Instructions
Over the last 2 weeks, how often have you been bothered by any of the following problems? For each question, select the response that best describes how often you have been bothered by that problem.
1. Feeling nervous, anxious, or on edge
Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?
2. Not being able to stop or control worrying
Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?
3. Worrying too much about different things
Over the last 2 weeks, how often have you been bothered by worrying too much about different things?
4. Trouble relaxing
Over the last 2 weeks, how often have you been bothered by having trouble relaxing?
5. Being so restless that it's hard to sit still
Over the last 2 weeks, how often have you been bothered by being so restless that it's hard to sit still?
6. Becoming easily annoyed or irritable
Over the last 2 weeks, how often have you been bothered by becoming easily annoyed or irritable?
7. Feeling afraid as if something awful might happen
Over the last 2 weeks, how often have you been bothered by feeling afraid as if something awful might happen?
GAD-7 Score Interpretation
0-4 points: Minimal anxiety
5-9 points: Mild anxiety
10-14 points: Moderate anxiety
15-21 points: Severe anxiety
Clinical Management
- Minimal (0-4): Continue routine monitoring
- Mild (5-9): Consider watchful waiting, repeat assessment, or brief intervention
- Moderate (10-14): Consider treatment with psychotherapy and/or medication
- Severe (15-21): Treatment with psychotherapy and/or medication recommended, consider psychiatric referral
- ⚠️ Assess for panic disorder, social anxiety, and other anxiety disorders
About GAD-7
- Validated screening tool for generalized anxiety disorder (GAD)
- Assesses symptoms over the past 2 weeks
- Each question scored 0-3 points
- Total score range: 0-21 points
- Corresponds to DSM-5 criteria for GAD
- Can be used for initial screening and monitoring treatment response
- Often used alongside PHQ-9 for comprehensive mental health screening
GAD-7 (Generalized Anxiety Disorder-7) Calculator
The Generalized Anxiety Disorder-7 (GAD-7) is a validated, widely-used screening tool for generalized anxiety disorder (GAD) severity. It consists of 7 questions that assess the frequency of anxiety symptoms over the past 2 weeks, corresponding to the diagnostic criteria for GAD in the DSM-5.
GAD-7 Questions and Scoring
The GAD-7 assesses the following 7 symptoms of generalized anxiety disorder:
- Feeling nervous, anxious, or on edge - General anxiety
- Not being able to stop or control worrying - Uncontrollable worry
- Worrying too much about different things - Excessive worry
- Trouble relaxing - Difficulty relaxing
- Being so restless that it's hard to sit still - Restlessness
- Becoming easily annoyed or irritable - Irritability
- Feeling afraid as if something awful might happen - Fear of catastrophe
Scoring System
Each question is scored on a 4-point scale:
- 0 points: Not at all
- 1 point: Several days
- 2 points: More than half the days
- 3 points: Nearly every day
Total score range: 0-21 points
Score Interpretation
Minimal Anxiety (0-4 points)
- Clinical significance: No significant anxiety symptoms
- Prevalence: Normal anxiety levels
- Management: Continue routine monitoring
- Follow-up: No specific intervention needed
- Treatment: Not indicated
Mild Anxiety (5-9 points)
- Clinical significance: Mild anxiety symptoms
- Prevalence: Common in general population
- Management: Consider watchful waiting, repeat assessment, or brief intervention
- Follow-up: Reassess in 2-4 weeks
- Treatment: Consider brief psychotherapy or lifestyle interventions
Moderate Anxiety (10-14 points)
- Clinical significance: Moderate anxiety symptoms
- Prevalence: Clinically significant anxiety
- Management: Consider treatment with psychotherapy and/or medication
- Follow-up: Monitor response to treatment
- Treatment: Psychotherapy and/or anxiolytic medication
Severe Anxiety (15-21 points)
- Clinical significance: Severe anxiety symptoms
- Prevalence: Significant functional impairment
- Management: Treatment with psychotherapy and/or medication recommended
- Follow-up: Close monitoring, consider psychiatric referral
- Treatment: Psychotherapy, anxiolytic medication, consider psychiatric consultation
