Generalized Anxiety Disorder 7-item scale (GAD-7)

The Generalized Anxiety Disorder 7-item scale (GAD-7) is one of the most widely used screening and monitoring tools for anxiety in clinical practice.

Questions: 7
Duration: 3 min
Original title: GAD-7 — Generalized Anxiety Disorder
Adaptation: Generalized Anxiety Disorder 7-item scale (GAD-7)
Authors: Spitzer, R.L., Kroenke, K., Williams, J.B.W., & Löwe, B.
Created: 2006

The Generalized Anxiety Disorder 7-item scale (GAD-7) is one of the most widely used screening and monitoring tools for anxiety in clinical practice. Originally developed to detect potential generalized anxiety disorder in primary care, it efficiently captures the core cognitive and somatic symptoms that characterize excessive worry and anxious apprehension.

As a brief, validated measure, the GAD-7 offers an excellent balance between clinical utility and patient burden. It maps directly onto DSM criteria, making it a reliable clinical anchor. Beyond initial intake, its sensitivity to change makes it an ideal instrument for tracking symptom trajectories and evaluating response to generalized anxiety interventions over time.

While robust for generalized anxiety, research indicates the instrument is also sensitive to panic, social anxiety, and PTSD, meaning a high score prompts a broader differential assessment. For clinicians, integrating the GAD-7 provides a standardized, repeatable metric that grounds the anxiety self-monitoring process and supports collaborative treatment planning.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

9/ 21

Brief 7-item self-report questionnaire designed to screen for generalized anxiety disorder (GAD) and evaluate the severity of anxiety symptoms in adults over the past two weeks. Developed by Spitzer et al. (2006), it is widely used in primary care and mental health settings, also demonstrating good psychometric performance for screening panic disorder, social anxiety disorder, and post-traumatic stress disorder.

0–9

Screening threshold not met

10–21

Generalised Anxiety Disorder

The threshold of 10 associated, in screening, with clinically significant anxiety symptoms is not met. The selected source does not characterize this range of the scale.

généralefemales · general population · Löwe et al. (2008)

021

M = 3.2 ± 3.5

généralemales · general population · Löwe et al. (2008)

021

M = 2.7 ± 3.2

généralemixed · general population · 18–29 years · Australia · Stocker et al. (2021)

021

M = 7.8 ± 5.9

généralemixed · general population · 30–49 years · Australia · Stocker et al. (2021)

021

M = 6.6 ± 5.4

généralemixed · general population · 50–69 years · Australia · Stocker et al. (2021)

021

M = 4.6 ± 4.9

généralemixed · general population · ≥ 70 years · Australia · Stocker et al. (2021)

021

M = 2.6 ± 3.6

Scoring

Sum, total score from 0 to 21, each item is scored on a 4-point scale (from 0 to 3).

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What the test measures

The GAD-7 measures the severity of core anxiety symptoms over the past two weeks, focusing primarily on the hallmark features of generalized anxiety disorder. It captures both the subjective cognitive experience of worry and the physiological arousal that accompanies it.

Anxious apprehension: The pervasive feeling of nervousness, tension, and being on edge.
Worry regulation: The perceived inability to control, stop, or manage shifting worries, reflecting core DSM-5 criteria for GAD.
Somatic hyperarousal: The physical manifestations of anxiety, including motor restlessness and difficulty relaxing.
Emotional reactivity: The tendency to become easily annoyed or irritable under the strain of chronic worry.
Catastrophic anticipation: The subjective fear of impending doom or awful events.

The scale is designed for use with adults and adolescents in both primary care and specialized mental health populations.

When and why to use it

Clinicians typically integrate the GAD-7 at multiple time points throughout the treatment trajectory to ensure measurement-based care. Its brevity allows it to be administered seamlessly without disrupting the therapeutic alliance.

Intake baseline: To establish the initial severity of anxiety symptoms and provide a quantifiable starting point for treatment.
Screening and detection: To flag potential clinical-level anxiety that warrants a deeper diagnostic interview, helping to recognize generalized anxiety disorder and related conditions.
Monitoring change: To track symptom fluctuation across sessions and evaluate the effectiveness of psychological or pharmacological interventions.
Differential support: To distinguish generalized worry severity when evaluating overlapping presentations like panic disorder or mood dysregulation.

Using a validated score anchors the clinical impression in objective data, helping both clinician and patient visualize progress and adjust the treatment plan accordingly.

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The questions

Over the last 2 weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge
This item probes the general subjective experience of anxious arousal and baseline tension.
- Not at all
- Several days
- More than half the days
- Nearly every day
2. Not being able to stop or control worrying
This item assesses the core cognitive feature of the disorder, specifically the perceived unmanageability of worry.
- Not at all
- Several days
- More than half the days
- Nearly every day
3. Worrying too much about different things
This item evaluates the pervasive and shifting nature of the patient's apprehensions across multiple life domains.
- Not at all
- Several days
- More than half the days
- Nearly every day
4. Trouble relaxing
This item examines the physiological inability to unwind and release muscular or mental tension.
- Not at all
- Several days
- More than half the days
- Nearly every day
5. Being so restless that it's hard to sit still
This item captures psychomotor agitation and the physical restlessness often associated with severe anxiety.
- Not at all
- Several days
- More than half the days
- Nearly every day
6. Becoming easily annoyed or irritable
This item highlights emotional reactivity, as chronic anxiety often depletes tolerance and increases frustration.
- Not at all
- Several days
- More than half the days
- Nearly every day
7. Feeling afraid as if something awful might happen
This item measures catastrophic thinking and the subjective anticipation of imminent threat or disaster.
- Not at all
- Several days
- More than half the days
- Nearly every day