Generalized Anxiety Disorder 7

The Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD).[1] The GAD-7 is normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.[2]

Generalized Anxiety Disorder 7 item
SynonymsGAD-7
LOINC69737-5

The GAD-7 has seven items, which measure severity of various signs of GAD according to reported response categories with assigned points.[2] The GAD-7 items include:

  1. Nervousness
  2. Inability to stop worrying
  3. Excessive worry
  4. Restlessness
  5. Difficulty in relaxing
  6. Easy irritation
  7. Fear of something awful happening[3]

An additional question at the end asks for a global rating of the severity of the patient's anxiety over the past 2 weeks.[2]

Interpretation of results

The assessment is indicated by the total score, which is made up by adding together the scores for the scale of all seven items with responses getting 0 to 3 points:

  • Not at all (0 points)
  • Several days (1 point)
  • More than half the days (2 points)
  • Nearly every day (3 points)[4]

The normative data enable users of the GAD-7 to discern whether an individual's anxiety score is normal, or mildly, moderately, or severely elevated.[5] However, it cannot be used as replacement for clinical assessment and additional evaluation should be used to confirm a diagnosis of GAD.[6]

Score Risk Level Suggested Intervention
0-4 No to Low risk None
5-9 Mild Repeat on follow-up
10-14 Moderate Further evaluation required. Consider adjusting treatment plan.
15+ Severe Adjust treatment plan. Higher level of care needed. Pharmacology re-evaluation.

Reliability and validity

The GAD-7 was originally validated in a primary care sample and a cutoff score of 10 (which the authors considered optimal) had a sensitivity value of 0.89 and a specificity value of 0.82 for identifying GAD. The authors of the questionnaire also found acceptable sensitivity and specificity values when the questionnaire was used as a general screen to identify other anxiety disorders (Panic Disorder, Social Anxiety, and PTSD) (GAD-7, score ≥ 8: sensitivity: 0.77, specificity: 0.82).[7]

The GAD-7 has shown adequate internal consistency reliability and validity for assessing anxiety across a wide range of samples and settings. It has been used in more than 2500 peer reviewed publications indexed in PubMed (current search here). The consensus is that it can efficient tool for screening for GAD and assessing its severity in clinical practice and research.[8] A meta-analysis found that it achieved acceptable accuracy at a cutoff point of 8 (sensitivity of 0.83, specificity: 0.84, pooling 12 samples and 5223 participants).[9]

The use of sumscores (i.e. summing the scores of each item) is supported by psychometric studies in some contexts, but using techniques based on factor analysis are deemed more precise.[10]

See also

References
  1. Spitzer RL, Kroenke K, Williams JB, Löwe B (May 2006). "A brief measure for assessing generalized anxiety disorder: the GAD-7". Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
  2. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY (March 2008). "Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population". Medical Care. 46 (3): 266–74. doi:10.1097/mlr.0b013e318160d093. PMID 18388841. S2CID 16052239.
  3. Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA (2015-04-27). "Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women". PLOS ONE. 10 (4): e0125096. Bibcode:2015PLoSO..1025096Z. doi:10.1371/journal.pone.0125096. PMC 4411061. PMID 25915929.
  4. Swinson RP (December 2006). "The GAD-7 scale was accurate for diagnosing generalised anxiety disorder". Evidence-Based Medicine. 11 (6): 184. doi:10.1136/ebm.11.6.184. PMID 17213178. S2CID 42283551.
  5. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY (March 2008). "Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population". Medical Care. 46 (3): 266–74. doi:10.1097/MLR.0b013e318160d093. JSTOR 40221654. PMID 18388841. S2CID 16052239.
  6. Dugas, Michel J.; Charette, Catherine A.; Gervais, Nicole J. (2018), "Generalized Anxiety Disorder (2nd ed.)", A Guide to Assessments That Work, Oxford University Press, pp. 293–310, doi:10.1093/med-psych/9780190492243.003.0014, retrieved 2022-11-30
  7. Plummer F, Manea L, Trepel D, McMillan D (2016-03-01). "Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis". General Hospital Psychiatry. 39: 24–31. doi:10.1016/j.genhosppsych.2015.11.005. PMID 26719105.
  8. Spitzer RL, Kroenke K, Williams JB, Löwe B (May 2006). "A brief measure for assessing generalized anxiety disorder: the GAD-7". Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
  9. Plummer, Faye; Manea, Laura; Trepel, Dominic; McMillan, Dean (2016). "Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis". General Hospital Psychiatry. 39: 24–31. doi:10.1016/j.genhosppsych.2015.11.005. PMID 26719105.
  10. De Man, Jeroen; Absetz, Pilvikki; Sathish, Thirunavukkarasu; Desloge, Allissa; Haregu, Tilahun; Oldenburg, Brian; Johnson, Leslie C. M.; Thankappan, Kavumpurathu Raman; Williams, Emily D. (2021-05-13). "Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis". Frontiers in Psychology. 12: 676398. doi:10.3389/fpsyg.2021.676398. ISSN 1664-1078. PMC 8155718. PMID 34054677.
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