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- An Introduction to Causal Mediation Analysis With a Comparison of 2 R Packages
- Sangmin Byeon, Woojoo Lee
- J Prev Med Public Health. 2023;56(4):303-311. Published online July 31, 2023
- DOI: https://doi.org/10.3961/jpmph.23.189
- 8,905 View
- 416 Download
- 9 Web of Science
- 9 Crossref
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Abstract
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Supplementary Material - Traditional mediation analysis, which relies on linear regression models, has faced criticism due to its limited suitability for cases involving different types of variables and complex covariates, such as interactions. This can result in unclear definitions of direct and indirect effects. As an alternative, causal mediation analysis using the counterfactual framework has been introduced to provide clearer definitions of direct and indirect effects while allowing for more flexible modeling methods. However, the conceptual understanding of this approach based on the counterfactual framework remains challenging for applied researchers. To address this issue, the present article was written to highlight and illustrate the definitions of causal estimands, including controlled direct effect, natural direct effect, and natural indirect effect, based on the key concept of nested counterfactuals. Furthermore, we recommend using 2 R packages, ‘medflex’ and ‘mediation’, to perform causal mediation analysis and provide public health examples. The article also offers caveats and guidelines for accurate interpretation of the results.
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SummaryKorean summary
전통적 매개분석은 여러 유형의 변수 혹은 복잡한 상호작용을 포함할 경우, 직접 및 간접효과의 정의가 불분명하다는 비판에 직면해왔다. 이에 대한 대안으로서 인과매개분석은 반사실적 개념에 기반하여 직접 및 간접효과를 명료하게 정의하며 유연한 모델링을 가능하게 한다. 다만 이 새로운 접근의 주요 개념을 응용 연구자들이 이해하는 데에는 다소 어려운 측면이 있다. 이러한 점에서 이 논문에서는 중첩된 반사실적 변수에 기반한 인과적 모수의 정의를 상술하고 인과매개분석을 위한 대표적인 R 패키지인 medflex 및 mediation을 활용하여 공공 보건 사례에 대한 분석 실례 및 유의사항을 제공하였다. -
Citations
Citations to this article as recorded by
- Sleep as a possible mediator in the association of mental health parameters with cardiovascular health indices in women: exploratory analyses from the Heart SCORE Study
Ida T. Fonkoue, Milena Silva, Susan B. Racette, Sandra E. Safo, Lisa de las Fuentes, Dawn Lowe, Imo A. Ebong, Daniel Buysse, Steven E. Reis, Anum Saeed
Menopause.2025; 32(2): 142. CrossRef - The U-shaped association of fasting plasma glucose to HbA1c ratio with mortality in diabetic and prediabetic populations: the mediating role of systemic immune-inflammation index
Ming Yang, Qing Shangguan, Guobo Xie, Guotai Sheng, Jingqi Yang
Frontiers in Endocrinology.2025;[Epub] CrossRef - Health literacy and frailty: the mediating role of instrumental activities of daily living
Keisuke Nakamura, Tomohiro Sasaki, Yoshiharu Yokokawa, Shinobu Yokouchi
Psychogeriatrics.2025;[Epub] CrossRef - The associations of cerebrospinal fluid ApoE and C1q with Alzheimer's disease biomarkers
Yu-Jing Lin, Ying Liu, Ze-Hu Sheng, Yan Fu, Ling-Zhi Ma, Zi-Hao Zhang, Lan-Yang Wang, Liang-Yu Huang, Min Liu, Zuo-Teng Wang, Lan Tan
Journal of Alzheimer’s Disease.2025; 104(3): 852. CrossRef - The mediating role of food insecurity in the relationship between income poverty and depressive symptoms and suicidal ideation: A nationwide study of Korean adults
Seong-Uk Baek, Jin-Ha Yoon
Social Science & Medicine.2025; 373: 117972. CrossRef - How does biological age acceleration mediate the associations of obesity with cardiovascular disease? Evidence from international multi-cohort studies
Lin Hu, Jiayuan Li, Zihuan Tang, Peng Gong, Zongqi Chang, Chen Yang, Tianpei Ma, Shuang Jiang, Chunxia Yang, Tao Zhang
Cardiovascular Diabetology.2025;[Epub] CrossRef - Social class and moral judgment: a process dissociation perspective
Andreas Tutic, Friederike Haiser, Ivar Krumpal
Frontiers in Sociology.2024;[Epub] CrossRef - Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study
Codie R. Rouleau, Daniele Chirico, Stephen B. Wilton, Matthew K. MacDonald, Tianqi Tao, Ross Arena, Tavis Campbell, Sandeep Aggarwal
Journal of the American Heart Association.2024;[Epub] CrossRef - Phenotypic age mediates effects of Life's Essential 8 on reduced mortality risk in US adults
Yuxuan Zhao, Haiming Yang, Rong Jiao, Yueqing Wang, Meng Xiao, Mingyu Song, Huan Yu, Chunxiao Liao, Yuanjie Pang, Wenjing Gao, Tao Huang, Canqing Yu, Jun Lv, Shengxu Li, Lu Qi, Liming Li, Dianjianyi Sun
