Associations between HEXACO personality traits, substance use disorders and behavioral addictions: A protocol for a comprehensive systematic review and meta-analysis

doi:10.21203/rs.3.rs-3483682/v1

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Associations between HEXACO personality traits, substance use disorders and behavioral addictions: A protocol for a comprehensive systematic review and meta-analysis

https://doi.org/10.21203/rs.3.rs-3483682/v1

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Background

While ample research has examined the connections between addiction and personality in general, there has yet to be a systematic study that investigates how various substance use disorders (SUD) and behavioural addictions are related to the dimensions of the HEXACO model of personality. This systematic review and meta-analysis aim to address this gap by comprehensively exploring the association between HEXACO personality traits and addiction disorders, including illegal substances (e.g., all narcotics in one group and cannabis in a separate category), and behavioural addictions (e.g., gambling and gaming problems, social media addiction, and compulsive sexual behaviour disorder; CSBD), within all types of sample populations.

Methods

The present paper will carry out a systematic review of the available literature using the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) guidelines. Searches will be conducted in databases including APA PsycINFO (Ovid), Medline (Ovid), ProQuest, Web of Science, CINAHL, and Wiley Online Library, and Google Scholar. Included studies will adhere to the following criteria: (1) original articles, published as full papers; (2) studies published in English or other European languages or Persian; (3) published in a peer-reviewed journal; (4) studies investigating the association between HEXACO personality traits and addictive disorders, including illegal substances (e.g., all narcotics and cannabis as separate categories), and behavioural addictions (e.g., gambling and gaming problems, social media addiction, and CSBD), within all types of sample populations. (5) Research reporting Pearson’s or Spearman’s r correlation coefficients of the variables of interest or any data that could be converted into a correlation coefficient, such as Cohen’s d/f, T value, F values, or Fishers Z will be included. Two researchers will independently screen all citations, full-text articles, and extract data. Risk of bias of the included studies will be assessed by the Newcastle-Ottawa Quality Assessment Scale (NOS), and Mixed Methods Appraisal Tool (MMAT). Data will be synthesized using a meta-analysis if the data are sufficient. Subgroup analyses will be conducted to investigate the impact of various moderators on effect sizes, and sensitivity analyses will examine the robustness of the results. Data analysis will be conducted in Stata 18 packages.

Discussion

This review and meta-analysis will be the first to systematically explore and integrate the evidence available on the association between the HEXACO personality traits and SUD and behavioural addictions. By consolidating information, the study enhances our understanding of the role of personality traits in the development and maintenance of SUD and behavioural addictions.

Systematic review registration:

PROSPERO CRD42023468153

HEXACO model

personality traits

substance use disorders

behavioural addictions

Addiction is a term commonly used to describe the excessive and uncontrolled consumption of psychoactive chemicals such as alcohol and other psychoactive substances (1). According to official psychiatric diagnostic systems, there are currently only two nonchemical addictions recognized (i.e., pathological gambling and gaming disorder) (2, 3). However, many scholars have argued and found empirical support for a range of other nonchemical/behavioural addictions as well (4, 5). Various subtypes of behavioural addictions have been suggested, including social media addiction (6), video game addiction (7), Internet addiction (8), exercise addiction (9), mobile phone addiction (10), shopping addiction (11), workaholism (6), and sex addiction (12, 13).

At a broad level, studies indicate that addiction represents a multifaceted challenge, impacting not only individual health but also society at large (14). This issue has detrimental effects on both mental and physical well-being, leading to significant negative outcomes (15). Unfortunately, psychologists and psychiatrists are less involved with addictions, both theoretically and therapeutically, than they are with other mental disorders (16). Several dispositional factors have been found to increase the likelihood of engaging in a variety of potentially addictive behaviours, both recreationally and at a problematic level (17). There is no doubt that personality traits play an important role in behavioural addictions. In most studies examining associations between personality traits and addiction disorders, some traits are considered predisposing factors for addiction (18). Therefore, certain personality characteristics may represent independent risk factors for addiction.

