Flexible approaches to computing mediated effects in generalized linear models: Generalized estimating equations and bootstrapping

In behavioral research, interest is often in examining the degree to which the effect of an independent variable X on an outcome Y is mediated by an intermediary or mediator variable M. This article illustrates how generalized estimating equations (GEE) modeling can be used to estimate the indirect or mediated effect, defined as the amount by which the regression coefficient of X on Y changes after adjusting for M. Advantages of this method are: (a) it applies to the class of generalized linear models, including linear, logistic, and Poisson regression as special cases; (b) it allows multiple independent variables and mediators in the same model; and (c) asymptotically valid standard errors and confidence intervals are obtained using standard software. This methodology is compared with the bootstrap, another general methodology that can be applied to the same broad class of models, and is evaluated using simulation in both linear and logistic regression scenarios. The methods are utilized to examine the degree to which the effect of low birthweight status on internalizing symptoms at age 20 is mediated through IQ at age 8.