Overview of the General Anxiety Disorder-7 (GAD-7) Assessment

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Self-Report Measures, Screenings and Assessments

Overview of the General Anxiety Disorder-7 (GAD-7) Assessment

THC Editorial Team January 27, 2021
Photo by Simon Berger on Unsplash
Photo by Simon Berger on Unsplash

Contents

What Is the General Anxiety Disorder-7 (GAD-7)?

The General Anxiety Disorder-7 (GAD-7) is one of the most frequently used tools by clinicians to screen clients for generalized anxiety disorder (GAD).1 It is a seven-item self-assessment survey that measures a person’s range of emotions in order to gauge the severity of their anxiety.

GAD affects 3.1% of the United States population (roughly 6.8 million adults).2 Most measures of anxiety are rather lengthy and require a long time to fill out. Therefore, in order to provide a faster option, Spritzer and colleagues developed the GAD-7 as a brief measure for assessing GAD.3 It was modeled after the Patient Health Questionnaire (PHQ-9), which assesses the severity of depression. The PHQ-9 has been well established in the research literature and is widely used in clinical settings by physicians.

BH Affiliate - sponsor, General Anxiety Disorder-7 (GAD-7) Assessment article

What Does the GAD-7 Measure?

This instrument uses selected criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) to screen individuals for possible GAD and to determine the severity of their symptoms.

The tool asks clients how often they have been bothered by the following seven problems during the prior 2 weeks:4

  • feeling nervous, anxious, or on edge
  • being unable to control excessive worrying or maladaptive thoughts
  • worrying too much about different things
  • having trouble relaxing
  • feeling restless
  • becoming annoyed or irritable
  • feeling as though something bad might happen

GAD-7 Scoring Guidelines

GAD-7 scoring is simple and was designed for easy self-assessment. People who use the tool answer each of the seven items by choosing a number from 0 to 3 on a four-point Likert scale:4

0 – Not at all

1 – Several days

2 – More than half the days

3 – Nearly every day

After a client assigns a score of 0, 1, 2, or 3 to each item, they can add all the resulting values to determine their total score, which can range from 0 to 21. Clients assess their level of anxiety by comparing their total score to the levels in the following scale:4

0–4 = minimal anxiety

5–9 = mild anxiety

10–14 = moderate anxiety

15–21 = severe anxiety

A statistically significant change in score over time is 5 or more points.4

Validity and Reliability of the GAD-7

Researchers assess the validity and reliability of their measures in order to evaluate the quality of their research. Reliability refers to how consistently reproducible the results of their research are, meaning if something is reliable, it is statistically consistent. Validity refers to how well the results measure what they are meant to measure, meaning if findings are valid, they are statistically accurate.5

Researchers have used clinical trials to thoroughly assess the validity and reliability of the GAD-7. According to Spitzer and colleagues, the GAD-7 has good reliability—including criterion, construct, and factorial—and procedural validity. The researchers noted a significant association among their study population that indicated the potential effectiveness of GAD-7: Patients who reported increasing scores on this instrument also exhibited increasing functional impairment. They concluded that the GAD-7 is a valid and efficient tool to screen for GAD in clinical populations.2,6

Lowe and colleagues assessed how well the GAD-7 performed in the general population of a medical center in Germany, and they found good internal consistency, reliability, and validity.6 Johnson and colleagues found the same results when they tested the measure within a heterogeneous psychiatric sample, which included individuals with eating disorders, anxiety disorders, depressive disorders, and trauma disorders.7 In addition to screening for GAD, researchers have found that it is effective at screening for panic disorder, social anxiety disorder, and posttraumatic stress disorder.4

Key Points on the GAD-7

The GAD-7 is a self-administered test that has been proven to screen individuals for generalized anxiety disorder with great effectiveness. It can be used in primary care settings to measure long-term changes in anxiety levels and to help indicate whether individuals may need therapeutic intervention.4 If your total score, on the GAD-7, causes concern, please contact your general physician or schedule a meeting with a qualified practitioner to discuss options for support.

References

  1. Jordan, P., Shedden-Mora, M. C., & Löwe, B. (2017). Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PloS One, 12(8), Article e0182162.
    https://doi.org/10.1371/journal.pone.0182162
  2. Anxiety and Depression Association of America. (n.d.). Facts & statistics.
    https://adaa.org/about-adaa/press-room/facts-statistics
  3. 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.
    https://doi.org/10.1001/archinte.166.10.1092
  4. Mirecc.va.gov. (n.d.). GAD-7 [Info sheet]. Retrieved January 25, 2021, from
    https://www.mirecc.va.gov/cih-visn2/Documents/Clinical/GAD_with_Info_Sheet.pdf
  5. Middleton, F. (2020, June 26). Reliability vs validity: What’s the difference?
    https://www.scribbr.com/methodology/reliability-vs-validity/
  6. 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.
    https://doi.org/10.1097/MLR.0b013e318160d093
  7. Johnson, S., Ulvenes, P., Oktedalen, T., & Hoffart, A. (2019, August 6). Psychometric properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a heterogeneous psychiatric sample. Frontiers in Psychology, 10(1713).
    https://doi.org/10.3389/fpsyg.2019.01713

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