GAD-7: a brief scale of anxiety symptoms
The GAD-7 asks seven questions about anxiety symptoms over the last two weeks. Health services worldwide use it for screening, not for diagnosis.
Where the scale comes from
The GAD-7 was published in 2006 by Robert Spitzer, Kurt Kroenke, Janet Williams and Bernd Löwe, the same team behind the PHQ-9 depression questionnaire. The goal was a short tool to identify generalized anxiety disorder in primary care visits (Spitzer et al., 2006).
The seven questions cover feeling nervous, not being able to stop worrying, worrying too much, trouble relaxing, restlessness, becoming easily irritated, and feeling afraid that something awful might happen. Each is answered from 0 ("not at all") to 3 ("nearly every day"), for a total of 0 to 21. The usual cut-offs are 5, 10 and 15, for mild, moderate and severe anxiety.
What the research says
In the original study of more than 2,700 primary care patients, a cut-off of 10 identified most people with generalized anxiety disorder and most of those without it (Spitzer et al., 2006). Later studies showed the scale also helps flag panic disorder, social anxiety and post-traumatic stress, though less accurately (Kroenke et al., 2007).
The GAD-7 has been validated in the general population (Löwe et al., 2008) and across many countries and languages. A meta-analysis concluded that it screens for anxiety disorders with acceptable accuracy, with optimal cut-offs between 8 and 11 depending on the setting (Plummer et al., 2016).
Limits of the scale
Anxiety is a normal and often useful emotion. The GAD-7 measures how often symptoms occur, not why: a hard stretch of life, poor sleep or physical conditions such as thyroid problems can raise the score. That's why the scale is for flagging when an assessment is worthwhile, not for making a diagnosis.
Limitations
The result reflects only the last two weeks and depends on how you read each question. The scale doesn't distinguish types of anxiety or assess other problems that may be present. A high score is not a diagnosis, and a low score doesn't rule out distress. If anxiety gets in the way of your daily life, talk to a health professional.
How Ethea adapts the model
Ethea presents the seven items with the original response options and adds up the points as in the publication, showing the reference ranges as guidance. This questionnaire was not created by Ethea: credit goes to Spitzer, Kroenke, Williams and Löwe. Unlike our forced-choice tests, here you rate each statement on its own, because that's how the scale was validated.
Ethea is not affiliated with the scale's authors or with any institution that distributes it.
References
Links with a DOI go to the original article. Where no DOI is given, the link opens a Google Scholar search.
- Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. DOI: 10.1001/archinte.166.10.1092(opens in a new tab)
- Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325. Search Google Scholar(opens in a new tab)
- Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46(3), 266–274. Search Google Scholar(opens in a new tab)
- Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. Search Google Scholar(opens in a new tab)