GAD-7 Questionnaire
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Looking for information about the GAD-7 questionnaire, a screening measure for anxiety? This article reviews how to use the GAD-7 screening tool and includes a free printable GAD-7 questionnaire to use in your practice.
Measurement-based care tools, like the GAD-7 screening tool, can be incredibly helpful to therapists and mental health clinicians to inform client and patient treatment decisions. In particular, the GAD-7 questionnaire is used to measure clients’ levels of anxiety.
Anxiety disorders are one of the most common mental health conditions, affecting an estimated 18% of American adults ages 18 to 54.
There are several types of anxiety disorders, including panic disorder, post-traumatic stress disorder (PTSD), phobias, obsessive compulsive disorder (OCD), and generalized anxiety disorder (GAD).
Rates of GAD are increasing in the United States, impacting 6.8 million American adults. Yet, only about 43% receive treatment, highlighting the need for effective screening and interventions.
What is generalized anxiety disorder?
Generalized anxiety disorder, or GAD, involves excessive worry, nervousness, stress, or fear about a specific issue or unexpected circumstances in everyday routines.
Worries may relate to work, school, family, health, or other concerns, and interfere with daily activities and quality of life.
Common symptoms of GAD include:
- Restlessness
- Difficulty concentrating
- Fatigue
- Trouble sleeping
- Fear or dread
- Muscle tension
- Feeling on edge
- Irritability
- Headaches
- Perspiration
While the specific cause(s) of GAD have not been specified, certain groups have a higher prevalence of the condition. For example, GAD is twice as prevalent in women than men, non-white racial identities, young adults, and individuals with low income status.
Given the prevalence and risk factors for GAD, and impairment to a person’s quality of life, therapists need a reliable measure to screen for generalized anxiety and make appropriate treatment decisions. So, what is the screening tool for anxiety?
What is the GAD-7 questionnaire?
The GAD-7 questionnaire was developed by Robert L. Spitzer, Kurt Kroenke, Janet B. Williams, and Berndt Lowe, as a 7-item screening tool based for generalized anxiety disorder.
The GAD-7 screening tool is based on the criteria for diagnosis of generalized anxiety disorder in the Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5), and is used in both mental health and primary care settings.
Researchers have found that the GAD-7 can successfully identify probable cases of generalized anxiety disorder along with degree of severity.
How to use the GAD-7 questionnaire
The GAD-7 questionnaire can be used as a screening tool in clinical settings. Therapists can administer it as part of therapy intake paperwork or at the beginning of a session.. Using an electronic health record (EHR) can take the extra work out of intake and send GAD-7 questionnaires directly to a client electronically.
The measure can be used as both an adolescent GAD screening tool and for adults, though it is intended for ages 11 and above. The questionnaire is brief and takes just a few minutes to complete.
In a therapeutic setting, the client may complete the questionnaire when initiating treatment, to help the therapist screen for anxiety and develop an appropriate treatment plan. The clinician may repeat the questionnaire throughout treatment to measure the client’s progress and see if symptoms have reduced.
What do the GAD-7 questionnaire results mean?
Each question of the GAD-7 asks the client to rate their answer on a four-point Likert scale:
- 0: Not at all
- 1: Several days
- 2: More than half the days
- 3: Nearly every day
The answers are then tallied to calculate the total GAD-7 score, which ranges from 0 to 21. The scores indicate the presence or absence of GAD anxiety and severity:
- 0-4: No anxiety
- 5-9: Mild anxiety
- 10-14: Moderate anxiety
- 15-21: Severe anxiety
How to use the GAD-7 questionnaire to inform treatment decisions
A client’s score can help to determine the severity of GAD, how it impacts the client’s day-to-day functioning, interventions required, and whether the symptoms could be attributed to other anxiety disorders.
For instance, treatment considerations may look like:
Mild anxiety (score of 5-9)
Determine overall impact on functioning, monitor thoughts and behaviors using a CBT thought log, consider brief interventions (such as relaxation techniques), and repeat GAD-7 in four weeks.
Moderate anxiety (score of 10-14)
Seek to understand causes of anxiety and impairments, begin regular therapy sessions, and start a treatment plan with anxiety-related interventions and skill building (such as DBT or CBT).
Severe anxiety (score of 15+)
Assess for safety, create safety plan, consider additional supports, may indicate further differential diagnosis, consider referral to medical or psychiatric provider for pharmacological interventions.
Download the free GAD screening tool PDF at the top of this article to save and use in your practice.
Assessing for other anxiety disorders
The creators of the GAD-7 also found that the measure is able to screen for three other common anxiety disorders with a score cut-off greater than 10:
| Test | Sensitivity | Specificity | Positive likelihood ratio |
| Generalized anxiety disorder | 89% | 82% | 5.1 |
| Panic disorder | 74% | 81% | 3.9 |
| Social anxiety disorder | 72% | 80% | 3.6 |
| Post-traumatic stress disorder | 66% | 81% | 3.5 |
| Any anxiety disorder | 68% | 88% | 5.5 |
Using your clinical judgment, you may want to determine if you need to assess for PTSD using the Posttraumatic Stress Disorder Checklist (PCL-5); panic disorder, using the Panic Disorder Severity Scale (PDSS); or social anxiety, using the Social Avoidance and Distress Scale (SADS).
Sources
- Bahrami, F., & Yousefi, N. (2011). Females are more anxious than males: a metacognitive perspective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939970/
- Mental health disorder statistics. (2023). https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics
- Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. https://www.researchgate.net/profile/Bernd-Loewe/publication/6466355_Anxiety_Disorders_in_Primary_Care_Prevalence_Impairment_Comorbidity_and_Detection/links/0a85e537f5d0462f61000000/Anxiety-Disorders-in-Primary-Care-Prevalence-Impairment-Comorbidity-and-Detection.pdf
- Mishra, A. K., & Varma, A. R. (2023). A Comprehensive Review of the Generalized Anxiety Disorder. https://doi.org/10.7759/cureus.46115
- Ruiz, M. A., Zamorano, E., García-Campayo, J., Pardo, A., Freire, O., & Rejas, J. (2011). Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. https://doi.org/10.1016/j.jad.2010.07.010
- Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410326
- What are anxiety disorders? (n.d.). https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
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