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Generalized Anxiety Disorder 7

Generalized Anxiety Disorder 7

What is GAD-7

The Generalized Anxiety Disorder 7 (GAD-7) is a brief scale for anxiety. It scores 7 common anxiety symptoms. Though originally developed to diagnose generalized anxiety disorder, the GAD-7 also proved to have good sensitivity and specificity as a screener for panic, social anxiety, and post- traumatic stress disorder. Recognizing signs of mental health disorders is not always easy. The Patient Health Questionnaire (PHQ) is a diagnostic tool for mental health disorders used by health care professionals that is quick and easy for patients to complete. In the mid-1990s, Robert L. Spitzer, MD, Janet B.W. Williams, DSW, and Kurt Kroenke, MD, and colleagues at Columbia University developed the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool containing modules on 12 different mental health disorders. They worked in collaboration with researchers at the Regenstrief Institute at Indiana University and with the support of an educational grant from Pfizer Inc. During the development of PRIME-MD, Drs. Spitzer, Williams and Kroenke, created the PHQ and GAD-7 screeners.

GAD-7 Printable PDF

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GAD-7 Scoring and Interpretation

This is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of ―not at all, ―several days, ―more than half the days, and ―nearly every day, respectively. GAD-7 total score for the seven items ranges from 0 to 21. Scores of 5, 10, and 15 represent cutpoints for mild, moderate, and severe anxiety, respectively. Though designed primarily as a screening and severity measure for generalized anxiety disorder, the GAD-7 also has moderately good operating characteristics for three other common anxiety disorders – panic disorder, social anxiety disorder, and post-traumatic stress disorder. When screening for anxiety disorders, a recommended cutpoint for further evaluation is a score of 10 or greater.

GAD-7 Scores and Anxiety Severity

Table 4
GAD-7 ScoreAnxiety Severity

0 – 4

None-Minimal

5 – 9

Mild

10 – 14

Moderate

15 – 21

Severe

Cutpoint of 10 or greater is considered a "yellow flag" (i.e., drawing attention to a possible clinically significant condition), while a cutpoint of 15 is a "red flag" (i.e., targeting individuals in whom active treatment is probably warranted).

PsyPack can automatically score the GAD-7 assessment and prepare corresponding tables and graphs.

GAD-7 sample result

Further, PsyPack automatically plots a graph to help you easily track progress over time.

GAD-7 track progress

Sample Report of GAD-7

Domain

Anxiety

What does GAD-7 measure

The purpose of the evaluation is to:

  • screen for anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder,
  • assess anxiety severity,
  • monitor anxiety severity.

Administration

Self-administered

Type of outcome tool

Clinical

Assessment modes

Questionnaire

Age and eligibility

14 years and above

Estimated time

Less than 5 minutes

Notes

Since the questionnaire relies on client self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the client understood the questionnaire, as well as other relevant information from the client.

Though originally developed to diagnose generalized anxiety disorder, the GAD-7 also proved to have good sensitivity and specificity as a screener for panic, social anxiety, and post- traumatic stress disorder.

Sensitivity to change for monitoring treatment outcomes: A particularly important use of a measure is its responsiveness to changes of condition severity over time. The GAD-7 has demonstrated change as a secondary anxiety outcome in several depression trials, but has not yet been studied as a primary outcome in anxiety trials. Also, since there is more diagnostic splitting for anxiety than for depressive disorders, it remains to be determined whether a single anxiety measure can suffice as an outcome measure. It is likely the GAD-7 will be useful but not yet certain it will be sufficient.

After making a provisional diagnosis with the GAD-7, there are additional clinical considerations that may affect decisions about management and treatment.

  • Have current symptoms been triggered by psychosocial stressor(s)?
  • What is the duration of the current disturbance and has the patient received any treatment for it? To what extent are the patient’s symptoms impairing his or her usual work and activities?
  • Is there a history of similar episodes, and were they treated?
  • Is there a family history of similar conditions?

Attribution and References

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.