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This chapter statistically tests the relationship between American hierarchy, property rights, and state capacity using mediation analysis. It finds that American economic hierarchy enhances property rights in partner states, indirectly strengthening state capacity. The analysis explores scope conditions and the interaction between security and economic hierarchy, highlighting the contrasting effects on state-building. The chapter discusses the implications of the quantitative results for cases like Afghanistan.
Exposure to multiple languages may support the development of Theory of Mind (ToM) in neurotypical (NT) and autistic children. However, previous research mainly applied group comparisons between monolingual and bilingual children, and the underlying mechanism of the observed difference remains unclear. The present study, therefore, sheds light on the effect of bilingualism on ToM in both NT and autistic children by measuring language experiences with a continuous operationalization. We measure ToM with a behavioral, linguistically simple tablet-based task, allowing inclusive assessment in autistic children. Analyses revealed no difference between monolingual and bilingual NT and autistic children. However, more balanced exposure to different languages within contexts positively predicted first-order false belief understanding in NT children but not autistic children. Mediation analysis showed that the impact in NT children was a direct effect and not mediated via other cognitive skills.
Adverse childhood experiences (ACEs) are associated with physical and mental health difficulties in adulthood. This study examines the associations of ACEs with functional impairment and life stress among military personnel, a population disproportionately affected by ACEs. We also evaluate the extent to which the associations of ACEs with functional outcomes are mediated through internalizing and externalizing disorders.
Methods
The sample included 4,666 STARRS Longitudinal Study (STARRS-LS) participants who provided information about ACEs upon enlistment in the US Army (2011–2012). Mental disorders were assessed in wave 1 (LS1; 2016–2018), and functional impairment and life stress were evaluated in wave 2 (LS2; 2018–2019) of STARRS-LS. Mediation analyses estimated the indirect associations of ACEs with physical health-related impairment, emotional health-related impairment, financial stress, and overall life stress at LS2 through internalizing and externalizing disorders at LS1.
Results
ACEs had significant indirect effects via mental disorders on all functional impairment and life stress outcomes, with internalizing disorders displaying stronger mediating effects than externalizing disorders (explaining 31–92% vs 5–15% of the total effects of ACEs, respectively). Additionally, ACEs exhibited significant direct effects on emotional health-related impairment, financial stress, and overall life stress, implying ACEs are also associated with these longer-term outcomes via alternative pathways.
Conclusions
This study indicates ACEs are linked to functional impairment and life stress among military personnel in part because of associated risks of mental disorders, particularly internalizing disorders. Consideration of ACEs should be incorporated into interventions to promote psychosocial functioning and resilience among military personnel.
In the past decade, researchers have been increasingly interested in understanding the process of language learning, in addition to the effect of instructional interventions on L2 performance gains (i.e., learning products). One goal of such investigations is to reveal the interplay between learning conditions, processes, and outcomes where, for example, certain conditions can promote attention to the learning targets, which in turn facilitates learning. However, the statistical modeling approach taken often does not align with the conceptualization of the complex relationships between these variables. Thus, in this paper, we introduce mediation analysis to SLA research. We offer a step-by-step, contextualized tutorial on the practical application of mediation analysis in three different research scenarios, each addressing a different research design using either simulated or open-source datasets. Our overall goal is to promote the use of statistical techniques that are consistent with the theorization of language learning processes as mediators.
Older people with depression exhibit better response to electroconvulsive therapy (ECT). We aimed to measure the total effect of age on ECT response and investigate whether this effect is mediated by psychotic features, psychomotor retardation, psychomotor agitation, age of onset, and episode duration.
Methods
We pooled data from four prospective Irish studies where ECT was administered for a major depressive episode (unipolar or bipolar) with baseline score ≥21 on the 24-item Hamilton Depression Rating Scale (HAM-D). The primary outcome was change in HAM-D between baseline and end of treatment. The estimands were total effect of age, estimated using linear regression, and the indirect effects for each putative mediator, estimated using causal mediation analyses.
