GAD-7: Generalized Anxiety Disorder Scale

What is the GAD-7?

The GAD-7 is a 7-item self-report questionnaire developed by Drs. Robert L. Spitzer, Kurt Kroenke, Janet B.W. Williams, and Bernd Löwe. It measures the severity of generalized anxiety disorder symptoms based on DSM-5 criteria, asking respondents how often they have been bothered by specific anxiety-related problems over the past two weeks.

Completing the GAD-7 takes 2 to 3 minutes. It is one of the most widely used anxiety screening instruments in clinical practice, with strong psychometric properties validated across primary care, psychiatric, and community settings. Like the PHQ-9, it is freely available with no licensing requirements.

While named for generalized anxiety disorder, the GAD-7 also shows good sensitivity for detecting panic disorder, social anxiety disorder, and post-traumatic stress disorder, making it a useful general anxiety screener beyond its primary diagnostic target.

GAD-7 Scoring & Severity Levels

Each item is scored on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 21.

A score of 10 or above is the standard threshold for clinical significance. When tracking treatment response, a 5-point change is considered clinically meaningful.

GAD-7 Questions

Respondents rate how often they have been bothered by the following problems over the last 2 weeks:

1. Feeling nervous, anxious, or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something awful might happen

Clinical Applications

The GAD-7 is widely used for both initial screening and ongoing progress monitoring in anxiety treatment. Its brevity makes it suitable for routine administration at every therapy session or at regular intervals during pharmacotherapy.

In measurement-based care, repeated GAD-7 scores create a clear trajectory of treatment response. A sustained drop below the clinical threshold of 10, or a reduction of 5 or more points from baseline, indicates meaningful clinical improvement and can inform decisions about continuing, adjusting, or stepping down treatment.

The GAD-2, consisting of the first two items (feeling nervous/anxious and uncontrollable worry), serves as an ultra-brief screener. A score of 3 or above on the GAD-2 suggests further evaluation is warranted and can be followed by the full GAD-7.

The GAD-7 is also among the most commonly used anxiety measures in clinical trials, providing a standardized metric for comparing treatment outcomes across studies.

Reliability & Validity

The GAD-7 demonstrates excellent internal consistency with a Cronbach's alpha of 0.92 and strong test-retest reliability. At the standard cutoff of 10, it achieves 89% sensitivity and 82% specificity for generalized anxiety disorder.

The measure has been validated across many languages and cultural contexts, and in populations including primary care patients, psychiatric outpatients, and community samples. It also shows good discriminant validity, distinguishing anxiety from depression when used alongside the PHQ-9.