Mental Health

GAD-7 Anxiety Scale

The Generalized Anxiety Disorder 7-item scale is the most widely validated and used anxiety screening tool in primary care. Score all 7 items based on the past 2 weeks for instant severity classification.

Spitzer et al. 2006 NICE recommended PDF export
Clinical screening tool. The GAD-7 is designed for use by healthcare professionals. Results require clinical interpretation. If you are in crisis or experiencing a mental health emergency, contact a mental health professional or emergency services immediately.
GAD-7, Over the past 2 weeks

How often have you been bothered by the following over the last 2 weeks?

If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?
GAD-7 Result
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Severity bands:

0-4
Minimal
5-9
Mild
10-14
Moderate
15-21
Severe

About the GAD-7

The GAD-7 was developed by Spitzer et al. (2006) and validated against structured clinical interviews. It has a sensitivity of 89% and specificity of 82% for GAD at a cutoff of 10 or above. It also screens reasonably well for panic disorder, social anxiety, and PTSD, making it useful as a general anxiety screening instrument even when GAD is not the primary suspected diagnosis. Anxiety disorders as a group are the most common mental health conditions in the US, according to the National Institute of Mental Health.

Severity classification and treatment

The suggested actions below follow the stepped-care approach set out in NICE Guideline CG113, matching treatment intensity to symptom severity rather than defaulting straight to medication.

ScoreSeveritySuggested action
0-4Minimal anxietyMonitor. Provide psychoeducation if symptoms are distressing.
5-9Mild anxietyWatchful waiting. Guided self-help, relaxation techniques, lifestyle advice.
10-14Moderate anxietyConsider active treatment: CBT, stepped care, or pharmacotherapy (SSRIs/SNRIs).
15-21Severe anxietyRefer to mental health services. Active pharmacotherapy. Safety assessment if indicated.

Ruling Out Physical Causes

Several physical conditions can produce anxiety-like symptoms and should be considered, especially with new-onset symptoms in someone with no prior anxiety history. Hyperthyroidism is the classic example, causing nervousness, tremor, palpitations, and sleep disturbance that can closely mimic GAD. Thyroid function tests (TSH, free T4) are a standard part of the initial workup; if results come back in different units than expected, our Lab Values Converter handles the mmol/L and pmol/L conversions.

Anxiety and Cardiovascular Risk

Anxiety disorders are associated with a modestly elevated long-term cardiovascular risk, and the physical symptoms of anxiety, palpitations and chest tightness in particular, can be difficult to distinguish from cardiac symptoms without further assessment. For patients with cardiovascular risk factors alongside anxiety, the Framingham Risk Score can help frame the conversation about overall risk.

GAD-2 as an initial screen

Items 1 and 2 of the GAD-7 (feeling nervous/anxious and not being able to control worry) form the GAD-2. A score of 3 or above on the GAD-2 warrants full GAD-7 completion. Sensitivity 86%, specificity 83% for GAD at this cutoff.

Comorbidity with depression

Anxiety and depression frequently co-occur. If a patient screens positive on the GAD-7, always consider completing the PHQ-9 as well. PHQ-9 and GAD-7 together in 10 minutes give a comprehensive picture of the most common mental health presentations in primary care.

Related tools

For depression screening, see PHQ-9. For stress assessment, see Perceived Stress Scale. For burnout, see Burnout Index. For sleep quality, see Sleep Quality Score.

References

Important: The GAD-7 is a screening and severity measurement tool, not a diagnostic instrument. Clinical diagnosis requires a comprehensive assessment by a qualified mental health professional.

Frequently Asked Questions

Can I use the GAD-7 to diagnose myself with an anxiety disorder?+
No. The GAD-7 is a screening and severity-tracking tool, not a diagnostic instrument. A high score suggests that a fuller clinical assessment is worthwhile, but only a qualified healthcare professional can make an actual diagnosis, since several other conditions can produce a similar symptom pattern and score. If your score is in the moderate or severe range, or your symptoms are affecting your daily life, the most useful next step is discussing the result with a doctor or mental health professional rather than treating the number itself as an answer.
How often should the GAD-7 be repeated?+
In clinical practice, the GAD-7 is typically repeated every 2 to 4 weeks during active treatment to track whether symptoms are improving, and less frequently (such as every few months) once symptoms are stable. Because each item asks about the past 2 weeks specifically, repeating it more often than that will not capture meaningful change.
What should I do if my score suggests severe anxiety?+
A score in the severe range (15-21) suggests that a prompt conversation with a doctor or mental health professional is worthwhile. This screening tool cannot tell you how urgent your specific situation is, so if you are having thoughts of harming yourself, or if you feel unable to keep yourself safe, contact a crisis line or emergency services right away rather than waiting to discuss a score.