Results
A total of 256 patients (mean age 57.8 [SD = 14.6], 60.2% female) were included. For every additional 10 years of age, HAM-D was estimated to decrease by a further 1.74 points over the ECT period (p < 0.001). Age acted on all putative mediators. Mechanistic theories, whereby a mediator drives treatment response, were confirmed for all putative mediators except age of onset. Consequently, mediation of the effect of age on change in HAM-D could be demonstrated for psychotic features, psychomotor retardation, psychomotor agitation, and episode duration but not for age of onset.
Conclusions
A total of 43.1% of the effect of older age on increased ECT response was explained by the mediators. Treatment planning could be improved by preferentially offering ECT to older adults, especially if presenting with psychotic features, greater severity of psychomotor disturbance, and earlier in the episode.
Research shows that meritocratic recruitment (MR) in public administration is positively related to improved government performance and developmental outcomes. However, the mechanisms behind these improvements remain understudied theoretically and empirically. This paper addresses this gap by theorising and testing two simultaneous pathways through which MR influences development outcomes. First, by prioritising competence over nepotism or political expedience, MR enhances the epistemic quality of bureaucratic personnel (the competence mechanism). Second, by creating incentive misalignment between bureaucrats and politicians, it enables bureaucrats to resist undue political influence, prioritise public interests in governance, and ultimately contribute to development (the impartiality mechanism). Applying mediation analysis to fourteen years of cross-national data, we examine whether changes in recruitment systems are associated with competence- and impartiality-laden indicators of government performance and developmental outcomes. The findings provide robust empirical support for these mechanisms, advancing theoretical understanding and empirical insights into the effects of MR.
This study was designed to explore the mediating role of serum 25-hydroxyvitamin D (25(OH) D) in Triglyceride–glucose (TyG) index and hypertension (HTN). Study participants were selected from the 2001 to 2018 National Health and Nutrition Examination Survey. Firstly, we estimated the association between TyG index and serum 25(OH)D with HTN using a weighted multivariable logistic regression model and restricted cubic spline. Secondly, we used a generalised additive model to investigate the correlation between TyG index and serum 25(OH)D. Lastly, serum 25(OH)D was investigated as a mediator in the association between TyG index and HTN. There were 14 099 subjects in total. TyG index was positively and linearly associated with HTN risk, while serum 25(OH)D had a U-shaped relationship with the prevalence of HTN. When the serum 25(OH)D levels were lower than 57·464 mmol/l, the prevalence of HTN decreased with the increase of serum 25(OH)D levels. When serum 25(OH)D levels rise above 57·464 mmol/l, the risk of HTN increases rapidly. Based on the U-shaped curve, serum 25(OH)D concentrations were divided into two groups: < 57·464 and ≥57·464 mmol/l. According to the mediation analysis, when serum 25(OH)D levels reached < 57·464 mmol/l, the positive association between the TyG index and incident HTN was increased by 25(OH)D. When serum 25(OH)D levels reached ≥ 57·464 mmol/l, the negative association between the TyG index and incident HTN was increased by 25(OH)D. There was a mediation effect between the TyG index and HTN, which was mediated by 25(OH)D. Therefore, we found that the association between serum 25(OH)D levels and TyG index may influence the prevalence of HTN.
To examine the potential indirect effect of meal frequency on mortality via obesity indices.
Design:
Prospective cohort study
Setting:
Korean Genome and Epidemiology Study.
Participants:
This cohort study involved 148 438 South Korean adults aged 40 years and older.
Results:
Meal frequency at the baseline survey was assessed using a validated FFQ. Outcomes included all-cause mortality, cancer mortality and CVD mortality. Cox proportional hazards regression models were employed to examine the relationship between meal frequency and the risk of mortality. Mediation analyses were performed with changes in obesity indices (BMI and weight circumference (WC)) as mediators. In comparison to the three-time group, the once-per-day and four-times-per-day groups had a higher risk for all-cause mortality. The irregular frequency group had a higher risk for CVD mortality. Both once-per-day and four-times-per-day groups exhibited higher risks for cancer mortality. The effect of meal frequency on all-cause mortality was partially mediated by WC. For specific-cause mortality, similar mediation effects were found.
Conclusions:
The data suggests that three meals per day have a lower mortality and longer life expectancy compared with other meal frequencies. Increased waist circumference partially mediates this effect. These findings support the implementation of a strategy that addresses meal frequency and weight reduction together.
