GAD-7 Anxiety Screening Score

Understanding the GAD-7 anxiety screening score — concept and principle

The Generalized Anxiety Disorder-7 (GAD-7) is a seven-question self-report scale for anxiety. You rate how often each symptom, such as nervousness, uncontrollable worry or irritability, has bothered you over the last two weeks. It was designed to screen for generalised anxiety disorder, but it also picks up other common anxiety problems such as panic disorder and social anxiety reasonably well. Doctors use it in primary care and to follow how anxiety changes over time.

How it is calculated

Each item is scored 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day), and the seven scores are added:

GAD-7 = item 1 + item 2 + … + item 7, range 0–21.

• 0–4 minimal; 5–9 mild; 10–14 moderate; 15–21 severe.
• A score of 10 or more is the usual cut-off for further assessment.

The principle

Generalised anxiety disorder is defined by excessive, hard-to-control worry together with physical and mental symptoms such as restlessness, tension and irritability. The GAD-7 items mirror those features. In the original study by Spitzer and colleagues, which compared GAD-7 scores with interviews by mental health professionals, a cut-off of 10 gave a sensitivity of about 89% and a specificity of about 82% for generalised anxiety disorder. The first two items alone form the GAD-2, a quicker first-step screen.

Worked example

1. Inputs: all seven items answered "Not at all (0)".
2. Total = 0 + 0 + 0 + 0 + 0 + 0 + 0 = 0.
3. 0 is below 5, so severity is minimal.

How to read the result

A score under 5 suggests few anxiety symptoms at the moment. Scores of 5–9 reflect mild symptoms that may ease with rest, exercise, sleep and stress reduction, though it is worth checking again later. Scores of 10 or more suggest that a doctor or mental health professional should assess you, both to confirm the type of anxiety and to look for physical causes such as an overactive thyroid, caffeine or certain medicines. Repeating the scale shows whether symptoms are improving.

Common mistakes

• Rating only today's feelings instead of the past two weeks.
• Assuming a high score diagnoses generalised anxiety disorder; other conditions can raise it too.
• Ignoring physical symptoms like chest pain or a racing heart that need medical checks of their own.

Frequently asked questions

What is a normal GAD-7 score?

Most people without an anxiety disorder score under 5, although stressful periods can raise the score temporarily.

Can GAD-7 measure response to treatment?

Yes. It is often repeated every few weeks to monitor change.

How is GAD-7 different from PHQ-9?

GAD-7 focuses on anxiety, PHQ-9 on depression. The two often occur together, so clinicians commonly use both.

Sources: Spitzer RL, Kroenke K, Williams JBW, Löwe B, A brief measure for assessing generalized anxiety disorder: the GAD-7, Archives of Internal Medicine 2006 · Kroenke K et al., Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection, Annals of Internal Medicine 2007