Psychiatry
GAD-7 (Anxiety)
Severity of generalised anxiety symptoms.
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Background
The GAD-7 (Generalised Anxiety Disorder 7-item scale) is a brief self-report questionnaire that measures the severity of generalised anxiety symptoms over the preceding two weeks. It was developed by Spitzer and colleagues alongside the PHQ depression measures for use in primary care. Each of its seven items — covering nervousness, uncontrollable worry, excessive worry, trouble relaxing, restlessness, irritability and a sense of dread — is rated from 0 (not at all) to 3 (nearly every day), giving a total of 0–21. Although designed for generalised anxiety, it also performs reasonably well as a general screen for panic, social anxiety and post-traumatic stress.
Interpreting the result
Scores fall into four bands: 0–4 minimal, 5–9 mild, 10–14 moderate and 15–21 severe anxiety. A score of 10 or more is the usual threshold for a probable anxiety disorder warranting further assessment, with reasonable sensitivity and specificity for generalised anxiety. Higher bands suggest greater functional impairment and a stronger case for active treatment. The score measures severity and tracks change but does not, on its own, make a diagnosis.
Worked example
A patient reports feeling on edge and unable to control worry nearly every day (3 + 3), worrying excessively and unable to relax more than half the days (2 + 2), with restlessness, irritability and dread on several days each (1 + 1 + 1). The total is 13, placing them in the moderate band and prompting a fuller clinical assessment.
Pearls / pitfalls
- A score of 10 or more is the practical cut-off for probable generalised anxiety, but the tool is a screen, not a diagnosis — confirm clinically.
- It rates the last two weeks only, so a single score can be skewed by a recent stressful event; serial scores are more informative.
- Always check for low mood and self-harm risk separately, as anxiety and depression frequently coexist.
- Self-report can be affected by insight, language and culture, so interpret alongside the clinical picture.
Evidence & validation
Derived and validated in a large primary-care sample by Spitzer et al. (2006) and widely reproduced; it is recommended within NICE guidance and the English UK Talking Therapies (IAPT) programme for identifying and monitoring anxiety.
Frequently asked questions
What GAD-7 score indicates an anxiety disorder?
A score of 10 or more is the usual threshold for a probable generalised anxiety disorder and should prompt further assessment. Scores of 15–21 indicate severe anxiety. The score supports, but does not replace, a clinical diagnosis.
Does the GAD-7 only detect generalised anxiety?
It was designed for generalised anxiety disorder but also performs reasonably as a screen for panic disorder, social anxiety and PTSD. A positive screen should be followed by a focused clinical assessment to clarify the diagnosis.
How often should it be repeated?
It is commonly repeated at intervals during treatment to monitor response, as it is sensitive to change. Comparing serial scores is more useful than relying on a single value.
Can patients complete it themselves?
Yes — it is a validated self-report tool that patients can complete on paper or electronically in a couple of minutes. A clinician should still review the answers, particularly any indication of distress or risk.
Does a low score rule out anxiety?
A minimal score makes a generalised anxiety disorder less likely but does not exclude other conditions or situational distress. Clinical judgement and the patient's own concerns should always be considered.
References
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
- NICE CG113: Generalised anxiety disorder and panic disorder in adults: management. 2011 (updated 2020).
About the creator
Spitzer RL et al.
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