Cross-Lagged Panel Model in Medical Research: A Cautionary Note

Longitudinal designs provide a strong inferential basis for uncovering reciprocal effects or causality between variables. For this analytic purpose, a cross-lagged panel model (CLPM) has been widely used in medical research, but the use of the CLPM has recently been criticized in methodological literature because parameter estimates in the CLPM conflate between-person and within-person processes. The aim of this study is to present some alternative models of the CLPM that can be used to examine reciprocal effects, and to illustrate potential consequences of ignoring the issue. A literature search, case studies, and simulation studies are used for this. We examined more than 300 medical papers published since 2009 that applied cross-lagged longitudinal models, finding that in all studies only a single model (typically, the CLPM) was performed and potential alternative models were not considered to test reciprocal effects. In 49% of the studies, only two time points were used, which makes it impossible to test such alternative models. Case studies and simulation studies showed that the CLPM often has worse model fit and markedly different estimates of cross-lagged parameters than alternative models, suggesting that research that relies on the CLPM only may draw erroneous conclusions regarding the presence, predominance, and sign of reciprocal effects as well as about causality.