Extended redundancy analysis (ERA) is a statistical approach to component-based multivariate regression modeling that explores interrelationships among multiple sets of while incorporating regression with a data-reduction technique. The extant models that utilize ERA have assumed the outcome variables with the same data type. Also, ERA models focused on estimating direct pathways only without explicitly addressing mediation effects. In this paper, ERA is extended to handle multiple mediators and mixed types of outcome variables by adopting a Bayesian framework, taking into account correlation structure among all of the outcome variables. The proposed method develops an algorithm that derives the joint posterior distribution of parameters using a Markov chain Monte Carlo algorithm. Simulations and an empirical dataset are provided to illustrate the usefulness of the proposed method.
Mediation analysis constitutes an important part of treatment study to identify the mechanisms by which an intervention achieves its effect. Structural equation model (SEM) is a popular framework for modeling such causal relationship. However, current methods impose various restrictions on the study designs and data distributions, limiting the utility of the information they provide in real study applications. In particular, in longitudinal studies missing data is commonly addressed under the assumption of missing at random (MAR), where current methods are unable to handle such missing data if parametric assumptions are violated.
In this paper, we propose a new, robust approach to address the limitations of current SEM within the context of longitudinal mediation analysis by utilizing a class of functional response models (FRM). Being distribution-free, the FRM-based approach does not impose any parametric assumption on data distributions. In addition, by extending the inverse probability weighted (IPW) estimates to the current context, the FRM-based SEM provides valid inference for longitudinal mediation analysis under the two most popular missing data mechanisms; missing completely at random (MCAR) and missing at random (MAR). We illustrate the approach with both real and simulated data.
A social network comprises both actors and the social connections among them. Such connections reflect the dependence among social actors, which is essential for individuals’ mental health and social development. In this article, we propose a mediation model with a social network as a mediator to investigate the potential mediation role of a social network. In the model, the dependence among actors is accounted for by a few mutually orthogonal latent dimensions which form a social space. The individuals’ positions in such a latent social space are directly involved in the mediation process between an independent and dependent variable. After showing that all the latent dimensions are equivalent in terms of their relationship to the social network and the meaning of each dimension is arbitrary, we propose to measure the whole mediation effect of a network. Although individuals’ positions in the latent space are not unique, we rigorously articulate that the proposed network mediation effect is still well defined. We use a Bayesian estimation method to estimate the model and evaluate its performance through an extensive simulation study under representative conditions. The usefulness of the network mediation model is demonstrated through an application to a college friendship network.
This research concerns a mediation model, where the mediator model is linear and the outcome model is also linear but with a treatment–mediator interaction term and a residual correlated with the residual of the mediator model. Assuming the treatment is randomly assigned, parameters in this mediation model are shown to be partially identifiable. Under the normality assumption on the residual of the mediator and the residual of the outcome, explicit full-information maximum likelihood estimates of model parameters are introduced given the correlation between the residual for the mediator and the residual for the outcome. A consistent variance matrix of these estimates is derived. Currently, the coefficients of this mediation model are estimated using the iterative feasible generalized least squares (IFGLS) method that is originally developed for seemingly unrelated regressions (SURs). We argue that this mediation model is not a system of SURs. While the IFGLS estimates are consistent, their variance matrix is not. Theoretical comparisons of the FIMLE variance matrix and the IFGLS variance matrix are conducted. Our results are demonstrated by simulation studies and an empirical study. The FIMLE method has been implemented in a freely available R package iMediate.
Despite wide applications of both mediation models and missing data techniques, formal discussion of mediation analysis with missing data is still rare. We introduce and compare four approaches to dealing with missing data in mediation analysis including listwise deletion, pairwise deletion, multiple imputation (MI), and a two-stage maximum likelihood (TS-ML) method. An R package bmem is developed to implement the four methods for mediation analysis with missing data in the structural equation modeling framework, and two real examples are used to illustrate the application of the four methods. The four methods are evaluated and compared under MCAR, MAR, and MNAR missing data mechanisms through simulation studies. Both MI and TS-ML perform well for MCAR and MAR data regardless of the inclusion of auxiliary variables and for AV-MNAR data with auxiliary variables. Although listwise deletion and pairwise deletion have low power and large parameter estimation bias in many studied conditions, they may provide useful information for exploring missing mechanisms.
