Title: Multiple questions for multiple mediators
Authors: Bianca Lucia De Stavola - University College London GOS Institute of Child Health (United Kingdom) [presenting]
Rhian Daniel - Cardiff University (United Kingdom)
Nadia Micali - UCL GOC Institute of Child Health (United Kingdom)
George Ploubidis - UCL Centre for Longitudinal Studies (United Kingdom)
Abstract: Investigating the mechanisms that may explain the causal links between an exposure and a temporally distal outcome often involves multiple interdependent mediators. Until recently, dealing with multiple mediators was restricted to settings where mediators relate to exposure and outcome only linearly. Extensions proposed in the causal inference literature to allow for interactions and non-linearities in the presence of multiple mediators initially focussed on natural direct and indirect effects. These however are not all identifiable, with the rest requiring stringent, and often unrealistic, assumptions. More recent developments have focussed interventional (or randomised interventional analogue) direct and indirect effects to deal with these issues. They can be identified under less restrictive assumptions, with generalizations dealing with time-varying exposures, mediators and confounders also possible. The mediation questions that can be addressed when estimating interventional effects differ from those asked by natural effects in subtle ways. We will review them, discuss their differences in emphasis, assumptions, and interpretation, and propose ways of exploiting these differences to assess the robustness of conclusions. We will use an epidemiological investigation of the mechanisms linking maternal pre-pregnancy weight status and offspring eating disorders behaviour to illustrate these points.