An overview of systematic reviews found suboptimal reporting and methodological limitations of mediation studies investigating causal mechanisms
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Objectives The objective of this study was to investigate whether systematic reviews of mediation studies identify limitations in reporting quality and methodological conduct.Study design and setting We conducted an overview of systematic reviews. We searched four databases (MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and PubMed) to identify systematic reviews of studies that used mediation analysis to investigate mechanisms of health care interventions or exposures in clinical populations between 2007 and 2017. Two reviewers independently screened titles and abstracts. Summary data on the characteristics, reporting quality, and methodological conduct of the studies included in the systematic reviews were extracted independently by two reviewers. The protocol was prospectively registered on PROSPERO (CRD42017059834).Results Fifty-four systematic reviews were included, representing 11 health care fields, 26 health conditions, and 2008 mediation studies. Eighteen of fifty-four systematic reviews (33%) explicitly stated that the reporting of primary studies was suboptimal. Of these, 14/18 (78%) reviews noted incomplete reporting of effect sizes and precision estimates from mediation analyses. Twenty-nine of fifty-four systematic reviews (54%) identified limitations in the methodological conduct of primary studies.Conclusion The reporting and methodological conduct of studies investigating mechanisms in health care seems to be suboptimal. Guidance is needed to improve the quality, completeness, and transparency of mediation studies.
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Methodological limitations and suboptimal reporting remain challenges across the mediation literature.
“methodological limitations and suboptimal reporting remain challenges across the mediation literature (Cashin et al., 2019).”
From Measuring the active elements of cognitive-behavioral therapies (2023) · cites this paper as Cashin et al., 2019
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- A2. Search Strategy 1. mechanism evaluation 2. mediat* 3. mediation analysis 4. mediation analyses 5. causal mediation analysis 6. causal mediation analyses 7. Combine 1-6 OR 8. systematic adj2 (review* or overview*) 9. systematic review 10. narrative review 11. meta analysis 12. meta-analysis 13. Combine 8-12 OR 14. 7 AND 13
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Cashin, A. G., McAuley, J. H., Lamb, S. E., Hopewell, S., Kamper, S. J., Williams, C. M., Henschke, N., & Lee, H. (2020) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2020-111406 · Cited by 15 · see citing works
Self-citationVo, T., Cashin, A. G., Superchi, C., Tu, P. H. T., Nguyen, T., Boutron, I., MacKinnon, D. P., VanderWeele, T. J., Lee, H., & Vansteelandt, S. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.12.013 · Cited by 14 · see citing works
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Cashin, A. G., McAuley, J. H., & Lee, H. (2022) · Implementation Research and Practice · doi:10.1177/26334895221105568 · Cited by 11 · see citing works
Self-citationCashin, A. G., McAuley, J. H., & Lee, H. (2022) · Nature Medicine · doi:10.1038/s41591-021-01674-2 · Cited by 8 · see citing works
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Design Parameter Values for Planning Mediation Studies with Teacher and Student Mathematics Outcomes
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Choosing what works for whom: towards a better use of mechanistic knowledge in clinical practice
Alaiti, R. K., Saragiotto, B. T., Fukusawa, L., Rabelo, N. D. D. A., & de Oliveira, A. S. (2021) · Archives of Physiotherapy · doi:10.1186/s40945-021-00122-1 · Cited by 5 · see citing works
Group inference for high-dimensional mediation models
Yu, K., Guo, X., & Luo, S. (2025) · Statistics and Computing · doi:10.1007/s11222-025-10591-0 · Cited by 3 · see citing works
Cashin, A. G., & Vo, T. (2024) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2024.111395 · Cited by 3 · see citing works
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A Reporting Guideline for Mediation Analyses
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Items for consideration in a reporting guideline for mediation analyses: a Delphi studyPreprint
Cashin, A. G., McAuley, J. H., Lamb, S. E., Hopewell, S., Kamper, S. J., Williams, C. M., Henschke, N., & Lee, H. (2020) · doi:10.31222/osf.io/yx96j · Cited by 2 · see citing works
Self-citationA New Tool for Reporting Mediation Analyses
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- Authors
- Cashin, A. G., Lee, H., Lamb, S. E., Hopewell, S., Mansell, G., Williams, C. M., Kamper, S. J., Henschke, N., & McAuley, J. H.
- Affiliations
- UNSW Sydney (AU)
- University of Oxford (GB)
- Aston University (GB)
- University of Newcastle Australia (AU)
- The University of Sydney (AU)
- Corresponding author
- Lee, Hopin
- ORCID
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 111
- Pages
- 60-68.e1
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2923845382
- Cited by
- 36
- References
- 85
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 6 · 2020: 3 · 2019: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Aston Publications Explorer (Aston University) (acceptedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- CEGA
- Laura and John Arnold Foundation
- University of New South Wales
- NeuRA
- Australian National Health and Medical Research Council (APP1126767)
- National Institute for Health Research (NIHR)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- mediation analysis, reporting quality, methodological limitations, causal mechanisms, health interventions, effect size, transparency
- MeSH terms
- Systematic Reviews as Topic, Research Design, Causality
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