The Five-Factor Model (FFM) is a predominant framework used to conceptualize personality traits. This model consists of five overarching domains that capture fundamental aspects of human personality. Extraversion (vs. introversion), agreeableness (vs. antagonism), conscientiousness (vs. independability or disinhibition), neuroticism (vs. emotional stability), and openness to experience (vs. closeness) are the higher-order domains in this model (19, 20). The FFM`s personality trait profiles associated with several clinical disorders have been examined, including alcohol use disorder (AUD), SUD (21), gambling disorder (GD) (22), Instagram addiction (23), smartphone addiction (24), social media addiction (25), online game addiction (26), and sex addiction (27, 28). Findings from these studies indicate that the relationships with personality traits vary among different addictions, a factor that could hold significance for both theoretical understanding and practical applications (29). Several meta-analyses have examined the FFM in relation to alcohol and substance abuse, finding that neuroticism and agreeableness are inversely associated with most addictions. However, conscientiousness tends to be inversely associated with these addiction disorders (30, 31). There has been a lack of consistency in the results regarding extraversion and openness and substance addictions. Extraversion, openness to experience, and neuroticism have been shown to positively relate to the use of social networks in some studies (23, 25, 32, 33). It has been found that individuals who score highly on extraversion and openness to experience use social media more frequently. In contrast, individuals with high levels of neuroticism have been shown to turn to social networks for emotional support (32). Moreover, a study conducted by Pinto et al. (27) examined the personality characteristics of male college students and their sexual compulsivity. According to their results, neuroticism was positively related to sexual compulsivity, whereas agreeableness had a negative relationship with the construct (27).

The FFM is widely adopted in the literature on addiction, however, other research has identified alternative personality structures using a similar lexical methodology (34). Accordingly, certain aspects of personality are underrepresented in the FFM (for example, Honesty-Humility) (35). As an alternative to the FFM, Lee and Ashton (36) present the HEXACO model of personality to address some of the limitations of the FFM and to provide an expanded method of examining personality characteristics. This model was developed from lexical studies that involved self and observer ratings of personality descriptive adjectives across various languages (37, 38). These studies indicated a six-factor solution to describe the variation in personality. According to the HEXACO model, the six main dimensions are Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness to Experience (O). While the extraversion, conscientiousness, and openness to experience dimensions in the HEXACO model largely align with their counterparts in the FFM model (39), the HEXACO model introduces rotated variants of agreeableness and emotionality (36). HEXACO model, for example, attributes traits like even temper, which reflects low neuroticism in the FFM, to agreeableness. Conversely, traits such as sentimentality, which are typically associated with agreeableness in the FFM, are assigned to emotionality. The most significant deviation from the FFM is the inclusion of honesty-humility as a sixth fundamental dimension of personality. Numerous studies have provided evidence supporting the validity of the honesty-humility factor (32, 40–43). This factor represents the sincerity of an individual regarding their interactions with others, the willingness to take advantage of others for personal gain, the desire for or motivation to acquire high status, as well as the modesty of an individual (44). There have been numerous studies examining the relationship between honesty and humility in various contexts, including the gambling severity (45–47), SUD (48), the workplace (49), academic settings (44), and in laboratory studies examining decision-making in social dilemmas (50).

The research landscape regarding the HEXACO model's relationship to SUD and behavioural addictions is evolving, with a growing number of studies emerging. In one exploration of the association between mobile phone addiction and HEXACO personality traits, findings indicated significant positive, negative, and negative relationships with neuroticism, extraversion, and conscientiousness, respectively (51). Enayati (2020) extended this research, revealing that honesty-humility, extroversion, conscientiousness, and openness to experience exhibit significant negative relationships with mobile phone addiction, while emotionality shows a significant positive correlation (52). In addition, Azizi et al. (2015) found that among HEXACO personality traits, only extroversion and openness to experience were significantly positively related to internet addiction (53).

