Generalised Anxiety Disorder 7 (GAD-7)

The GAD-7 is a seven item self-report questionnaire that screens for generalised anxiety disorder and measures the severity of anxiety symptoms over the preceding two weeks. Each item is scored from 0 to 3, giving a total from 0 to 21.

It is a screening and monitoring tool. It is also used to screen for panic disorder, social anxiety and post-traumatic stress disorder, although its sensitivity for these conditions is lower.

Usage. It is used in primary care, specialist mental health services, and in monitoring response to treatment.

Indications. Screening in patients with symptoms suggestive of anxiety, routine monitoring of known anxiety, and assessment of response over time.

Preparation and technique. The patient completes the questionnaire in private, in a language they understand. Responses are reviewed with the clinician, particularly where the score is high.

Contraindications and precautions. Reliability is limited in people with cognitive impairment, limited literacy, or acute distress. Clinical judgement shapes interpretation in these groups.

Interpretation.

• Scores of 0 to 4 indicate minimal anxiety.
• Scores of 5 to 9 indicate mild anxiety.
• Scores of 10 to 14 indicate moderate anxiety, and a score of 10 or more is a threshold for probable generalised anxiety disorder.
• Scores of 15 to 21 indicate severe anxiety.

Causes of a raised score. Generalised anxiety disorder, other anxiety disorders, depression, medical conditions such as thyroid disease, substance use, and medication effects.

Critical values and findings needing immediate action. A high score with features of panic, chest pain, breathlessness or collapse requires same day medical review to exclude cardiac or respiratory causes.

Limitations and artefacts. The questionnaire measures symptoms, not the diagnosis. Overlap with depression means that a high score may reflect a mixed picture. Physical symptoms of medical illness can inflate scores.

Follow up tests. A structured clinical interview to confirm the diagnosis, thyroid function tests, full blood count, and caffeine and substance use history.

Special groups. Older adults may report physical symptoms more than worry. Adolescents and pregnant women are assessed with awareness of the context of their symptoms.