ThesisPDF Available

Marginal Mediation Analysis: A New Framework for Interpretable Mediated Effects

Authors:
  • Highmark Health

Abstract and Figures

Mediation analysis is built to answer not only if one variable affects another, but how the effect takes place. However, it lacks interpretable effect size estimates in situations where the mediator (an intermediate variable) and/or the outcome is categorical or otherwise non-normally distributed. By integrating a powerful approach known as average marginal effects within mediation analysis—termed Marginal Mediation Analysis (MMA)—the issues regarding categorical mediators and/or outcomes are, in large part, resolved. This new approach allows the estimation of the indirect effects (those effects of the predictor that affect the outcome through the mediator) that are interpreted in the same way as mediation analysis with continuous, normally-distributed mediators and outcomes. This also, in turn, resolves the troubling situation wherein the indirect plus the direct effect does not equal the total effect (i.e., the total effect does not equal the total effect). By offering this information in mediation, interventionists and lawmakers can better understand where efforts and resources can make the greatest impact. This project presents the development and the software of MMA, describes the evaluation of its performance, and reports an application of MMA to health data. The approach is successful in several aspects: 1) the software works across a wide variety of situations as the {MarginalMediation} R package; 2) MMA performed well and was statistically powered much like other mediation analysis approaches; and 3) the application demonstrated the increased amount of interpretable information that is provided in contrast to other approaches.
Content may be subject to copyright.
A preview of the PDF is not available
... The method of marginal mediation analysis proposed by Barrett (2018) is found best to analyze the model. Marginal Mediation Analysis integrates the method of Average Marginal Effects (AMEs) proposed by Bartus (2005) in mediation analysis. ...
... Marginal mediation is the latest approach to deal with binary mediators and/ or binary outcomes and to get effect size of each mediator without any interpretability issues. Barrett (2018) discussed the existing methods and their limitations to deal with categorical outcomes and mediators. It is illustrated that the marginal mediation analysis makes the interpretation of indirect effects more meaningful and simple in the models which were previously considered problematic (models with categorical mediators and outcomes). ...
... The following steps will be followed to estimate the direct and indirect effect of education on life satisfaction as proposed by the method of Marginal mediation by Barrett (2018). ...
Article
Full-text available
The current micro-level study explores the impact of education on life satisfaction of individuals in Pakistan via six mediating factors that are health, employment status, marital status, number of children, the scale of income and freedom of choice. The differences based on gender, marital status and the scale of income are also analyzed by using data from Wave 6 (2010-2014) of the World Values Survey. The marginal mediation technique by Barrett (2018) is used. It is observed that education plays a significant role in affecting life satisfaction. The channels of health, freedom and scale of income are found significant in the analysis of the full sample. Different paths are found operative for opposite genders. Comparison based on the scale of income shows that more channels are found effective for the middle class as compared to rich and poor.
... The limitations of the study to be pointed out result from the fact that mediation has not been examined in a longitudinal model, so it should be considered more as a source of hypotheses than confirmed mechanisms. Moreover, for lack of an appropriate method, the mediation analysis was conducted for each cluster separately, which may produce overestimations, so this part of the results should be approached with caution (Barrett, 2018). ...
Preprint
Aims The aim of the study was to identify psychological determinants of particular patterns of playing P2W games (including problem gaming): coping strategies and motivation to play.Methods The article presents the results of the study conducted among online Pay to Win (P2W) gamers (n = 868), defined as those who have declared to make payments in online games in order to gain an advantage over gamers who refuse to pay. ResultsThe two patterns of problem gaming differed in their predictors; the pattern of larger contributions is associated with self-enhancement motivation, and the pattern of small frequent contributions is associated with social motivation and escape from problems.Conclusions The social factor proved to be the differentiator between the most distinct types of players. In this context, the question can be raised whether players who pay only for the aesthetic aspects of the game (and not for progress) should be excluded from P2W players. The mechanisms involved in these players may be similar, and if different, they would be worthwhile to analyze. Perhaps for some players P2W games are not strictly speaking “pay to win” but rather “pay to win admiration” games.
