Ministry of Education, Culture, Sports, Science and Technology, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites National Policy Agency, 2024
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationreasoningDemand for adolescent-centered mental health services is increasing, driven by rising psychiatric issues.
“Demand for adolescent-centered mental health services is increasing, driven by rising psychiatric issues.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAnalog Games were popular with those having ASD, social anxiety, or selective mutism, possibly because structured rules reduce communicative pressure.
“Analog Games were popular with those having ASD, social anxiety, or selective mutism-possibly because structured rules reduce communicative pressure.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataShort Video Production and Dance had low attendance, indicating popularity alone does not ensure engagement.
“Short Video Production and Dance had low attendance, indicating popularity alone does not ensure engagement.”
- Also stated in: § Abstract · hedged
“Notably, some culturally relevant activities (Dance, Short Video Production) had low attendance, indicating that popularity alone does not ensure engagement.”
Quote in the paperSubstantial claim- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
- Rests on an assumption: Dance and Short Video Production are culturally relevant activities for Japanese adolescents.
- Also stated in: § Abstract · hedged
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningThese findings highlight the importance of culturally adapted adolescent mental health services in Japan and globally.
“These findings highlight the importance of culturally adapted adolescent mental health services in Japan and globally.”
Quote in the paperNot a substantial claim- Rests on an assumption: The high attendance of youth-culture programs reflects the youth-culture content rather than other factors such as staff, novelty, or schedule.
May combine two claims.
Interpretationown dataGroup therapies like SST and Psychodrama and CBT drew high engagement, suggesting demand for structured interventions.
“Group therapies like SST and Psychodrama and CBT also drew high engagement, suggesting demand for structured interventions.”
Quote in the paperNot a substantial claim- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
May combine two claims.
InterpretationreasoningFactors like task difficulty, accessibility, and emotional readiness matter for engagement.
“Factors like task difficulty, accessibility, and emotional readiness matter.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
InterpretationreasoningDance requires physical coordination, and video production involves cognitive planning and technical skills, which are potential barriers.
“Dance requires physical coordination, and video production involves cognitive planning and technical skillspotential barriers.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitationlishi, a traditional East Asian exercise, improved engagement among Vietnamese older adults with historically low psychiatric service use.
“Similarly, lishi, a traditional East Asian exercise, improved engagement among Vietnamese older adults with historically low psychiatric service use (Huang et al., 2025).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Huang et al., 2025
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationown dataThe high rate of female participation suggests that these programs are especially popular among women.
“In particular, the high rate of female participation suggests that these programs are especially popular among women.”
Quote in the paperNot a substantial claim- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningController use difficulty possibly explains the low participation in Nintendo Switch Sports.
“Nintendo Switch Sports had low Table 1.(Continued) participation, possibly due to controller use difficulty.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationDigital Art Class had high participation, likely due to digital art's popularity in Japan.
“Digital Art Class had high participation, likely due to digital art's popularity in Japan.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Agency for Cultural Affairs, Japan, n.d.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenTwo psychiatrists reviewed medical records.
“Two psychiatrists reviewed medical records.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn general, Japanese psychiatric day care programs include recreational activities, handicrafts, computer-based clerical work, sports, cooking, reading, tea breaks, psychoeducation, social skills training (SST), and job preparation.
“In general, Japanese psychiatric day care programs include recreational activities, handicrafts, computer-based clerical work, sports, cooking, reading, tea breaks, psychoeducation, social skills training (SST), and job preparation (Japanese Association of Day Care, 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Japanese Association of Day Care, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe causes of school refusal and suicide are varied, but may include family and school-related issues.
“The causes of school refusal and suicide are varied, but may include family and school-related issues, indicating the importance of having a supportive space like day care (Ministry of Education, Culture, Sports, Science and Technology, 2022;National Policy Agency, 2024).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Ministry of Education, Culture, Sports, Science and Technology, 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites National Policy Agency, 2024
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationown dataAlthough Yoga had fewer overall participants, it appealed to older and long-term users, showing that traditional programs can succeed when adapted for adolescents.
“Although Yoga had fewer overall participants, it appealed to older and long-term users, showing that traditional programs can succeed when adapted for adolescents.”
Quote in the paperNot a substantial claim- Rests on an assumption: Attendance or participation in day care programs is a valid indicator of engagement.
The paper relies on this without support.
Attendance or participation in day care programs is a valid indicator of engagement.
“This study outlines our adolescent-oriented programs and examines participant engagement and retention.”
“Attendance trends by diagnosis, age group, and sex were assessed using data from selected days.”
The paper relies on this without support.
The selected days used for attendance assessment are representative of overall attendance patterns.
“Attendance trends by diagnosis, age group, and sex were assessed using data from selected days.”
The paper relies on this without support.
Withdrawal reasons inferred from medical records are accurate and complete.
“This information was inferred from medical records.”
The paper relies on this without support.
The high attendance of youth-culture programs reflects the youth-culture content rather than other factors such as staff, novelty, or schedule.
“Programs incorporating youth culture appear effective in engaging adolescents.”
The paper relies on this without support.
Dance and Short Video Production are culturally relevant activities for Japanese adolescents.
“However, not all culturally relevant activities succeeded.”
The authors state this as an assumption.
Adolescent day care requires programs more specifically tailored to their developmental stage.
“However, we speculated that adolescent day care requires programs that are more specifically tailored to their developmental stage.”
The paper relies on this without support.
The psychiatric diagnoses recorded in medical records are valid.
“Participants had varied psychiatric diagnoses, with some experiencing school refusal without diagnosis.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
February participant count conflicts with attendance count
MajorThe abstract says 88 adolescents participated in February 2024, but the Results say only 26 attended at least once that month. These cannot both describe the number who participated during February.
“In February 2024, 88 adolescents (46 male, 42 female; mostly early to mid-teens) participated.”
“Twenty-six attended at least once in February 2024, and only 14 had regularly attended for over a year.”
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Flagged first, then by citations
Research works printed but not linked: 2
- Japanese Association of Day Care. (2016). New Q&A on psychiatric day care (1st ed.). Igaku-Shoin.
- Nakane Y., Mine M. (2013). Anti-stigma research into school education on mental disorders: Descriptions in junior and senior high school textbooks in Japan. Japanese Bulletin of Social Psychiatry, 22, 452–473.
- Authors
- Ogata, Y., & Hosokawa, T.
- Affiliations
- Stress Care Tokyo Ueno Ekimae Clinic, Japan
- Corresponding author
- Ogata, Yu
- Venue
- International Journal of Social Psychiatry
- Publisher
- SAGE Publications
- Published
- 2025-09-05
- Volume
- 71
- Issue
- 8
- Pages
- 1649-1660
- ISSN
- 0020-7640 (ISSN-L)
- 1741-2854
- OpenAlex
- W4414020049
- Cited by
- 0
- References
- 21
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Social Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Keywords
- youth culture, cultural acceptability, program engagement, attendance patterns, school refusal, mental health stigma, social skills training, psychodrama, cognitive behavioral therapy, acceptance and commitment therapy, digital art, autism spectrum disorder, social anxiety disorder, selective mutism, dance, short video production
- MeSH terms
- East Asian People, Adolescent, Mental Disorders, Day Care, Medical, Female, Humans, Japan, Male, Cognitive Behavioral Therapy, Social Stigma, Culturally Competent Care
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