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.
Severity classification and treatment
| Score | Severity | Suggested action |
|---|---|---|
| 0-4 | Minimal anxiety | Monitor. Provide psychoeducation if symptoms are distressing. |
| 5-9 | Mild anxiety | Watchful waiting. Guided self-help, relaxation techniques, lifestyle advice. |
| 10-14 | Moderate anxiety | Consider active treatment: CBT, stepped care, or pharmacotherapy (SSRIs/SNRIs). |
| 15-21 | Severe anxiety | Refer to mental health services. Active pharmacotherapy. Safety assessment if indicated. |
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
- Spitzer RL, et al. "A brief measure for assessing generalized anxiety disorder." Arch Intern Med. 2006;166(10):1092-1097.
- NICE Guideline CG113. Generalised anxiety disorder and panic disorder in adults. NICE, 2011 (updated 2019).