GAD-7 (General Anxiety Disorder-7)
Why Use
Objectively determine initial symptoms severity and monitor symptom changes/effect of treatment over time.
When to Use
Rapid screening for the presence of a clinically significant anxiety disorder (GAD, PD, SP & PTSD), especially in outpatient settings.
Formula
Pearls / Pitfalls
The GAD-7 is useful in primary care and mental health settings as a screening tool and symptom severity measure for the four most common anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, Social Phobia and PostTraumatic Stress Disorder). It is 70-90% sensitive and 80-90% specific across disorders / cutoffs (see Evidence section for more). Higher GAD-7 scores correlate with disability and functional impairment (in measures such as work productivity and health care utilization). ( Spitzer RL 2006 ) ( Ruiz MA 2011 ) The last item “How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?” - although not used in the calculation - is a good indicator of the patient’s global impairment and can be used to track treatment response.
Management
Scores ≥10: Further assessment (including diagnostic interview and mental status examination) and/or referral to a mental health professional recommended. Score Symptom Severity Comments 5-9 Mild Monitor 10*-14 Moderate Possible clinically significant condition >15 Severe Active treatment probably warranted *For Panic Disorder, Social Phobia, & PTSD, cutoff score of 8 may be used for optimal sensitivity/specificity (see Evidence section).
Critical Actions
This tool should be used for screening and monitoring symptom severity and cannot replace a clinical assessment and diagnosis. Do not forget to rule out medical causes of anxiety before diagnosing an anxiety disorder (for example, EKG for arrhythmias, TSH for thyroid disease).
More Information
For all questions, answer with one of the following: Not at all = 0 Several days = +1 More than half the days = +2 Nearly every day = +3 The last question of the GAD-7 is a good indicator of patient's global impairment, though not included in the final calculation of points.