In the realm of problematic smartphone use, Horwood, S., & Anglim (2018) found moderate negative correlations with honesty-humility, agreeableness, conscientiousness, and openness, whereas emotionality exhibited a positive correlation (54). A study focused on online game addiction in female high school students, revealing that HEXACO personality traits indirectly influenced addiction through impulsivity (55). Zafar et al. (2018) delved into Facebook addiction, discovering significant positive correlations with extraversion, emotionality, and openness to experience, while honesty-humility, agreeableness, and conscientiousness displayed a significant negative correlation (56). Moreover, some research has found that lower scores on honesty-humility are significantly associated with greater gambling severity (45–47). McGrath et al. (2018) found that honesty-humility, agreeableness, and conscientiousness were all negatively associated with problem gambling severity scores (47). Rasher et al. (2018) examined HEXACO personality traits in relation to disordered engagement in three addictive behaviours: AUD, cannabis use disorder (CUD), and GD. Multinomial logistic regression analyses revealed lower levels of honesty-humility among individuals with AUD and GD, and higher levels of openness to experience among individuals with CUD compared to control participants (48).

While some studies explore the association between HEXACO traits and addiction, there are currently no published meta-analytic reviews that synthesize research on HEXACO personality traits, SUD, and behavioural addiction. This gap is important because facet-level analyses can clarify which components of each of the six HEXACO domains drive the association with SUD and behavioural addictions. This would provide insight into potential mechanisms that contribute to addiction. Therefore, an updated and comprehensive review of both published and unpublished research is needed to examine the links between HEXACO personality traits and SUD and behavioural addiction.

Objectives of this research

The primary objective of this proposed meta-analysis is to systematically review all existing research exploring the association between HEXACO personality traits and addiction disorders, including illegal substances (e.g., all narcotics in one group and cannabis in a separate category), and behavioural addictions (e.g., gambling and gaming problems, social media addiction, and CSBD), within all types of sample populations. The research questions of this study, based on previous research, are the following:

RQ1: Is there an association between HEXACO personality traits and the use of illegal substances, including alcohol, nicotine, and all narcotics and cannabis?

RQ2: Is there an association between HEXACO personality traits and behavioural addictions, including gambling and gaming problems, social media addiction and CSBD?

The current study findings will be reported based on the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) guidelines (57) (refer to Fig. 1 in Additional file 1 for the PRISMA flow chart of systematic search and extraction procedure), and is registered on PROSPERO, an international register of systematic reviews (58) (registration number: CRD42023468153). Any changes to the protocol will be recorded on PROSPERO.

Population

The population for this systematic review and meta-analysis is wide-ranging to ensure a thorough understanding of the links between HEXACO personality traits, SUD, and behavioral addictions. It encompasses individuals of any age above 18 years, gender, socio-economic background, and cultural or ethnic identity. The review includes both clinical populations (those with diagnosed substance use or behavioral addictions) and non-clinical populations from the general public. Studies from any geographical location are considered, provided they are published in English, other European languages, or Persian.

Eligibility criteria

For studies to be eligible for inclusion, they will have to meet the following criteria: 1) any original articles, published as full papers; 2) studies published in English or other European languages or Persian; 3) published in a peer-reviewed journal; 4) studies investigating the association between HEXACO personality traits and addictive disorders, including illegal substances (e.g., all narcotics and cannabis as separate categories), and behavioural addictions (e.g., gambling and gaming problems, social media addiction, and CSBD), within all types of sample populations; 5) research reporting Pearson’s or Spearman’s r correlation coefficients of the variables of interest, or any data that could be converted into a correlation coefficient, such as Cohen’s d/f, T value, or Fishers Z. Studies will be excluded if they are 1) based on case studies and qualitative designs; 2) measuring personality traits similar to the HEXACO model, but not the actual traits; and 3) not published in a peer-reviewed journal.