Genetic vulnerability to mental disorders has been associated with coronavirus disease-19 (COVID-19) outcomes. We explored whether polygenic risk scores (PRSs) for several mental disorders predicted poorer clinical and psychological COVID-19 outcomes in people with pre-existing depression.
Methods
Data from three assessments of the Australian Genetics of Depression Study (N = 4405; 52.2 years ± 14.9; 76.2% females) were analyzed. Outcomes included COVID-19 clinical outcomes (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection and long COVID, noting the low incidence of COVID-19 cases in Australia at that time) and COVID-19 psychological outcomes (COVID-related stress and COVID-19 burnout). Predictors included PRS for depression, bipolar disorder, schizophrenia, and anxiety. The associations between these PRSs and the outcomes were assessed with adjusted linear/logistic/multinomial regressions. Mediation (N = 4338) and moderation (N = 3326) analyses were performed to explore the potential influence of anxiety symptoms and resilience on the identified associations between the PRSs and COVID-19 psychological outcomes.
Results
None of the selected PRS predicted SARS-CoV-2 infection or long COVID. In contrast, the depression PRS predicted higher levels of COVID-19 burnout. Anxiety symptoms fully mediated the association between the depression PRS and COVID-19 burnout. Resilience did not moderate this association.
Conclusions
A higher genetic risk for depression predicted higher COVID-19 burnout and this association was fully mediated by anxiety symptoms. Interventions targeting anxiety symptoms may be effective in mitigating the psychological effects of a pandemic among people with depression.
Both depression and respiratory disease are common today in young populations. However, little is known about the relationship between them.
Aims
This study aims to explore the association between depression in childhood to early adulthood and respiratory health outcomes in early adulthood, and the potential underlying mechanisms.
Method
A prospective study was conducted based on the Swedish BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi [Children, Allergy, Milieu, Stockholm, Epidemiology]) birth cohort (n = 4089). We identified clinically diagnosed depression through the dispensation of antidepressants, using national register data confirmed by self-reported diagnosis. At the 24-year follow-up, respiratory health was assessed via questionnaires and clinical evaluation. Metabolic and inflammatory profiles were analysed to explore potential mechanisms.
Results
Among the 2994 participants who provided study data, 403 (13.5%) had depression at any time point from around age 10 to 25 years. Depression was associated with higher risks of any chronic bronchitis symptoms (odds ratio = 1.58, 95% CI 1.21–2.06) and respiratory symptoms (odds ratio = 1.41, 95% CI 1.11–1.80) in early adulthood, independent of body mass index (BMI) and smoking status. Compared to individuals without depression, those with depression had a higher fat mass index (FMI (β = 0.48, 95% CI 0.22–0.74)) and increased blood levels of fibroblast growth factor 21 and Interleukin-6 in early adulthood. These markers together with FMI were found to partly mediate the association between depression and respiratory symptoms (total mediation proportion: 19.8 and 15.4%, respectively, P < 0.01).
Conclusions
Depression in childhood to early adulthood was associated with an increased risk of respiratory ill-health in early adulthood, independently of smoking. Metabolic and inflammatory dysregulations may underlie this link.
