The GAD-7 is a brief, widely used screening and severity measure for generalized anxiety. This page explains what the GAD-7 is, what it measures, the questions it contains, how it is scored, and how it is used in clinical settings.
What is the GAD-7?
The GAD-7 (Generalized Anxiety Disorder 7-item scale) is a seven-item self-report questionnaire that screens for and measures the severity of generalized anxiety. It was developed by Spitzer, Kroenke, Williams, and Löwe and published in 2006. It is free to use and has been validated for primary care and other settings, and although designed for generalized anxiety disorder, it also has useful screening properties for panic disorder, social anxiety disorder, and post-traumatic stress disorder.
What does the GAD-7 measure?
The GAD-7 measures the frequency of core anxiety symptoms over the previous two weeks, producing a single severity score. It is used both to flag people who may have an anxiety disorder and to monitor symptom severity over time.
What questions are included in the GAD-7?
The seven items ask how often, over the last two weeks, the respondent has been bothered by: feeling nervous, anxious, or on edge; not being able to stop or control worrying; worrying too much about different things; trouble relaxing; being so restless that it is hard to sit still; becoming easily annoyed or irritable; and feeling afraid as if something awful might happen.
How is the GAD-7 scored?
Each item is scored 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day). The seven items are summed for a total score from 0 to 21. Cut-points of 5, 10, and 15 correspond to mild, moderate, and severe anxiety, respectively (0 to 4 is considered minimal). A score of 10 or higher is the commonly recommended threshold for further evaluation; at that cut-point the original study reported a sensitivity of 89% and a specificity of 82% for generalized anxiety disorder.
How is the GAD-7 used in clinical practice?
The GAD-7 is used to screen for anxiety, to gauge baseline severity, and to track response to treatment such as therapy or medication. Because surgical and chronic-pain outcomes can be influenced by psychological factors, generic mental-health measures like the GAD-7 are sometimes collected alongside condition-specific PROMs. A positive screen supports, but does not replace, a clinical diagnostic assessment.
Strengths and limitations
The GAD-7 is brief, free, easy to score, and well validated. Its limitations include being a screening and severity tool rather than a diagnostic instrument, and reduced specificity in some populations, so elevated scores should prompt clinical evaluation rather than a definitive diagnosis.
Frequently asked questions
What GAD-7 score indicates anxiety? Scores of 5, 10, and 15 mark mild, moderate, and severe anxiety; 10 or higher is the usual threshold for further evaluation.
What is the range of the GAD-7? The total score ranges from 0 to 21, with higher scores indicating more severe anxiety.
Is the GAD-7 a diagnosis? No. It is a screening and severity measure; a diagnosis requires a clinical assessment.
References
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097.
- Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine. 2007;146(5):317-325.
- Löwe B, Decker O, Müller S, et al. Validation and standardization of the GAD-7 in the general population. Medical Care. 2008;46(3):266-274.
Note: This page is educational. If you are struggling with anxiety, speak with a qualified healthcare professional.