Article
Full-text available
Whether Latinx families use youth mental health services (MHS) depends on complex influences of barriers and facilitators within and outside of the home. This research sought to shed light on caregiver strain as part of the equation focused on parental identification and responses to youth mental health needs. We examined multiple dimensions of caregiver strain as potential mediators between youth mental health symptom severity and psychological counseling utilization. The present sample consisted of 598 Latinx caregivers to youths ages 6–18 who provided information on youth internalizing and externalizing problems, caregiver strain, and youth psychological counseling service utilization within the last year. Our findings suggest that youth symptom severity (internalizing and externalizing problems) was generally positively associated with dimensions of caregiver strain. Youth symptom severity through objective and subjective internalized strain pathways were associated with greater odds of youth MHS utilization. In contrast, youth symptom severity through subjective externalized strain reduced the odds that Latinx caregivers would report utilizing youth MHS. These models only partially mediated the relationship between youth problems and service use. Findings suggest that Latinx caregivers may navigate conflicting sources of strain related to their child’s mental health problem severity in ways that may differentially impact the odds that they access youth MHS. Along with addressing structural and systemic barriers to care, utilization of psychological counseling services may also be improved through interventions that help Latinx caregivers view youth services as avenues for addressing caregiver strain and providing psychoeducation that frames externalized strain within a mental health lens.
Article
Full-text available
Purpose: Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility. Method: Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria-who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)-or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker. Results: All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility. Conclusion: Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.
Article
Full-text available
Objective: The coevolution of adolescent social networks, alcohol use, and physical activity is studied. Previous research has independently evaluated each behavior, overlooking the potential power of examining their development within a shared social context. The current study extends previous research by examining the dynamics of friendship networks, alcohol use, and physical activity in conjunction, including the concurrent engagement in both behaviors, with a nationally representative sample of U.S. adolescents. Special attention is paid to differing patterns of peer selection and peer assimilation across behaviors. Method: Data come from 2 high schools (n = 640; n = 1,156) within the National Longitudinal Study of Adolescent to Adult Health. Longitudinal stochastic actor-based models were used to separate peer selection and assimilation processes to differentiate the mechanisms linking friendships and both behaviors as well as the relationship between alcohol use and physical activity. Results: Findings suggest distinct differences in the importance of peer selection and assimilation processes to adolescent alcohol use and physical activity. In both schools, adolescents selected friends based on similarity in alcohol use, but no selection effect was found for physical activity. Conversely, assimilation to friends' behavior occurred for physical activity, yet evidence for alcohol assimilation was mixed. No significant relationship between alcohol use and physical activity emerged. Conclusions: Intervention efforts that focus on friend influence in changing health behavior may have particular success with adolescent physical activity. Programs aimed at alcohol use would benefit from including an emphasis on preventing negative friend formations. (PsycINFO Database Record
Article
OBJECTIVES: Our aim with this article is to evaluate whether the prevalence of hearing loss is increasing among adolescents living in the United States. METHODS: All available data about hearing loss among adolescents from the large, federally funded National Health and Nutrition Examination Survey (NHANES) were analyzed. By using the 4 data releases between 1994 and 2010 (a total of 6891 adolescents), the prevalence of adolescent hearing loss >15 and ≥25 dB at low frequencies (0.5, 1, and 2 kHz) and high frequencies (3, 4, 6, and 8 kHz) for bilateral, unilateral, and any loss were calculated. RESULTS: Only 13 of 90 comparisons of prevalence across combinations of degree, frequency, and laterality of hearing loss revealed a statistically significant increase at P < .05. Among the 18 subgroups of degree, frequency, and laterality, 61% had a lower prevalence of hearing loss in 2010 than in 1994, and 100% of the subgroups had a lower prevalence in 2010 than in 2006. CONCLUSIONS: With previous analyses of NHANES data from 1994 to 2006, researchers showed that hearing loss among US adolescents was increasing. Based on the NHANES data from 1994 to 2010 that are now available, there is no consistent evidence that hearing loss among adolescents in the United States is increasing. Results reveal that conclusions about trends using data from 2 time points can be misleading. NHANES should resume collecting audiometric data as part of their data collection protocol so that trends in the prevalence of childhood hearing loss can be documented.
