Usage of the SPUR™ Adherence Profiling Tool in depression and anxiety: Initial Findings


The aim of this study was to determine whether the SPUR™ diagnostic tool

  1. Retains its predictive validity to measure non-adherence for patients with hypertension
  2. Can identify patients who may suffer from clinical depression
  3. Can identify patients who may suffer from General Anxiety Disorder (GAD)

The 2 key outputs to keep in mind

  • The predictive validity of SPUR™ to measure non-adherence of chronic patients is confirmed in hypertension.
  • SPUR™ can flag patients at risk of depression and GAD, which represents an important extension of its value to improve health intervention.


563 people were recruited through Amazon’s Mechanical Turk facility. All were US adults diagnosed with hypertension who are currently prescribed an anti-hypertension medication.
Patients provided demographic and health-related information and filled out the following questionnaires:

  • SPUR™
  • PROMs measuring adherence
    - The Morisky Medication Adherence Scale-8 (MMAS-8)
    - The Medication Adherence Report Scale- 5 (MARS-5)
    - The Extent of Non-Adherence scale (ENA)
    - The Beliefs about Medication Questionnaire (BMQ)
  • Mental health questionnaires:
    - The Patient Health Questionnaire-8 (PHQ-8), often used to diagnose depression
    - The Generalized Anxiety Disorder-7 (GAD-7), widely used to diagnose general anxiety disorder

Pearson Correlation Coefficients were calculated to examine correlations between the various PROMs

Scores in all of the PROMs were then compared for patients who had PHQ-8 scores greater than or equal to 10 as opposed to those with scores less than 10. Individual PHQ item responses were then applied to patients identified as being at risk to investigate whether a single PHQ item might be used to further refine results.

The same methodology was then used for anxiety, using GAD-7.


The risk of non-adherence assessed by the SPUR™ score is correlated with established Patient-Reported Outcomes (PROMs) in this study. Its predictive validity to measure non-adherence of chronic patients is confirmed in hypertension.

Using SPUR™ in digital adherence technology (DAT) applications in combination with just one item from mental health assessment scales PHQ-8 or GAD-7 could help healthcare professionals identify patients at need of a mental health intervention and a more complete mental health diagnosis.

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See also

Scientific communications

A multiple-cohort analysis of the SPUR 6/24 patient-reported adherence tool


Clinical Ink and Observia: Pioneering Personalized Patient Engagement in Clinical Trials


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