Pathways to health: conceptual clarification and appropriate statistical treatment of mediator, moderator, and indirect effects using examples from burnout research

Abstract

In my role as consulting statistical editor for the South African Journal of Psychology, I have witnessed a steady increase in articles that focused on the presumed role of mediator and moderator variables. While straightforward cause–effect studies have an important explanatory role, our task in the helping profession is to identify those factors that ‘intervene’ and make individuals differentially vulnerable in the cause–effect relationship. However, in a significant number of papers I have reviewed, there appeared to be considerable conceptual confusion about these variables with moderator and mediator often used interchangeably. In addition, no single paper I have reviewed considered indirect effects. This article attempts to differentiate between the various roles that a third variable can play in the adverse condition–wellbeing relationship (e.g., the stress–depression relationship). In addition, the appropriate statistical procedures for testing these roles are demonstrated using burnout research data. In this particular research project, 207 secondary school teachers completed a range of research questionnaires designed to assess among others burnout, work environment, social support, personal competence, coping, and problem-solving appraisal. Using this data, the various roles that third variables can play are demonstrated using hierarchical regression analyses.

Depression among health care students in the time of COVID-19: the mediating role of resilience in the hopelessness–depression relationship

“…Resilience correlated negatively with hopelessness, depression, and all subscales of the CESD scale except for positive affect. These relationships support what is referred to in the literature as the 'health-sustaining role' (Pretorius, 2020) of protective factors such as resilience. This role implies that an increase in resilience would directly result in a decrease in hopelessness and depression irrespective of resilience's position as the mechanism through which hopelessness impacts depression.…”

A looming mental health pandemic in the time of COVID-19? Role of fortitude in the interrelationship between loneliness, anxiety, and life satisfaction among young adults

“…Zero does not fall within the confidence interval, which indicates that fortitude mediated the relationship between loneliness and anxiety. However, if it is the presumed mediator that is reduced, it would indicate that the independent variable is the mediated pathway (Pretorius, 2020). The regression coefficient for fortitude was also reduced in Step 2 of the regression analyses (β = −.26, p < .001), and the indirect effect of fortitude on anxiety was significant (β = −.33, p = .007).…”

Psychological distress in the time of COVID-19: The relationship between anxiety, hopelessness, and depression and the mediating role of sense of coherence.

“…The majority of studies on the influence of protective factors (e.g., self-efficacy, social support, locus of control, fortitude, etc.) on psychological outcomes have described these factors as having a moderating or mediating function—that is, they mediate or moderate the harmful effects of adverse events on psychological functioning (see Pretorius, 2020 for an overview). In addition to these pathways (i.e., moderation and mediation), the direct association between the protective factors and adverse conditions should also be considered important (Pretorius, 2020).…”

“…In addition to these pathways (i.e., moderation and mediation), the direct association between the protective factors and adverse conditions should also be considered important (Pretorius, 2020). The direct effects hypothesis, also referred to as the health-sustaining model (Shumaker & Brownell, 1984), postulates that the effect of a third variable (e.g., self-efficacy or social support) on well-being is independent of the level of the adverse event or environmental stressor (Pretorius, 2020). Theoretically, this means that an increase in the levels of the third variable (e.g., SOC) will result in an increase in psychological well-being, regardless of the level of the adverse environmental condition.…”

“…on psychological outcomes have described these factors as having a moderating or mediating function—that is, they mediate or moderate the harmful effects of adverse events on psychological functioning (see Pretorius, 2020 for an overview). In addition to these pathways (i.e., moderation and mediation), the direct association between the protective factors and adverse conditions should also be considered important (Pretorius, 2020). The direct effects hypothesis, also referred to as the health-sustaining model (Shumaker & Brownell, 1984), postulates that the effect of a third variable (e.g., self-efficacy or social support) on well-being is independent of the level of the adverse event or environmental stressor (Pretorius, 2020).…”