Institutional members access full text with Ovid®

Share this article on:

Identification of Natural Direct Effects When a Confounder of the Mediator Is Directly Affected by Exposure

Tchetgen Tchetgen, Eric J.; VanderWeele, Tyler J.

doi: 10.1097/EDE.0000000000000054

Natural direct and indirect effects formalize traditional notions of mediation analysis into a rigorous causal framework and have recently received considerable attention in epidemiology and in social sciences. Sufficient conditions for the identification of natural direct effects were formulated by Judea Pearl under a nonparametric structural equations model, which assumes certain independencies between potential outcomes. A common situation in epidemiology is that a confounder of the mediator-outcome relationship is itself affected by the exposure, in which case natural direct effects fail to be nonparametrically identified without additional assumptions, even under Pearl’s nonparametric structural equations model. In this article, we show that when a single binary confounder of the mediator is affected by the exposure, the natural direct effect is nonparametrically identified under the model, assuming monotonicity about the effect of the exposure on the confounder. A similar result is shown to hold for a vector of binary confounders of the mediator under a certain independence assumption about the confounders. Finally, we show that natural direct effects are more generally identified if there is no additive mean interaction between the mediator and the confounders of the mediator affected by exposure. When correct, this latter assumption is particularly appealing because it does not require monotonicity of effects of the exposure. In addition, it places no restriction on the nature of the confounders of the mediator, which can be continuous or polytomous.

Supplemental Digital Content is available in the text.

From the Departments of Epidemiology and Biostatistics, Harvard University, Boston, MA.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Eric J. Tchetgen Tchetgen, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc