GAD-7 (General Anxiety Disorder-7) Calculator
What is the GAD-7?
The Generalized Anxiety Disorder-7 (GAD-7) is a self-administered screening and severity measure for generalized anxiety disorder. Developed by Spitzer, Kroenke, Williams, and Löwe, it consists of seven questions that assess anxiety symptoms experienced over the past two weeks.
The GAD-7 has been validated in primary care settings and is widely used due to its brevity, ease of administration, and strong psychometric properties. It can be used both as an initial screening tool and to monitor treatment response over time.
Clinical Applications
The GAD-7 serves several important clinical functions:
- Screening: Identifying patients who may have generalized anxiety disorder
- Severity Assessment: Determining the severity of anxiety symptoms
- Monitoring: Tracking changes in anxiety severity over time and in response to treatment
- Treatment Planning: Guiding decisions about the need for treatment and the type of intervention
Interpretation of GAD-7 Scores
The total score on the GAD-7 ranges from 0 to 21, with higher scores indicating more severe anxiety:
| Total Score | Anxiety Severity | Recommended Action |
|---|---|---|
| 0-4 | Minimal | Monitor; may not require treatment |
| 5-9 | Mild | Watchful waiting; consider follow-up |
| 10-14 | Moderate | Possible clinically significant condition; consider intervention |
| 15-21 | Severe | Active treatment with pharmacotherapy and/or psychotherapy warranted |
Diagnostic Considerations
A score of 10 or greater on the GAD-7 represents a reasonable cut point for identifying cases of GAD. However, the GAD-7 is a screening tool, not a diagnostic instrument. Scores should be interpreted in the context of a comprehensive clinical assessment.
The GAD-7 has good sensitivity and specificity for detecting generalized anxiety disorder, but it can also detect other common anxiety disorders:
- Panic disorder
- Social anxiety disorder
- Post-traumatic stress disorder
When a patient scores in the moderate to severe range, further assessment is recommended to determine the specific type of anxiety disorder and to rule out other conditions.
Functional Impact
The GAD-7 includes an additional question (not scored) that assesses the functional impact of the reported symptoms:
"If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?"
This functional impact question helps clinicians understand how anxiety symptoms are affecting the patient's daily life and can guide treatment decisions and priorities.
Monitoring Treatment Response
The GAD-7 can be used to monitor changes in anxiety symptoms over time. A decrease of 5 points or more represents a clinically meaningful improvement. Regular administration of the GAD-7 during treatment can help:
- Track symptom improvement
- Identify treatment-resistant symptoms
- Guide adjustments to the treatment plan
- Determine when treatment goals have been achieved
Limitations
While the GAD-7 is a valuable tool, it has several limitations:
- It is a screening tool, not a definitive diagnostic test for anxiety disorders
- It may not capture all aspects of anxiety or related conditions
- Cultural factors may influence how symptoms are reported and interpreted
- Some medical conditions can cause symptoms that overlap with anxiety
- The tool relies on self-reporting, which may be affected by recall bias or other factors
References
- Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317-325.
- Löwe B, Decker O, Müller S, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266-274.
- Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24-31.