Information sources

Literature searches will be conducted across various electronic literature databases, such as APA PsycINFO (Ovid), Medline (Ovid), ProQuest, Web of Science, PubMed, CINAHL, and Wiley Online Library. Also, a literature search will be conducted on Google Scholar, of which we will review the first 50 pages due to a large number of results (over 12,000 hits).

Search Strategy

We chose "HEXACO" as our one and only search term, after advice from a research librarian. In the case of the HEXACO model, there is a limited number of published articles. The HEXACO model of personality is a new phenomenon with limited existing evidence. Searching with the singular search term "HEXACO", we assume that we are guaranteed to identify all articles on HEXACO. Making a more elaborate combination of search terms will necessarily limit the number of search results, and we could potentially miss out on relevant articles.

Being a relatively new phenomena explains why "HEXACO" is not yet an established term in Controlled Vocabulary /Subject Headings. Including the more general Subject Headings of "Personality traits" or "Personality Tests" in the search strategy would include a very large number of articles not relevant for the research question of this review.

No applied limits will be used in the search strategy, and the reason for this being the same as the rationale for using only the one search term "HEXACO": The safest way of ensuring that no relevant articles are missed, is to do all excluding of articles in the screening process. And this is possible to do because of the fact that the one search term "HEXACO" with no limits applied results in a manageable number of results to screen. The search field definition chosen in each database will be the default alternative, covering a minimum of titles and abstract. As an example, our APA PsycINFO (Ovid) Search Strategy is as follows: hexaco.mp. [mp = title, abstract, heading word, table of contents, key concepts, original title, tests & measures, mesh word]

In addition to searching with the term "HEXACO" with the default search field definition in all the mentioned databases, we will employ additional methods in our literature search. We will employ backward tracking (inspecting reference lists in relevant identified literature). Moreover, we leverage artificial intelligence in our research, specifically using Keenious Plus by transferring relevant articles into its platform to identify matching articles that are relevant to our research, helping us uncover any potentially missed articles.

Selection process

An initial screening of titles and abstracts of identified papers will be performed by two independent reviewers (FSH and PH), who will assess each study for relevance according to the pre-specified eligibility criteria. Studies that cannot be conclusively excluded from title and abstract screening will be taken forward to full text screening, at which stage the full text will be obtained and a second screening process performed, again by two independent reviewers. This will result in a final set of papers to be included in the review. Discrepancies between the two reviewers at any stage will be resolved through discussion and, if required, referral to a third reviewer (EKE). The number of studies identified, included and excluded at each stage will be reported using the PRISMA flow diagram (59) together with reasons for exclusion at the full-text stage. Moreover, to calculate interrater reliability and the degree of agreement between the initial choices made by two independent raters, we will use Cohen’s kappa statistic or percentage agreement (60). Moreover, to ensure consistency and reliability in the screening process, we will conduct a pilot screening process with a small sample of papers (n = 20) before initiating full-scale screening. This pilot will allow the reviewers to discuss their interpretations of the eligibility criteria and refine their approach if necessary.

Data management

Covidence Systematic Review software (69) will be used to manage references throughout the review process. Covidence's systematic approach ensures an organized and efficient review, enhancing both reliability and collaboration between reviewers. This comprehensive software will be employed at all stages, including screening titles and abstracts, reviewing full texts, and extracting data. Initially, all relevant articles identified from the database searches will be imported into Covidence. The software will then automatically remove duplicates, after which two independent reviewers will commence the screening process.

