GAD-7 Anxiety Screener

What the GAD-7 measures

The Generalized Anxiety Disorder-7 (GAD-7), developed by Spitzer and colleagues and published in Archives of Internal Medicine in 2006, is the most widely used anxiety screening tool in primary care. It consists of 7 questions based on the DSM-5 criteria for Generalized Anxiety Disorder. Each question is scored 0 (not at all) to 3 (nearly every day), yielding a total from 0 to 21. The GAD-7 is free, self-administered, and takes about 2 minutes to complete.

Beyond GAD, a broad anxiety screen

Although designed for Generalized Anxiety Disorder, the GAD-7 performs reasonably well as a screen for panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). A score ≥10 has a sensitivity of about 89% and specificity of 82% for any anxiety disorder. This makes it a useful general anxiety screen, though a positive result should be followed by a more detailed clinical assessment to identify the specific anxiety disorder.

The ultra-short GAD-2

The first two questions of the GAD-7 (feeling nervous/anxious/on edge; not being able to stop worrying) constitute the GAD-2, an ultra-short screen. A GAD-2 score ≥3 has similar sensitivity to the full GAD-7 for detecting any anxiety disorder. The GAD-2 is useful in busy clinical settings where time is limited, a negative GAD-2 effectively rules out clinically significant anxiety.

Score interpretation and treatment

Scores of 0-4 indicate minimal anxiety. 5-9 indicates mild anxiety, self-care measures (exercise, mindfulness, reducing caffeine, improving sleep) are typically sufficient. 10-14 indicates moderate anxiety, the threshold for considering active treatment. Cognitive Behavioral Therapy (CBT) is first-line for most anxiety disorders, with SSRIs or SNRIs as first-line medications. 15-21 indicates severe anxiety, combination treatment with CBT and medication is typically recommended.

Anxiety vs. depression, they often coexist

Anxiety and depression are highly comorbid, approximately 50-60% of patients with depression also have an anxiety disorder, and vice versa. The PHQ-9 and GAD-7 are often administered together as a quick combined screen. When both are positive, treatment should address both conditions. SSRIs are effective for both anxiety and depression, and CBT techniques can be adapted for both. The presence of comorbid anxiety can worsen depression outcomes and increase suicide risk, so identifying and treating both is important.

When to seek immediate help

The GAD-7 does not directly assess for panic attacks, suicidal thoughts, or acute crisis. If you are experiencing panic attacks (sudden intense fear with physical symptoms like racing heart, shortness of breath, chest pain), seek medical evaluation to rule out cardiac causes. If you are having thoughts of self-harm, contact the 988 Suicide & Crisis Lifeline (call or text 988 in the US) or go to your nearest emergency department. Anxiety disorders are highly treatable, the sooner you seek help, the better the outcomes.