Clinical Applications
Screening and Diagnosis
- Primary care screening: Routine anxiety screening in adults
- Diagnostic aid: Helps identify clinically significant anxiety
- Severity assessment: Quantifies anxiety severity
- Treatment planning: Guides treatment decisions based on severity
- Monitoring response: Tracks treatment effectiveness over time
Treatment Monitoring
- Baseline assessment: Establish pretreatment severity
- Response monitoring: Track symptom improvement
- Remission assessment: Determine when symptoms have resolved
- Relapse detection: Identify return of symptoms
- Treatment adjustment: Guide medication or therapy changes
Important Considerations
Differential Diagnosis
- Panic disorder: Assess for panic attacks and agoraphobia
- Social anxiety disorder: Evaluate social fears and avoidance
- Specific phobias: Identify specific feared objects or situations
- Post-traumatic stress disorder: Assess for trauma history
- Obsessive-compulsive disorder: Evaluate obsessions and compulsions
- Medical conditions: Rule out medical causes of anxiety
Limitations
- Self-reported symptoms may be unreliable
- Does not replace clinical judgment
- May not capture atypical presentations
- Cultural and language barriers may affect accuracy
- Requires patient literacy and comprehension
- May not distinguish between different anxiety disorders
Special Populations
- Elderly patients: May have somatic symptoms predominating
- Adolescents: May require modified interpretation
- Pregnant/postpartum women: Consider perinatal anxiety
- Chronic medical conditions: Symptoms may overlap with medical illness
- Substance use disorders: May complicate interpretation
Clinical Pearls
- Use clinical judgment in addition to GAD-7 scores
- Consider cultural and social factors in interpretation
- Monitor for treatment response and side effects
- Address comorbid conditions that may affect anxiety
- Consider referral to mental health specialist for moderate-severe anxiety
- Document GAD-7 scores in medical records for tracking
- Use in conjunction with other clinical assessments
- Assess for other anxiety disorders and mood disorders
Treatment Recommendations
Mild Anxiety (5-9 points)
- Watchful waiting with follow-up
- Brief psychotherapy (CBT, mindfulness-based therapy)
- Lifestyle modifications (exercise, stress management, sleep hygiene)
- Support groups or self-help resources
- Relaxation techniques and breathing exercises
Moderate Anxiety (10-14 points)
- Psychotherapy (CBT, acceptance and commitment therapy)
- Antidepressant medication (SSRIs, SNRIs)
- Combined treatment approach
- Regular monitoring of response
- Stress management and coping skills training
Severe Anxiety (15-21 points)
- Antidepressant medication (SSRIs, SNRIs)
- Psychotherapy
- Consider psychiatric consultation
- Close monitoring for safety and response
- Consider intensive treatment programs
- Address functional impairment and quality of life
Comorbidity Considerations
Common Comorbidities
- Depression: Often co-occurs with anxiety disorders
- Substance use disorders: Self-medication with alcohol or drugs
- Medical conditions: Cardiovascular, respiratory, endocrine disorders
- Other anxiety disorders: Panic disorder, social anxiety, specific phobias
- Personality disorders: May complicate treatment
Assessment of Comorbidities
- Screen for depression using PHQ-9
- Assess for substance use and abuse
- Evaluate for medical conditions that may cause anxiety
- Consider comprehensive psychiatric evaluation
- Address all comorbid conditions in treatment planning
This calculator provides a validated method for screening and monitoring generalized anxiety disorder severity, helping to guide appropriate treatment decisions and track patient progress over time. The GAD-7 is widely used in clinical practice and has been validated in multiple populations and settings.
References
- Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- Kroenke K, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317-325.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 2013.
- Plummer F, et al. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24-31.
- Löwe B, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266-274.
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