Estimation of Controlled Direct Effects in the Presence of Exposure-Induced Confounding and Latent Variables

Estimation of the direct effect of an exposure on an outcome requires adjustment for confounders of the exposure-outcome and mediator-outcome relationships. When some of the latter confounders have been affected by the exposure, then standard regression adjustment is prone to possibly severe bias. The use of inverse probability weighting under so-called marginal structural models has recently been suggested as a solution in the psychological literature. In this article, we show how progress can alternatively be made via G-estimation. We show that this estimation method can be easily embedded within the structural equation modeling framework and could in particular be used for estimating direct effects in the presence of latent variables. Moreover, by avoiding inverse probability weighting, it accommodates the typical problem of unstable weights in the alternative estimation approaches based on marginal structural models. We illustrate the approach both by simulations and by the analysis of a longitudinal study in individiduals who ended a romantic relationship. In this example we explore whether the effect of attachment anxiety during the relationship on mental distress 2 years after the breakup is mediated by rumination or not.