Fig 1. Directed acyclic graph (DAG).

We theorize that patient satisfaction with healthcare quality is a manifestation of patients’ interactions with providers and the healthcare system within which they receive healthcare. The direct path from patient satisfaction to antidepressant adherence/discontinuation was quantified, all other relationships (dashed arrows) were accounted for in the analysis as covariates. Potential reverse association is represented as a feedback loop from patient perceptions of the effectiveness of antidepressant to depression-related factors (red dashed line).