Data Extraction

The Covidence Systematic Review software allows us to incorporate personalized headings, subheadings, single-choice fields, multiple choices, and tables (61). A meticulous data extraction sheet will be developed based on our study objectives. This sheet will be made available within the Covidence platform, accessible to the reviewers responsible for data extraction. This development will be guided by the outcomes of the full text screening stage, following templates provided by experts in systematic reviewing within the platform. Two independent reviewers (FSH and PH) will conduct data extraction in this platform for all included studies. In instances where multiple publications arise from a single study, we will consolidate all sources and extract the data into a unified form. The data items to be extracted encompass various elements, including study design, age and gender of participants, country of study, sample size (n), setting, methods of assessing personality traits, SUD, and behavioral addictions. Additionally, relevant findings, including effect sizes converted to correlation coefficients (r), will be extracted. If the correlation coefficients are not provided directly, we will also extract sample size, standard deviation (SD), and means for both the addiction and control groups to facilitate the conversion to the correlation coefficients. A pilot test will be conducted by extracting data from a small sample of retrieved studies (n = 5) to assess the feasibility and refine the data extraction form, and to ensure that the two reviewers extract data in a similar manner.

Quality and risk of bias assessment

Assessing risk of bias in included studies is important in determining the validity of the results and interpretation of findings. The risk of bias of included studies will be assessed by two independent reviewers (FSH and PH) using the appropriate quality assessment tool based on the specific study design. The Newcastle-Ottawa Quality Assessment Scale (NOS) will be used for Cross-Sectional Studies, and the Mixed Methods Appraisal Tool (MMAT) will be used to assess the quality of other types of studies (62, 63). In case of disagreements, consensus will be sought through discussion between raters and, if necessary, with the third reviewer (EKE). The degree of agreement will be calculated as a percentage.

The Newcastle-Ottawa Quality Assessment Scale (NOS) (62) will be used to assess the risk of bias in cross-sectional studies, which is a well-established tool designed for evaluating the quality of non-randomized studies. The NOS provides predefined criteria for assessing bias/quality through a checklist consisting of three main categories. It is possible to obtain a maximum score of 10 stars, where a higher score indicates higher quality/less bias. The first category is “selection” and relates to the representativeness of the sample, sample size, comparability between respondents and nonrespondents, and ascertainment of the exposure. This category provides a maximum of five stars. The second category is “comparability” and concerns whether confounding factors are controlled for. This category provides a maximum of two stars. The third category is “outcome” and represents assessment of the outcome and the statistical tests. The maximum score on this category is three stars. In the current study, studies with five stars or more will be considered to have moderate to good quality.

The Mixed Methods Appraisal Tool (MMAT) 2018 version (72) will be used to assess the risk of bias in other types of included studies. The MMAT is an effective tool for appraising studies with diverse designs included in systematic reviews. It enables methodological quality assessment across five study categories: (1) qualitative, (2) randomized controlled, (3) non-randomized, (4) quantitative descriptive, and (5) mixed methods. Each category is associated with five specific quality criteria. The MMAT process involves two stages: an initial screening followed by a detailed appraisal based on the study design. Assessment responses are classified as ‘yes’, ‘no’, or ‘can’t tell’ to collectively provide an overall risk of bias evaluation for each study. MMAT assessments will be applied to each manuscript individually. We will also calculate and report the level of inter-reviewer agreement on the MMAT risk of bias evaluations.

The results of the risk of bias assessment will be used to interpret the findings appropriately. In this meta-analysis, studies will be weighted based on their precision, determined by the inverse of their variance. This approach assigns greater influence on more reliable studies with smaller variance, enhancing the accuracy and minimizing bias in the combined effect size. The potential impact of lower-quality studies on the overall findings will also be discussed.

Data analysis and synthesis

This study will report effect sizes that will be converted into correlation coefficients to standardize the measurement of associations across studies. We will use random effects models to pool effect sizes rather than fixed effects models due to the anticipated variations in sample characteristics, methods, and measures across the included studies. Random effects models account for between-study heterogeneity and provide more conservative and generalizable estimates when there is underlying true variance in effect sizes (64). This approach is particularly suited for our research given the diverse nature of addictions and personality dimensions being investigated.

