Calculators / Anxiety and trauma
GAD-7
Generalized Anxiety Disorder 7-item scale. Anxiety screening and severity.
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The GAD-7 calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Screening adults for clinically significant anxiety in primary care and psychiatry.
- Rating anxiety severity at baseline.
- Tracking response to treatment with the same scale at each visit.
Do not use it for
- Diagnosing generalized anxiety disorder. It does not check the six-month duration or exclude other causes.
- Telling GAD from panic, social anxiety, PTSD or OCD.
- Anxiety caused by a medical condition, a substance or medication withdrawal, which it cannot separate out.
Ask the person to answer for the last 2 weeks. Choose one answer for each of the seven items. The last question, about difficulty, is not part of the score.
GAD-7
Answer the questions to see the result.
This calculator adds up the score in your browser. Nothing you enter is stored or sent.
More about the GAD-7
About the GAD-7What it is and what it is for
The GAD-7 was written to detect generalized anxiety disorder in primary care. Seven items ask how often the person has been bothered by core anxiety symptoms over the past two weeks, from not at all (0) to nearly every day (3). The total runs from 0 to 21.
It does well beyond its original target. Scores also rise in panic disorder, social anxiety disorder and PTSD, which makes it a reasonable general anxiety screen and a clean way to track change. It does not tell you which anxiety disorder is behind the score.
How to use itGiving it and scoring it
Ask for the last two weeks. Score each answer from 0 to 3 and add the seven items for a total from 0 to 21. This page does the addition. The difficulty question is not part of the total.
The person can complete it alone or you can read it aloud. Check that no item is blank.
Interpreting the scoreScore ranges and what they suggest
| Score | What it suggests | Usual response |
|---|---|---|
| 0 to 4 | MinimalFew or no anxiety symptoms. | No treatment from the score alone. |
| 5 to 9 | MildSome anxiety. Often a reaction to stress. | Monitor and repeat. Offer education and self-help or brief therapy. |
| 10 to 14 | ModerateThe usual screening cutoff for probable GAD and other anxiety disorders. | Clinical evaluation, then treatment with CBT, medication, or both. |
| 15 to 21 | SevereMarked anxiety, usually with impairment. | Evaluate promptly, treat actively, and check for depression and suicidal thoughts. |
Bands are from Spitzer, Kroenke, Williams and Löwe (2006). A cutoff of 8 is used by some programs when sensitivity matters more than false positives.
Pearls and pitfallsTips and common mistakes
- A total of 10 or more is the usual positive screen, with sensitivity near 89% and specificity near 82% for GAD in the development study. A cutoff of 8 shifts that toward more sensitivity.
- Ask about panic attacks, social fears and trauma when the score is high. The GAD-7 will not point to them.
- Anxiety and depression co-occur. Pair it with the PHQ-9 when the score is 10 or more.
- Use it to track change. A fall of 4 or more points, or a drop to under 5, is a meaningful result.
- Item 5, restlessness, rises with akathisia, stimulants and ADHD. Think about medications when it stands out.
EvidenceAccuracy and reliability
- Development study (Spitzer 2006, 2,740 primary care patients): a score of 10 or more had 89% sensitivity and 82% specificity for generalized anxiety disorder on a structured interview. Internal consistency was 0.92 and test-retest reliability 0.83.
- A meta-analysis (Plummer 2016) found a pooled sensitivity of 0.83 and specificity of 0.84 at a cutoff of 8.
- Minimal clinically important difference: about 4 points (Toussaint 2020).
- It has been validated in the general population and in many languages. Use caution in adolescents, where cutoffs are less settled.
Source, license and referencesWhere it comes from
The GAD-7 was developed by Drs. Robert L. Spitzer, Kurt Kroenke, Janet B. W. Williams and Bernd Löwe, with an educational grant from Pfizer Inc. The authors state that no permission is required to reproduce, translate, display or distribute it.
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic meta-analysis. Gen Hosp Psychiatry. 2016;39:24-31.
- Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317-325.
- Toussaint A, Hüsing P, Gumz A, et al. Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). J Affect Disord. 2020;265:395-401.