Article
Background: The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. Methods: We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. Results: The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and 10,734amongwomen,and33.5encountersand10,734 among women, and 33.5 encounters and 11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and 4803amongwomen,and19.5encountersand4803 among women, and 19.5 encounters and 8001 among men. Conclusions: Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.
Article
This study replicated, with modifications, previous research of dyad reading using texts at various levels of difficulty (Morgan, 1997). The current project measured the effects of using above–grade-level texts on reading achievement and sought to determine the influences of dyad reading on both lead and assisted readers. Results indicate that weaker readers, using texts at two, three, and four grade levels above their instructional levels with the assistance of lead readers, outscored both proficient and less proficient students in the control group across multiple measures of reading achievement. However, the gains made by assisted readers were not significantly different relative to the various text levels. When all assessments were considered, assisted readers reading texts two grade levels above their instructional levels showed the most robust gains in oral reading fluency and comprehension. Lead readers also benefited from dyad reading and continued their respective reading developmental trajectories across measures.
Article
Exploratory mediation analysis refers to a class of methods used to identify a set of potential mediators of a process of interest. Despite its exploratory nature, conventional approaches are rooted in confirmatory traditions, and as such have limitations in exploratory contexts. We propose a two-stage approach called exploratory mediation analysis via regularization (XMed) to better address these concerns. We demonstrate that this approach is able to correctly identify mediators more often than conventional approaches and that its estimates are unbiased. Finally, this approach is illustrated through an empirical example examining the relationship between college acceptance and enrollment.
Article
Background Many dynamics in the relationship among military service-related disabilities, health care benefits, mental health disorders, and post-deployment homelessness among US Veterans are not well understood. Objectives Determine whether Veterans with a disability-related discharge from military service are at higher risk for homelessness, whether Veterans Health Administration (VHA) service-connected disability benefits mitigates that risk, and whether risks associated with discharge type, service-connected disability, or the interaction between them vary as a function of mental health disorders. Methods Retrospective cohort study of 364,997 Veterans with a disability-related or routine discharge and initial VHA encounter between 2005–2013. Logistic regression and survival analyses were used to estimate homelessness risk as a function of discharge status, mental health disorders, and receipt of VHA disability benefits. Results Disability-discharged Veterans had higher rates of homelessness compared to routine discharges (15.1 verses 9.1 per 1,000 person-years at risk). At the time of the first VHA encounter, mental health disorders were associated with differentially greater risk for homelessness among Veterans with a disability discharge relative to those with a routine discharge. During the first year of VHA service usage, higher levels of disability benefits were protective against homelessness among routinely-discharged Veterans, but not among disability-discharged Veterans. By 5-years, disability discharge was a risk factor for homelessness (AOR=1.30). Conclusions In the long-term, disability discharge is an independent risk factor for homelessness. While VHA disability benefits help mitigate homelessness risk among routinely-discharged Veterans during the early reintegration period, they may not offer sufficient protection for disability-discharged Veterans.
Article
Measurement error adds noise to predictions, increases uncertainty in parameter estimates, and makes it more difficult to discover new phenomena or to distinguish among competing theories. A common view is that any study finding an effect under noisy conditions provides evidence that the underlying effect is particularly strong and robust. Yet, statistical significance conveys very little information when measurements are noisy. In noisy research settings, poor measurement can contribute to exaggerated estimates of effect size. This problem and related misunderstandings are key components in a feedback loop that perpetuates the replication crisis in science.