Semiparametric causal mediation analysis under unmeasured mediator-outcome confounding

Although the exposure can be randomly assigned in studies of mediation effects, any form of direct intervention on the mediator is often infeasible. As a result, unmeasured mediator-outcome confounding can seldom be ruled out. We propose semiparametric identification of natural direct and indirect effects in the presence of unmeasured mediator-outcome confounding by leveraging heteroskedasticity restrictions on the observed data law. For inference, we develop semiparametric estimators that remain consistent under partial misspecification of the observed data model. We illustrate the robustness of the proposed estimators through both simulations and an application to evaluate the effect of self-efficacy on fatigue among health care workers during the COVID-19 outbreak.