General Anxiety Disorder (GAD-7)
Measure severity of anxiety
Jennifer Glen
Provided by
EVAL FoundationInstructions
The GAD-7 is a screening tool used by health practitioners to determine initial symptom severity and monitor effect of treatment over time and does not replace a clinical assessment and diagnosis.
Ask: How often have you been bothered by the following over the past 2 weeks?
Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States (Locke, Kirst & Shultz, 2015). The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 can objectively determine initial symptom severity and monitor symptom changes and the effect of treatment over time. Studies suggest 70-90% sensitivity and 80-90% specificity across anxiety disorders. Higher GAD-7 scores correlate with disability and functional impairment in measures to include work productivity and health care utilization (Spitzer, 2006 & Ruiz, 2011). The scale was originally developed and validated based on the DSM-IV criteria. However, since the publication of the DSM-V criteria, the scale remains clinically useful because the differences in GAD diagnostic criteria are minimal.
.Summary
The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 is a 7-question assessment. A range of 0-3 points are assigned to each answer. The 8th question assesses global impairment and is not counted in the score (max score of 21 points).
Scoring & Recommendations
The first 7 questions will answer with one of the following:
| Answer | Points |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| Result | Recommendation | Score |
| No anxiety disorder | N/A | < 5 points |
| Mild anxiety disorder | Monitor | 5-9 points |
| Studies suggest a score ≥ 8 in suspected Panic Disorder, Social Phobia or PTSD may be a moderate anxiety disorder | Need for further evaluation and referral for possible clinically significant condition. | 8-9 points |
| Moderate anxiety disorder | Need for further evaluation and referral for possible clinically significant condition. | 10-14 points |
| Severe anxiety disorder | Need for further evaluation and referral for possible clinically significant condition. Active treatment is likely warranted. | > 15 points |
Additional Considerations
The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.
The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.
In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:
- Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism
- Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases
- Neurologic diseases: Temporal lobe epilepsy, TIA
- Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders
- Substance abuse withdrawal
- Medications: Common ones include albuterol, levothyroxine, decongestants
Lifestyles recommendations that may reduce anxiety-related symptoms include:
- Identifying and removing possible triggers
- Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.
- Stimulants: Can include medications, supplements or caffeine products ingested in the evening.
- Nicotine
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Stress
- Improving sleep quality and quantity
- Physical activity
Therapeutic modalities that may reduce anxiety-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Botanicals and supplements (See table 6)
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
.
All questions & possible results
InstructionsTitle not visible
Feeling nervous, anxious, or on edge
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
Not being able to stop or control worrying
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
Worrying too much about different things
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly everyday
Trouble relaxing
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly everyday
Being so restless that it's hard to sit still
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
Becoming easily annoyed or irritable
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
Feeling afraid as if something awful might happen
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
How difficult have these problems made it to do work, take care of things at home, or get along with other people?
Optional: Not included in the final score. Helps to assess global impairment.
Select one option:
- Not at all
- Somewhat difficult (Several days)
- Very difficult (More than half the days)
- Extremely difficult (Nearly every day)
Possible results
Studies suggest a score ≥ 8 in suspected Panic Disorder, Social Phobia or PTSD may be a moderate anxiety disorder
In suspected Panic Disorder, Social Phobia or PTSD, a ≥ 8 indicates a need for further evaluation for a possible clinically significant condition.
The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.
The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.
In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:
- Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism
- Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases
- Neurologic diseases: Temporal lobe epilepsy, TIA
- Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders
- Substance abuse withdrawal
- Medications: Common ones include albuterol, levothyroxine, decongestants
Lifestyles recommendations that may reduce anxiety-related symptoms include:
- Identifying and removing possible triggers
- Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.
- Stimulants: Can include medications, supplements or caffeine products ingested in the evening.
- Nicotine
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Stress
- Improving sleep quality and quantity
- Physical activity
Therapeutic modalities that may reduce anxiety-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Botanicals and supplements (See table 6)
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
Mild anxiety disorder (5-9 points)
In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:
- Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism
- Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases
- Neurologic diseases: Temporal lobe epilepsy, TIA
- Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders
- Substance abuse withdrawal
- Medications: Common ones include albuterol, levothyroxine, decongestants
Lifestyles recommendations that may reduce anxiety-related symptoms include:
- Identifying and removing possible triggers
- Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.
- Stimulants: Can include medications, supplements or caffeine products ingested in the evening.
- Nicotine
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Stress
- Improving sleep quality and quantity
- Physical activity
Therapeutic modalities that may reduce anxiety-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Botanicals and supplements (See table 6)
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
Severe anxiety disorder (> 15 points)
When screening for anxiety disorders, a score > 15 indicates a need for further evaluation and referral for possible clinically significant condition. Active treatment is likely warranted.
The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.
The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.
In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:
- Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism
- Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases
- Neurologic diseases: Temporal lobe epilepsy, TIA
- Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders
- Substance abuse withdrawal
- Medications: Common ones include albuterol, levothyroxine, decongestants
Lifestyles recommendations that may reduce anxiety-related symptoms include:
- Identifying and removing possible triggers
- Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.
- Stimulants: Can include medications, supplements or caffeine products ingested in the evening.
- Nicotine
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Stress
- Improving sleep quality and quantity
- Physical activity
Therapeutic modalities that may reduce anxiety-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Botanicals and supplements (See table 6)
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
Moderate anxiety disorder (10-14 points)
When screening for anxiety disorders, a score > 9 indicates a need for further evaluation and referral for possible clinically significant condition.
The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.
The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.
In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:
- Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism
- Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases
- Neurologic diseases: Temporal lobe epilepsy, TIA
- Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders
- Substance abuse withdrawal
- Medications: Common ones include albuterol, levothyroxine, decongestants
Lifestyles recommendations that may reduce anxiety-related symptoms include:
- Identifying and removing possible triggers
- Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.
- Stimulants: Can include medications, supplements or caffeine products ingested in the evening.
- Nicotine
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Stress
- Improving sleep quality and quantity
- Physical activity
Therapeutic modalities that may reduce anxiety-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Botanicals and supplements (See table 6)
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
Literature
- A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. — Spitzer RL, Kroenke K, Williams JB, Löwe B.
- Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. J Affect Disord. 2011 Feb;128(3):277-86. — Ruiz MA, Zamorano E, García-Campayo J, Pardo A, Freire O, Rejas J.
- Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 1;91(9):617-24. — Locke AB, Kirst N, Shultz CG.
