The GAD-7 questionnaire

Abstract

The Generalized Anxiety Disorder (GAD-7) questionnaire is a seven-item, self-report anxiety questionnaire designed to assess the patient’s health status during the previous 2 weeks. The items enquire about the degree to which the patient has been bothered by feeling nervous, anxious or on edge, not being able to stop or control worrying, worrying too much about different things, having trouble relaxing, being so restless that it is hard to sit still, becoming easily annoyed or irritable and feeling afraid as if something might happen. The questionnaire was designed by Spitzer et al. [1] and published in 2006. It is quick to administer and is now used in research and clinical settings. The copyright is held by Pfizer Inc. but the questionnaire is free to use. The questionnaire has been validated for use as a screening tool and severity measure [1,2], in primary care [3] and in general populations [4]. Scores of 0, 1 or 2 are given for experiencing symptoms ‘not at all’, for ‘several days’, for ‘more than half the days’ and for ‘nearly every day’, respectively. The scores are then totalled and presented from 0 to 21. Scores of 5, 10 and 15 represent cut-off points for mild, moderate and severe anxiety, respectively. When screening for an anxiety disorder, a recommended cut-off point for referral for further evaluation is 10 or greater. Using the threshold score of 10, the GAD-7 has sensitivity of 89% and specificity of 82% for generalized anxiety disorder. It is also moderately good at screening for other anxiety disorders—panic disorder (sensitivity 74%, specificity 81%), social anxiety disorder (sensitivity 72%, specificity 80%) and post-traumatic stress disorder (sensitivity 66%, specificity 81%) [5]. The GAD-7 has been compared with other anxiety questionnaires such as the Penn State Worry Questionnaire for Measuring Response (PSWQMR) during Treatment of Generalized Anxiety Disorders, which is widely used in the USA. The GAD-7 was found, when compared with the PSWQMR to be more sensitive in detecting change in status, in the clinical setting. Both questionnaires had internal consistency (Cronbach’s alpha 0.79–0.91 (GAD-7) and 0.86–0.91 (PSWQMR), respectively) [6].

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