GAD-7 PDF: Print the Seven-Question Anxiety Screener

About this tool

The GAD-7 PDF on this page is the seven-item Generalized Anxiety Disorder scale. Each item describes one way anxiety shows up, from being unable to stop worrying to feeling afraid that something awful might happen, and each is rated for the last two weeks on a four-point frequency scale running from Not at all to Nearly every day. The whole instrument is seven questions, a total between 0 and 21, and one extra unscored question about how much the problems interfere with work, home life and getting along with other people.

Spitzer, Kroenke, Williams and Lowe published the GAD-7 in Archives of Internal Medicine in 2006. They built it in 15 primary care clinics in the United States: 2,740 patients completed the questionnaire and 965 of them were then interviewed by a mental health professional over the telephone, blind to the scores. Internal consistency was excellent, with a Cronbach alpha of 0.92, and at the optimal cut point of 10 or greater the scale showed a sensitivity of 89 percent and a specificity of 82 percent for generalized anxiety disorder. Like the rest of the PHQ family it was placed in the public domain.

The published cutpoints are 5, 10 and 15, marking mild, moderate and severe anxiety, and 10 is the point at which a fuller evaluation is usually recommended. Those bands describe how much symptom load a person reported, not how unusual they are. A later systematic review and diagnostic meta-analysis by Plummer and colleagues in 2016 found that a cutoff of 8 gave acceptable accuracy for identifying generalized anxiety disorder, with pooled sensitivity and specificity around 0.83 and 0.84 and similar performance across thresholds of 7 to 10, so the exact line is a judgment call rather than a fact of nature.

The GAD-7 was designed for generalized anxiety disorder, which is the worry-driven kind: persistent apprehension about several areas of life, hard to switch off, usually with physical restlessness and poor sleep alongside it. In 2007 Kroenke and colleagues reported in the Annals of Internal Medicine on how the same scale behaves as a general anxiety screen, using the 965 interviewed patients from the validation study. The scale and its two-item short form performed reasonably well as screeners for all four disorders examined, with areas under the curve between 0.80 and 0.91 for generalized anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder.

That last finding is often repeated too enthusiastically. Performing reasonably as a screen is not the same as telling disorders apart. A 14 on the GAD-7 says that a meaningful amount of anxiety was reported; it cannot say whether the problem is sustained worry, discrete panic attacks, dread of being watched and judged, or the hyperarousal that follows a traumatic event, and those four lead to different treatments. The same 2007 paper found that about one in five primary care patients met criteria for at least one anxiety disorder and that 41 percent of them were getting no treatment at all.

In practice the GAD-7 is used in two ways. First as a door: a few minutes at the start of a primary care or intake appointment, to turn a vague sense that someone is on edge into something specific enough to ask about. Second as a ruler: the same seven questions repeated every few weeks while a treatment is adjusted, so improvement is visible rather than guessed at. The first two items are sometimes used alone as the GAD-2 when time is very short, and they often sit next to the two-item depression screen on the same page.

A total is not a diagnosis, and it does not identify a cause. Anxiety that looks like generalized anxiety disorder on paper can turn out to be an overactive thyroid, too much caffeine, a medication side effect, alcohol or benzodiazepine withdrawal, a cardiac or respiratory problem, untreated sleep apnea, or a perfectly proportionate reaction to a frightening situation that any reasonable person would be anxious about. The form asks nothing about any of that. It also cannot tell whether anxiety is the main problem or the loudest symptom of depression, since the two travel together often.

A low score does not close the subject either. Anxiety that is narrow, such as a specific phobia or a fear limited to one situation, can leave the GAD-7 almost untouched while still shaping a life around avoidance. If the total is low but something still feels wrong, that is worth saying out loud rather than filing the form away. Equally, a high total in the week of a bereavement, a diagnosis or a job loss may be telling you about the week rather than about an anxiety disorder.

Print the sheet and fill it in by hand if you want something to take to an appointment, or hand it to a patient on paper if you are the clinician. If you would rather answer on screen and have the total worked out for you, the interactive version is at Anxiety Test, and for skills to use while you wait for an appointment see Anxiety Coping Skills. Keep the completed sheets. Three of them from across a couple of months say far more in an appointment than one total does.

Reviewed by Michael Callans, MSW
Checked the seven items, the response options and the 0 to 21 scoring against the published scale, and confirmed the page separates what the GAD-7 screens for from what it cannot tell apart.

References

1. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092
2. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine. 2007;146(5):317-325.
3. Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. General Hospital Psychiatry. 2016;39:24-31.
4. Pfizer Inc. Patient Health Questionnaire (PHQ) Screeners: official instruction manual, 2010. https://www.phqscreeners.com

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