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Background: Antidepressants (ADs) are the mainstay of treatment for patients with major depressive disorder (MDD). Insufficient efficacy of ADs and tolerability issues/side effects, such as treatment-emergent sexual dysfunction (TESD), can lead to treatment discontinuation, symptom persistence, and diminished quality of life. Methods: In this cross-sectional, internet-based survey, patients with MDD (aged 18–64 years) treated with ADs were categorized as continuers, switchers, or discontinuers based on their current oral AD use and any prior oral AD use in the last 12 months. The Carelon Research Healthcare Integrated Research Database was used as a sampling frame to identify survey-eligible adult patients. The survey fielding was conducted from May 29–October 1, 2020. Results: Overall, 900 patients completed the survey (554 [62%] continuers, 298 [33%] switchers, and 48 [5%] discontinuers). The 852 patients currently using ADs reported current use of 1178 ADs (mean: 1.4 AD per patient), while the 294 respondents who either switched or discontinued ADs reported using a total of 534 ADs in the past 12 months (mean: 1.8 AD per patient). Provider recommendations, treatment efficacy, and medication side effects played an important role in AD continuation, switching, or discontinuation. Furthermore, 19% of respondents (continuers and switchers) with no history of sexual problems reported sexual problems with use of at least one current or prior AD. Limitations: The discontinuer cohort was small with few respondents; thus, the between-group statistical comparisons were limited. Conclusions: These findings highlight the importance of patient-physician shared decision-making for MDD management, including minimization of side effects.

Commercially-insured adults comprise a majority of health plan members but are least likely to be surveyed about their social needs. Little is known, consequently, about health-related social needs (HRSNs) in this population. The primary aim of this study was to assess the prevalence of HRSNs and health among commercially-insured adults and estimate their relationship with health outcomes and spending.This cross-sectional study used survey data from a representative sample of Elevance Health commercially insured members residing in Georgia and Indiana (U.S.) Adult members reported on HSRNs across nine different domains. Survey data were linked to medical claims data, and regression models were used to estimate the relationship between HRSNs and self-reported health, emergency department visits, three major health outcomes, and healthcare spending (medical and pharmaceutical).Of 1,160 commercially insured adults, 76 % indicated ≥ 1 HRSN, and 29 % reported > 3 HRSNs, (i.e., “high” HRSN). Each HRSN was associated with 2.2 (95 % CI, 1.84–2.55) additional unhealthy days per month, 3.0 percent (95 % CI 1.36 – 4.57) higher prevalence of anxiety/depression, 2.2 percent (95 % CI 0.88 – 3.50) higher prevalence of hypertension, 3.9 more ED visits per 1,000 member-months (95 % CI, 0.29–7.42), and $1,418 higher total healthcare spending (95 % CI, $614.67-$2,220.39) over a 12-month period.The widespread prevalence of HRSNs among commercially insured adults demonstrates the importance of screening all health plan members for HRSNs—not just Medicare and Medicaid members. Commercially insured members who experience high HRSN are at significantly higher risk for worse health, even after controlling for income and demographic characteristics.

**Background:** Lack of adherence with prescribed medications among the asthma populations exacerbates health outcomes and increases social and economic costs. **Objectives:** The proposed study aims to model patient-centric structural determinants of adherence rates among asthma patients and explore the potential of mobile health apps such as the TRUSTR platform to improve adherence using its power of monetary and non-monetary chatbotting and non-monetary nudges. Following specific hypotheses are tested: (1) Patient attributes, such as their age and medical condition, have significant effect on their adherence with the prescribed treatment plans. (2) Behavioral nudging with rewards and engagement via mobile health apps will increase adherence rates. **Methods:** The patient population (N = 37 359) consists of commercially insured patients with asthma who have been identified from administrative claims in the HealthCore Integrated Research Database (HIRD) between April 1, 2018 and March 31, 2019. Two Structural Equation Models (SEMs) are estimated to quantify direct, indirect, and total effect sizes of age and medical condition on proportion of days covered (PDC) and medical possession ratio (MPR), mediated by patient medical and pharmacy visits. Fourteen additional SEMs were estimated to lateralize TRUSTR findings and conduct sensitivity analysis. **Results:** HIRD data reveal mean adherence rate of 59% (standard deviation (SD) 29%) for PDC and 58% for MPR (SD 36%). Key structural findings from SEMs derived from the HIRD dataset indicate that each additional year in the age of the patient has a positive total effect on the adherence rate. Patients with poor medical condition are likely to have lower adherence rate, but this direct effect is countered by mediating variables. Further, each additional reward and higher engagement with a mobile app is likely to have a positive total effect on increasing the adherence rate. **Conclusions:** HIRD data reveal mean adherence rate of 59% (SD 29%), providing the evidence for the opportunity to increase adherence rate by around 40%. Statistical modeling results reveal structural determinants, such as the opportunity to nudge, are higher among younger patients, as they have higher probability of being non-adherent. Methodologically, lateralization approach demonstrates the potential to capture real-world evidence beyond clinical data and merge it with clinical data.