Generalized Anxiety Disorder 7 Explained

Generalized Anxiety Disorder 7 item
Synonyms:GAD-7

The Generalized Anxiety Disorder 7-item scale (GAD-7) is a widely used self-administered diagnostic tool designed to screen for and assess the severity of generalized anxiety disorder (GAD).[1] Comprising seven items, the GAD-7 measures the frequency of anxiety symptoms over the past two weeks, with respondents rating each item on a scale from "not at all" to "nearly every day." Developed by Dr. Robert L. Spitzer and colleagues, the GAD-7 is commonly used in both clinical settings and research to identify GAD and to monitor treatment outcomes. It is valued for its simplicity, reliability, and validity in detecting anxiety symptoms in diverse populations.

The GAD-7 is normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.[2] A systematic review compared screening tools and concluded that the GAD-7 is the most efficient one for identifying GAD as well as panic disorders in primary care populations.[3]

Criteria

The GAD-7 has seven items, which measure severity of various signs of GAD according to reported response categories with assigned points. 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[4]

Response options range from “not at all” (= 0 points), “several days” (= 1 point), “more than half the days” (= 2 points), and “nearly every day” (= 3 points) with a score range from 0-21 points.

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:

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.[6] However, while the GAD-7 seem to be able to provide probable cases of GAD, it cannot be used as replacement for clinical assessment and additional evaluation should be used to confirm a diagnosis of GAD.[7]

!Score!Risk Level!Suggested Intervention
0-4No to Low riskNone
5-9MildRepeat on follow-up
10-14ModerateFurther evaluation required. Consider adjusting treatment plan.
15+SevereAdjust 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).[8]

The GAD-7 has further been studied and validated in numerous other samples and settings. [9] It has been shown to correlate with other measures of anxiety and has been considered superior to other questionnaires. [10] [11] [12] The GAD-7 has been evaluated in samples of both children and young individuals [13] as well as older adults. [14] 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.[15] 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).[16]

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.[17]

See also

Notes and References

  1. Spitzer RL, Kroenke K, Williams JB, Löwe B . A brief measure for assessing generalized anxiety disorder: the GAD-7 . Archives of Internal Medicine . 166 . 10 . 1092–1097 . May 2006 . 16717171 . 10.1001/archinte.166.10.1092 . Robert Spitzer (psychiatrist) . free . Janet B. W. Williams .
  2. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY . Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population . Medical Care . 46 . 3 . 266–274 . March 2008 . 18388841 . 10.1097/mlr.0b013e318160d093 . 16052239 .
  3. Herr NR, Williams JW, Benjamin S, McDuffie J . Does this patient have generalized anxiety or panic disorder?: The Rational Clinical Examination systematic review . JAMA . 312 . 1 . 78–84 . July 2014 . 25058220 . 10.1001/jama.2014.5950 .
  4. Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA . Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women . PLOS ONE . 10 . 4 . e0125096 . 2015-04-27 . 25915929 . 4411061 . 10.1371/journal.pone.0125096 . 2015PLoSO..1025096Z . free .
  5. Swinson RP . The GAD-7 scale was accurate for diagnosing generalised anxiety disorder . Evidence-Based Medicine . 11 . 6 . 184 . December 2006 . 17213178 . 10.1136/ebm.11.6.184 . 42283551 .
  6. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY . Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population . Medical Care . 46 . 3 . 266–274 . March 2008 . 18388841 . 10.1097/MLR.0b013e318160d093 . 16052239 . 40221654 .
  7. Book: Dugas MJ, Charette CA, Gervais NJ . John . Eric J. . Hunsley . Mash . A Guide to Assessments That Work . Generalized Anxiety Disorder . 2nd . 2018 . 293–310 . Oxford University Press . 10.1093/med-psych/9780190492243.003.0014 . 978-0-19-049224-3 .
  8. 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 . General Hospital Psychiatry . 39 . 24–31 . 2016-03-01 . 26719105 . 10.1016/j.genhosppsych.2015.11.005 .
  9. Kroenke K, Spitzer RL, Williams JB, Löwe B . The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review . General Hospital Psychiatry . 32 . 4 . 345–359 . 2010-07-01 . 20633738 . 10.1016/j.genhosppsych.2010.03.006 .
  10. Dear BF, Titov N, Sunderland M, McMillan D, Anderson T, Lorian C, Robinson E . Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder . Cognitive Behaviour Therapy . 40 . 3 . 216–227 . September 2011 . 21770844 . 10.1080/16506073.2011.582138 .
  11. Simpson W, Glazer M, Michalski N, Steiner M, Frey BN . Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period . Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie . 59 . 8 . 434–440 . August 2014 . 25161068 . 4143300 . 10.1177/070674371405900806 .
  12. Peters L, Peters A, Andreopoulos E, Pollock N, Pande RL, Mochari-Greenberger H . Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting . Heliyon . 7 . 3 . e06473 . March 2021 . 33817367 . 8010403 . 10.1016/j.heliyon.2021.e06473 . free .
  13. Guzick A, Storch EA, Smárason O, Minhajuddin A, Drummond K, Riddle D, Hettema JM, Mayes TL, Pitts S, Dodd C, Trivedi MH . Psychometric properties of the GAD-7 and PROMIS-Anxiety-4a among youth with depression and suicidality: Results from the Texas youth depression and suicide research network . Journal of Psychiatric Research . 170 . 237–244 . February 2024 . 38169247 . 10.1016/j.jpsychires.2023.12.033 .
  14. Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, Schellberg D, Brenner H, Müller H, Löwe B . Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study . The American Journal of Geriatric Psychiatry . 22 . 10 . 1029–1038 . October 2014 . 23768681 . 10.1016/j.jagp.2013.01.076 .
  15. Spitzer RL, Kroenke K, Williams JB, Löwe B . A brief measure for assessing generalized anxiety disorder: the GAD-7 . Archives of Internal Medicine . 166 . 10 . 1092–1097 . May 2006 . 16717171 . 10.1001/archinte.166.10.1092 . free .
  16. 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 . General Hospital Psychiatry . 39 . 24–31 . 2016 . 26719105 . 10.1016/j.genhosppsych.2015.11.005 .
  17. De Man J, Absetz P, Sathish T, Desloge A, Haregu T, Oldenburg B, Johnson LC, Thankappan KR, Williams ED . Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis . Frontiers in Psychology . 12 . 676398 . 2021-05-13 . 34054677 . 8155718 . 10.3389/fpsyg.2021.676398 . free .

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