Interpretation and identification of causal mediation

Abstract

This article reviews the foundations of causal mediation analysis and offers a general and transparent account of the conditions necessary for the identification of natural direct and indirect effects, thus facilitating a more informed judgment of the plausibility of these conditions in specific applications. I show that the conditions usually cited in the literature are overly restrictive and can be relaxed substantially without compromising identification. In particular, I show that natural effects can be identified by methods that go beyond standard adjustment for confounders, applicable to observational studies in which treatment assignment remains confounded with the mediator or with the outcome. These identification conditions can be validated algorithmically from the diagrammatic description of one's model and are guaranteed to produce unbiased results whenever the description is correct. The identification conditions can be further relaxed in parametric models, possibly including interactions, and permit one to compare the relative importance of several pathways, mediated by interdependent variables.