Purpose <p>Epidemiologic studies of hikikomori, a form of prolonged social withdrawal, are limited. This study aimed to look for indicators in a European country of a problem first detected in Japan, estimating the prevalence of hikikomori risk and examining the relationship between hikikomori risk and sociodemographic factors, health status, and health services use.</p> Methods <p>Data from the European Health Interview Survey collected in 2019 were used, consisting of a nationally representative sample (unweighted <i>N</i> = 45,962; weighted <i>N</i> = 52,012,922.578) of persons aged 15–75 years and over in Italy. Difficulty in going out not due to medical illnesses/functional limitations or chronic illnesses was considered a proxy condition for hikikomori, i.e., hikikomori risk. Hikikomori risk was further differentiated based on difficulty in social participation.</p> Results <p>The overall prevalence of hikikomori risk was 1.7% (95%CI: 1.6–1.9) corresponding to a weighted count of 866,743 persons. This was comprised of a 0.7% prevalence of hikikomori risk with no difficulty in social participation (95%CI: 0.6–0.8%; weighted <i>n</i> = 343,920), 0.9% prevalence of hikikomori with difficulty in social participation (95%CI: 0.8–1.0%; weighted <i>n</i> = 445,165) and 0.1% prevalence of hikikomori risk with no interest for social participation (95%CI: 0.1–0.2%; weighted <i>n</i> = 77,657). Low vitality and mental health index, low social support, high depressive symptoms, and difficulty accessing mental health services were significantly associated with hikikomori risk.</p> Conclusion <p>The prevalence of individuals at risk for hikikomori is on par with many psychiatric disorders. Given the prevalence and functional impairment faced by individuals at risk for hikikomori, they represent a group worthy of the attention of public health experts and other stakeholders in the health arena and beyond.</p>