VALIDATION AND CULTURAL ADAPTATION OF THE URDU HIKIKOMORI QUESTIONNAIRE (HQ-8) IN MIDDLE-AGED ASTHMA PATIENTS

Abstract

Introduction: Pathological social withdrawal, known as Hikikomori, is emerging as a critical mental health issue worldwide, impacting diverse demographics, including adults managing chronic diseases. Despite its growing prevalence, there is a lack of validated instruments to measure this condition in specific linguistic and clinical settings. The primary objective of this research was to translate the Hikikomori/Social Withdrawal Questionnaire 8 item version (HQ-8) into Urdu and assess its psychometric validity within a sample of middle-aged adults suffering from asthma.

Methodology: The study recruited 200 participants aged 45–65 years with a confirmed asthma diagnosis. To establish convergent validity, the newly translated HQ-8 was administered alongside two other measures: the Adverse Childhood Experiences (ACEs) questionnaire (modified to a 5-point Likert scale (Bond, Stone, Salcido, & Schnarrs, 2021) and the Emotional Regulation Questionnaire (ERQ) in its Urdu adaptation. The study utilized exploratory and confirmatory factor analyses to verify the scale's structure. Reliability was tested through internal consistency metrics and a 2-week test–retest procedure.

Results: Factor analyses confirmed a unidimensional structure for the HQ-8, characterized by robust item loadings and superior model fit statistics. The tool demonstrated high internal consistency (α = 0.87; ω = 0.88) and solid stability over time (ICC = 0.78). In terms of validity, higher scores on the HQ-8 were positively associated with greater ACEs and the use of expressive suppression.

Conclusion: The HQ-8-Urdu proves to be a psychometrically sound and culturally suitable instrument for evaluating social withdrawal among middle-aged asthma patients. These results provide a new avenue for understanding how childhood adversity and emotion regulation deficits contribute to social isolation in individuals living with chronic respiratory conditions.