Table 3 Key considerations in a causal mediation analysis involving attention-deficit/hyperactivity, problematic online gaming, and mental health

Temporal order of exposure, mediator, and outcome

Establishing a clear temporal order of attention-deficit/hyperactivity, problematic online gaming, and mental health necessitates the inclusion of at least three time points. Failure to address this can result in reverse causation and inability to establish causal relationships.

Exposure-mediator confounding and mediator-outcome confounding when examining natural direct and indirect effects

Comprehensive adjustment is required for attention-deficit/hyperactivity-problematic online gaming, problematic online gaming-mental health, and attention-deficit/hyperactivity-mental health confounding. Without this, confounding bias and reverse causation can compromise the findings.

Exposure-mediator interaction

The interaction between attention-deficit/hyperactivity and problematic online gaming likely exists in real-world scenarios and must be accounted for. Ignoring this can lead to model misspecification and failure to capture the dynamics of mediation.