The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study

Abstract

Background: There are positive and negative correlations in different directions between smoking and personality traits and health-related quality of life (HRQOL), while smoking may have a masking path between personality and HRQOL. Understanding the masking pathway of smoking between personality and HRQOL can help deepen the understanding of the mechanisms of psychosocial effects of smoking and provide new ideas for developing tobacco control strategies. Objective:The purpose of this study was to investigate the correlation between Big Five personality and health-related quality of life (HRQOL), and whether smoking mediates the relationship between Big Five personality and HRQOL.Methods: This was a cross-sectional survey with data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents (PBICR). Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL, controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test.Results: Extraversion (?=.001, P<.05), Agreeableness (?=.003, P <.05), and Neuroticism (?=.003, P<.05) were positively correlated with HRQOL, while Openness was negatively correlated with HRQOL (?=.001, P<.05). Smoking was associated with a decrease in HRQOL and mediated the positive effect on HRQOL between Extraversion (z=-2.482, P<.05), Agreeableness (z=-2.264, P<.05), and Neuroticism (z=-3.230, P<.05). Subgroup analyses further showed that smoking mediated the effect of Neuroticism personality on HRQOL in the chronically ill population (z=-2.724, P<.05), and in the non-chronically ill population, smoking contributed to the effect of smoking on HRQOL in Extraversion personality (z=-2.299, P<.05), Agreeableness personality (z=-2.382, P<.05), and Neuroticism personality (z=-2.213, P<.05). Conclusions:This study provided evidence that there is a correlation between personality and HRQOL, and also found that smoking plays a role in mediating the connection between personality and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual's personality, highlighting the significance of Extraversion, Agreeableness, and Neuroticism.