Precision Clinical Medicine.2024;[Epub] CrossRef
- Sleep as a possible mediator in the association of mental health parameters with cardiovascular health indices in women: exploratory analyses from the Heart SCORE Study
Perspective
- iDENTIfyme Informative Campaign: Raising Forensic Dental Identification Awareness in the Community
- Emilio Nuzzolese
- J Prev Med Public Health. 2021;54(3):218-219. Published online April 20, 2021
- DOI: https://doi.org/10.3961/jpmph.21.081
- 4,496 View
- 126 Download
- 1 Crossref
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Abstract
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- The identification of human remains can be performed visually through families and next-of-kin, but it is not advisable to rely only on visual recognition; instead, it is preferable to conduct a forensic comparison of antemortem and postmortem data for primary identifiers (fingerprints, DNA, and dental data). A dental autopsy is particularly valuable in the identification process of skeletonized, carbonized, saponified, and fragmented human remains. The principal challenge in the identification process is the search and collection of antemortem data. To this end, all dental information held on a missing person can represent a precious source of individualizing information that families should share with the police or investigating agencies after reporting a disappearance.
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Summary
Citations
Citations to this article as recorded by- Creating Awareness Regarding Forensic Odontology Among Non-Forensic Persons for Successful Dental Identifications
H. Pandey, E. Nuzzolese
Journal of Forensic Dental Sciences.2022; : 136. CrossRef
English Abstract- Job Satisfaction, Subjective Class Identification and Associated Factors of Professional Socialization in Korean Physicians.
- Hyung Gon Yoon, Seok Jun Yoon, In Kyoung Hwang, Yeong Bae Mun, Hee Young Lee
- J Prev Med Public Health. 2008;41(1):30-38.
- DOI: https://doi.org/10.3961/jpmph.2008.41.1.30
- 5,327 View
- 34 Download
- 2 Crossref
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Abstract
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- OBJECTIVES
The aim of this study was to determine the relationship between the core properties of professional socialization and social status satisfaction, economic reward satisfaction, and subjective class identification. METHODS: Medical knowledge and skill, autonomy, and professional value factors were used as essential properties of professional socialization to determine the association with job satisfaction and subjective class identification. The authors used a self-administered questionnaire survey and collected nationwide data between July and August 2003, with 211 responses used for final analysis. RESULTS: 'Age' and 'trust and respect' were positively associated with social status satisfaction, and 'occupation' was negatively associated. 'Income' and 'trust and respect' were positively related to economic reward satisfaction, and 'practicing for oneself', and 'a sense of duty and attendance' were negatively related. 'Practicing for oneself', 'not believing explanations', and 'a sense of duty and attendance' had a positive relationship with subjective class identification. 'Income', 'knowledge system', 'medical mistakes', 'treating like goods', 'meaning and joy', and 'trust and respect' had a negative relationship. CONCLSIONS: The core property variables of professional socialization had a different relationship with social status satisfaction, economic reward satisfaction and subjective class identification. In particular, many core property variables were associated with subjective class identification positively or negatively. The development of professional socialization would help promote job satisfaction and subjective class identification. -
Summary
Citations
Citations to this article as recorded by- The Gap Between Physicians and the Public in Satisfaction with the National Health Insurance System in Korea
Kye-Hyun Kim, Eun-Cheol Park, Myung-Il Hahm
Journal of Korean Medical Science.2012; 27(6): 579. CrossRef - Qualitative Research on Experience of Primary Physicians Operating Their Primary Health Care Centers
Daegeun Lee, Myung Sun Yi, Eun Young Park, Sung Hee Jo, Sang Min Park
Korean Journal of Family Medicine.2010; 31(4): 275. CrossRef
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