To investigate the associations between dietary patterns and biological ageing, identify the most recommended dietary pattern for ageing and explore the potential mediating role of gut microbiota in less-developed ethnic minority regions (LEMRs). This prospective cohort study included 8288 participants aged 30–79 years from the China Multi-Ethnic Cohort study. Anthropometric measurements and clinical biomarkers were utilised to construct biological age based on Klemera and Doubal’s method (KDM-BA) and KDM-BA acceleration (KDM-AA). Dietary information was obtained through the baseline FFQ. Six dietary patterns were constructed: plant-based diet index, healthful plant-based diet index, unhealthful plant-based diet index, healthy diet score, Dietary Approaches to Stop Hypertension (DASH), and alternative Mediterranean diets. Follow-up adjusted for baseline analysis assessed the associations between dietary patterns and KDM-AA. Additionally, quantile G-computation identified significant beneficial and harmful food groups. In the subsample of 764 participants, we used causal mediation model to explore the mediating role of gut microbiota in these associations. The results showed that all dietary patterns were associated with KDM-AA, with DASH exhibiting the strongest negative association (β = −0·91, 95 % CI (–1·19, −0·63)). The component analyses revealed that beneficial food groups primarily included tea and soy products, whereas harmful groups mainly comprised salt and processed vegetables. In mediation analysis, the Synergistetes and Pyramidobacter possibly mediated the negative associations between plant-based diets and KDM-AA (5·61–9·19 %). Overall, healthy dietary patterns, especially DASH, are negatively associated with biological ageing in LEMRs, indicating that Synergistetes and Pyramidobacter may be potential mediators. Developing appropriate strategies may promote healthy ageing in LEMRs.
The Thinking Healthy Program (THP) is a multicomponent low-intensity cognitive behavioral therapy-based psychosocial intervention. This intervention has been shown to be clinically effective in perinatal depression (PND) and feasible for implementation in low-resourced settings. It has also been shown to work universally for different phenotypes of PND. However, the mechanism through which THP resolves different phenotypes of PND are unclear. The present investigation presents secondary mediation analyses of a dataset curated from a cluster randomized controlled trial conducted in Pakistan assessing the effectiveness of the THP. Women aged 16–45 years in their third pregnancy trimester, with a diagnosis of PND, underwent 16 sessions of the intervention. The severity of depression was assessed using the Hamilton Depression Rating Scale (HDRS). 2-1-1 mediation models revealed that social support exerted significant mediation in driving the intervention effects for improving the severity of depressive symptoms on the HDRS [B (SE) = 0.45 (0.09), 95% CI: 0.30–0.60] and its symptom dimensions of core emotional symptoms [B (SE) = 0.27 (0.06), 95% CI: 0.18–0.37], somatic symptoms [B (SE) = 0.24 (0.04), 95% CI: 0.16–0.31] and insomnia symptoms [B (SE) = 0.04 (0.02), 95% CI: 0.02–0.07].
Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear.
Aims:
To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2).
Method:
A cross-sectional study was conducted among Asian out-patients with schizophrenia (January–April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators.
Results:
Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=–.013, .031) and –.003 (–.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety–paranoia relationship.
Conclusions:
Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants’ characteristics.
Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).
Methods
Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).
Results
Smoking (HRs range 1.04–1.10) and physical inactivity (HRs range 1.01–1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03–1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).
Conclusions
Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
Although suicide bereavement is associated with suicide and self-harm, evidence regarding mechanisms is lacking. We investigated whether depression and substance use (alcohol and/or other drugs) explain the association between partner suicide bereavement and suicide.
Methods
Linkage of nationwide, longitudinal data from Denmark for the period 1980–2016 facilitated a comparison of 22 668 individuals exposed to bereavement by a partner's suicide with 913 402 individuals bereaved by a partner's death due to other causes. Using causal mediation models, we estimated the degree to which depression and substance use (considered separately) mediated the association between suicide bereavement and suicide.
Results
Suicide-bereaved partners were found to have a higher risk of suicide (HRadj = 1.59, 95% CI 1.36–1.86) and of depression (ORadj 1.16, 95% CI 1.09–1.25) when compared to other-bereaved partners, but a lower risk of substance use (ORadj 0.83; 95% CI 0.78–0.88). An increased risk of suicide was found among any bereaved individuals with a depression diagnosis recorded post-bereavement (ORadj 3.92, 95% CI 3.55–4.34). Mediation analysis revealed that depression mediated 2% (1.68%; 95% CI 0.23%–3.14%; p = 0.024) of the association between suicide bereavement and suicide in partners when using bereaved controls.
Conclusions
Depression is a partial mediator of the association between suicide bereavement and suicide. Efforts to prevent and optimize the treatment of depression in suicide-bereaved people could reduce their suicide risk. Our findings might be conservative because we did not include cases of depression diagnosed in primary care. Further work is needed to understand this and other mediators.