To assess the heterogeneity among studies, Cochran’s Q test and the I²-index will be employed. We will interpret the I²-values as an indication of the proportion of total variation in estimated effects that may be attributed to heterogeneity rather than to chance.

To assess the heterogeneity among studies, Cochran’s Q test and the I² index will be employed.

We will interpret the I²-values as an indication of the proportion of total variation in estimated effects that may be attributed to heterogeneity rather than to chance. An I²-value greater than 50% will be indicative of substantial heterogeneity (Higgins et al., 2003). As the correlation coefficient is not normally distributed, we will use Z-transformation Z=\(\frac{1}{2}\text{ln (}\frac{1+\rho }{1-\rho })\) in the meta-analytic calculations. Meta-analysis will be used to pool the results of studies.

To investigate the impact of publication bias, which can occur when the likelihood of a study being published is influenced by the nature or direction of its results, we will construct funnel plots and conduct regression-based Egger's test and nonparametric Trim and Fill analysis. These analyses will help identify and adjust for asymmetry in the effect size distribution that may suggest the presence of publication bias.

Subgroup analysis and meta-regression will be conducted to explore potential sources of heterogeneity. Subgroup analysis will be performed according to age, gender, ethnicity, marital status, occupational status, and educational attainment. The specific criteria for defining these subgroups will be determined after a comprehensive review of the included studies, ensuring clarity and appropriateness for each variable. This approach aims to enhance our understanding of how these variables may differentially impact the association between HEXACO personality traits and addiction-related outcomes.

Sensitivity analysis will be performed using studies based on representative samples to assess how the exclusion of studies of potentially lower methodological rigor or with specific population characteristics affects the robustness of our findings. This analysis will help ensure the conclusions drawn from our meta-analysis are not unduly influenced by a subset of the included studies. Data will be analysed with Stata VER.18 (65).

The present systematic review and meta-analysis aim to examine the associations between the HEXACO personality traits and addiction disorders, including illegal substances (e.g., all narcotics in one category and cannabis in another), and behavioural addictions (e.g., gambling and gaming problems, social media addiction, and CSBD), within all types of sample populations. The results of this study will provide valuable insights into the potential impact of personality traits on SUD and behavioural addictions. This study will be the first to systematically summarize the associations between personality traits of the HEXACO model, SUD and behavioural addictions. One potential limitation is the scarcity of existing research specifically focused on the associations between the HEXACO model, SUD and behavioural addictions. The HEXACO model is relatively new compared to other personality frameworks, such as the FFM, and therefore, the number of studies investigating its relationship with addictive disorders may be limited. This scarcity can constrain the pool of eligible studies for inclusion in a systematic review/meta-analysis, potentially affecting the robustness and generalizability of the findings. Despite these limitations, understanding the associations between HEXACO personality traits and SUD and behavioural addictions can aid in the development of targeted interventions for individuals with specific personality characteristics.

CSBD: compulsive sexual behaviour disorder; FFM: five-factor model; AUD: Alcohol use disorder; SUD: substance use disorders; GD: gambling disorder; CUD: cannabis use disorder.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Competing interests

The authors declare that they have no competing interests.

Funding

This study does not have external funding.

Authors' contributions

EKE, SP, KTEM, and FS conceived and designed the systematic review. FS wrote the first draft of the manuscript. SP contributed significantly to the design, methodology, and revision of the protocol. All authors revised and approved the final manuscript.

Acknowledgements

Not applicable.

Authors' information

1) Department of Psychosocial Science, University of Bergen, Bergen, Norway. 2) Department of Psychosocial Science, University of Bergen, Bergen, Norway. 3) Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway 4) Department of Clinical Psychology, University of Bergen, Bergen, Norway. 5) Department of Psychosocial Science, University of Bergen, Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

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Reviewers invited by journal
18 Mar, 2024
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Associations between HEXACO personality traits, substance use disorders and behavioral addictions: A protocol for a comprehensive systematic review and meta-analysis

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