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An important recent development in mediation analysis is the use of causal mediation analysis. Causal mediation analysis decomposes the total exposure effect into causal direct and indirect effects in the presence of exposure-mediator interaction. However, in practice, traditional mediation analysis is still most widely used. The aim of this paper is to demonstrate the similarities and differences between the causal and traditional estimators for mediation models with a continuous mediator, a binary outcome, and exposure-mediator interaction. A real-life data example, analytical comparisons, and a simulation study were used to demonstrate the similarities and differences between the traditional and causal estimators. The causal and traditional estimators provide similar indirect effect estimates, but different direct and total effect estimates. Traditional mediation analysis may only be used when conditional direct effect estimates are of interest. Causal mediation analysis is the generally preferred method as its casual effect estimates help unravel causal mechanisms. [ABSTRACT FROM AUTHOR]

Mediation analysis is a methodology used to understand how and why an independent variable (X) transmits its effect to an outcome (Y) through a mediator (M). New causal mediation methods based on the potential outcomes framework and counterfactual framework are a seminal advancement for mediation analysis, because they focus on the causal basis of mediation analysis. There are several programs available to estimate causal mediation effects, but these programs differ substantially in data set up, estimation, output, and software platform. To compare these programs, an empirical example is presented, and a single mediator model with treatment-mediator interaction was estimated with a continuous mediator and a continuous outcome in each program. Even though the software packages employ different estimation methods, they do provide similar causal effect estimates for mediation models with a continuous mediator and outcome. A detailed explanation of program similarities, unique features, and recommendations is discussed. [ABSTRACT FROM AUTHOR]