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    GAD-7 (General Anxiety Disorder-7)

    Measures severity of anxiety.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Rapid screening for the presence of a clinically significant anxiety disorder (GAD, PD, SP & PTSD), especially in outpatient settings.

    • The GAD-7 is useful in primary care and mental health settings as a screening tool and symptom severity measure for the four most common anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, Social Phobia and PostTraumatic Stress Disorder).
    • It is 70-90% sensitive and 80-90% specific across disorders / cutoffs (see EBM section for more).
    • Higher GAD-7 scores correlate with disability and functional impairment (in measures such as work productivity and health care utilization). (Spitzer RL 2006) (Ruiz MA 2011)
    • The last item “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?” - although not used in the calculation - is a good indicator of the patient’s global impairment and can be used to track treatment response.

    Objectively determine initial symptoms severity and monitor symptom changes/effect of treatment over time.

    Over the last 2 weeks, how often have you been bothered by any of the following problems?
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    If any of the above were scored more than “Not at all”:
    Not at all
    0
    Somewhat difficult
    +1
    Very difficult
    +2
    Extremely difficult
    +3
    About the Creator
    Dr. Robert L. Spitzer
    Content Contributors

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Scores ≥10: Further assessment (including diagnostic interview and mental status examination) and/or referral to a mental health professional recommended.

    ScoreSymptom SeverityComments
    5-9MildMonitor
    10*-14ModeratePossible clinically significant condition
    >15SevereActive treatment probably warranted

    *For Panic Disorder, Social Phobia, & PTSD, cutoff score of 8 may be used for optimal sensitivity/specificity (see EBM section).

    Critical Actions

    • This tool should be used for screening and monitoring symptom severity and cannot replace a clinical assessment and diagnosis.
    • Do not forget to rule out medical causes of anxiety before diagnosing an anxiety disorder (for example, EKG for arrhythmias, TSH for thyroid disease).

    Formula

    0-21 score, with 0-3 points for each of seven questions.

    Facts & Figures

    For all questions, answer with one of the following:

    • Not at all = 0
    • Several days = +1
    • More than half the days = +2
    • Nearly every day = +3

    The last question of the GAD-7 is a good indicator of patient's global impairment, though not included in the final calculation of points.

    Evidence Appraisal

    Initially validated in 2149 patients as a diagnostic tool for GAD (cutoff score 10-> sensitivity 89%, specificity 82%, test-retest reliability with ICC=0.83) (Spitzer RL 2006), the GAD-7 was later also found to have reasonable sensitivity and specificity as a screener for panic disorder, social phobia and PTSD (cutoff score 8- sensitivity 77%, specificity 82%; cutoff score 10 - sensitivity 68% and specificity 88% for any anxiety disorder). (Kroenke K 2007)

    Dr. Robert L. Spitzer

    About the Creator

    Robert L. Spitzer, MD, served as professor of psychiatry at Columbia University for 49 years before retiring in 2010. He was influential in the advancement of The Diagnostic and Statistical Manual of Mental Disorders (DSM). He is recognized in many fields in psychiatry from severe mental illness to comparative diagnostics, such as the United States–United Kingdom Diagnostic Project, in which he helped author a paper comparing schizophrenia definitions in the US and UK.

    To view Dr. Robert L. Spitzer's publications, visit PubMed

    Content Contributors