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Generalized Anxiety Disorder 7-item (GAD-7)

ShareThe Generalized Anxiety Disorder 7-item (GAD-7) is a easy to perform initial screening tool for generalized anxiety disorder1.

Over the last 2 weeks, how often have you been bothered by the following problems?

1. Feeling nervous, anxious or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

4. Trouble relaxing

5. Being so restless that it is hard to sit still

6. Becoming easily annoyed or irritable

7. Feeling afraid as if something awful might happen

GAD-7 score obtained by adding score for each question (total points)

How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Interpretation:


When screening for anxiety disorders, a score of 8 or greater represents a reasonable cut-point for identifying probable cases of generalized anxiety disorder; further diagnostic assessment is warranted to determine the presence and type of anxiety disorder. Using a cut-off of 8 the GAD-7 has a sensitivity of 92% and specificity of 76% for diagnosis generalized anxiety disorder. 2,3

The following cut-offs correlate with level of anxiety severity:

  • Score 0-4: Minimal Anxiety
  • Score 5-9: Mild Anxiety
  • Score 10-14: Moderate Anxiety
  • Score greater than 15: Severe Anxiety

Based on a recent meta-analysis, some experts have recommended considering using a cut-off of 8 in order to optimize sensitivity without compromising specificity2.

Performance as Screening Tool for Anxiety Disorders

Although designed as a screening tool for generalized anxiety, the GAD-7 is also performs reasonably well as a screening tool for three other common anxiety disorders—Panic Disorder, Social Anxiety Disorder, and Posttraumatic Stress Disorder. 3

Performance of GAD-7 as Screening Tool for Anxiety Disorders3
(Using GAD-7 Score Cut-off of ≥10)
TestSensitivitySpecificityPositive Likelihood Ratio
Generalized Anxiety Disorder89%82%5.1
Panic Disorder74%81%3.9
Social Anxiety Disorder72%80%3.6
Post-Traumatic Stress Disorder66%81%3.5
Any anxiety disorder68%88%5.5

Sources

  1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092-7.
  2. Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24-31.
  3. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317-25.

Acknowledgement

The GAD-7 was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.

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