GAD-7: Generalized Anxiety Disorder-7

The Generalized Anxiety Disorder-7 (GAD-7) is a short self-report questionnaire for anxiety. Each of its seven questions asks how often a common anxiety symptom has bothered the person over the last 2 weeks, from "Not at all" to "Nearly every day". It was developed by Spitzer, Kroenke, Williams and Lowe (2006).

It was built to screen for generalized anxiety disorder, and it also picks up other common anxiety difficulties, such as panic, social anxiety and post-traumatic stress. Therapists use it as a quick screen and as a repeatable measure of progress, alongside a clinical conversation.

The GAD-7 supports structured screening, a baseline measurement, treatment planning and progress monitoring for adolescents and adults. A therapist reviews it with the person's concerns, history, daily functioning, medical and medication context, caffeine and substance use, supports and recent stressors.

• Intake: a baseline score at the start of care.
• Treatment planning: how much weight anxiety should have in the plan.
• Progress monitoring: repeat it and compare scores across sessions.
• Review and follow-up: spot a return of symptoms or a stall in progress.

The person answers all seven questions in private, rating how often each problem has bothered them in the past 2 weeks: 0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day. It takes about 2 minutes. A therapist, not the questionnaire, interprets the result.

The standard form ends with one more question: how difficult have these problems made it to work, take care of things at home or get along with other people. It is not part of the score, but a high answer shows how much the anxiety is affecting daily life and is worth talking about.

There is one total score, found in three steps.

1. Give each of the seven answers its number: Not at all is 0, Several days is 1, More than half the days is 2, Nearly every day is 3.
2. Add the seven numbers. The total runs from 0 to 21. There is no reverse scoring and no subscales.
3. Look the total up against the severity levels, below.

Example: if the seven answers are 2, 2, 1, 1, 1, 2 and 1, the total is 10, which falls in the Moderate level.

The total score falls into one of four levels.

A score of 10 or more is the cut-off most often used to flag a higher likelihood of a clinically significant anxiety disorder, and it is the usual point for a closer assessment. Some services use a lower cut-off of 8 to catch more people, at the cost of more false alarms. When the GAD-7 is repeated, a change of 4 points or more is commonly treated as clinically meaningful.

These levels are guides, not diagnoses. A low score does not rule out an anxiety difficulty the person has described, and a high score is a reason for a closer conversation, not a conclusion.

No. None of its questions asks about suicide or self-harm, so a clinician needs to ask about risk directly, whatever the score is. Anxiety often occurs with low mood, and the PHQ-9 is commonly used alongside the GAD-7 for that reason.

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• It is a screening and monitoring tool, not a diagnosis. Only a clinical assessment can diagnose an anxiety disorder.
• It covers the past 2 weeks only, and relies on the person's own answers.
• Scores can be affected by caffeine, medicines, medical conditions such as thyroid problems, substances, trauma and recent events.
• It does not say what kind of anxiety is present. Panic, social anxiety, health anxiety, OCD and trauma-related anxiety all raise scores.
• How well a cut-off works varies by population, setting and language.

The GAD-7 measures anxiety only, in seven questions over 2 weeks. The PHQ-9 is its counterpart for depression. The DASS-21 measures depression, anxiety and stress in one sitting over the past week and gives three separate scores.

Many therapists use the GAD-7 and PHQ-9 together at intake, because anxiety and low mood so often go hand in hand, and the DASS-21 when they also want a read on stress.

The original validation study (Spitzer and colleagues, 2006) reported good internal consistency (Cronbach's alpha of about .92) and test-retest reliability of about .83. A cut-off of 10 correctly identified most people with generalized anxiety disorder (sensitivity of about 89%) and most people without it (specificity of about 82%). Since then it has been studied in primary care, general population, adolescent and international samples. The best cut-off differs between groups, so findings from one population should not be assumed to hold for another.