General Anxiety Disorder-7 (GAD-7)

What is generalized anxiety disorder?

General anxiety disorder (GAD) is a common mental health condition characterized by excessive and persistent worry about various aspects of life. Unlike specific phobias or panic disorders, GAD involves chronic and uncontrollable worry that is often disproportionate to the actual circumstances.

Most common anxiety disorders involve a range of physical and psychological symptoms, including restlessness, fatigue, difficulty concentrating, muscle tension, and sleep disturbances.

In GAD, the worry is about several activities or events for more than half the days for at least six months. These symptoms can then significantly impair daily functioning and quality of life. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) notes these criteria (American Psychiatric Association, 2013).

GAD is more than just occasional worry or stress; it involves a constant state of apprehension and anxiety that interferes with daily activities and relationships. The constant worry can be accompanied by physical symptoms such as headaches, stomach problems, and muscle tension.

Assessing generalized anxiety disorder

Assessing generalized anxiety disorder is crucial for providing appropriate treatment and monitoring progress. Here are several methods healthcare professionals can employ:

• GAD-7 questionnaire: The Generalized Anxiety Disorder-7 (GAD-7) is a widely used screening tool for identifying and measuring the severity of GAD symptoms (Spitzer et al., 2006).
• Clinical interviews: Structured diagnostic interviews, such as the Structured Clinical Interview for DSM (SCID) or the Mini-International Neuropsychiatric Interview (MINI), can help establish a formal diagnosis of GAD and rule out other anxiety disorders, panic disorder, and post-traumatic stress disorder.
• Behavioral observations: Observing the patient's behavior, mannerisms, and nonverbal cues during the clinical encounter can provide valuable insights into their anxiety levels and potential triggers. For instance, fidgeting, restlessness, or excessive worry may be indicative of GAD symptoms.
• Physiological measures: In some cases, healthcare professionals may assess physiological indicators of anxiety, such as elevated heart rate, increased blood pressure, or excessive sweating. These measures can provide objective data to support the diagnosis and monitor treatment effectiveness.

What is the General Anxiety Disorder-7 (GAD-7)?

The GAD-7 is a self-report questionnaire that consists of seven items designed to measure the frequency of anxiety symptoms over the past two weeks. Each item is scored on a scale from 0 (not at all) to 3 (nearly every day), with higher scores indicating more severe anxiety (Spitzer et al., 2006).

This generalised anxiety disorder assessment is a reliable and valid screening tool widely used in clinical practice and research settings. It has been extensively studied and has demonstrated good psychometric properties, including excellent internal consistency, test-retest reliability, and convergent and divergent validity (Löwe et al., 2008). This proves helpful in identifying probable cases of GAD.

How to use this GAD-7

If you're a mental health professional who wants to use this assessment, here's a step-by-step guide on how to use this resource:

Step 1: Introduce the GAD-7 to the client

Explain that it's a brief questionnaire designed to measure the severity of anxiety symptoms over the past two weeks.

Step 2: Administer the GAD-7

Provide the patient with the seven-item questionnaire and ask them to rate the frequency of each symptom on a scale of 0 (not at all) to 3 (nearly every day) (Spitzer et al., 2006).

Step 3: Score the GAD-7

Add up the scores for all seven items to obtain the total score, which ranges from 0 to 21. Higher scores indicate more severe anxiety symptoms.

Step 4: Use the GAD-7 score to inform clinical decision-making

The score can help determine the need for further assessment, treatment planning, and monitoring of anxiety symptoms. Remember that the GAD-7 is a screening tool and should not be used as the sole basis for diagnosis.

Scoring and interpretation

Scoring and interpreting the GAD-7 is straightforward, making it a practical tool for healthcare practitioners to assess the severity of generalized anxiety disorder symptoms.

The GAD-7 consists of seven questions, each scored on a scale from 0 to 3, with 0 representing "not at all" and 3 representing "nearly every day." The total score is calculated by summing up the scores for each question, ranging from 0 to 21.

The total GAD-7 score indicates the severity of anxiety symptoms, with higher scores suggesting more severe anxiety. The recommended interpretation of the scores is as follows (Spitzer et al., 2006):

• 0-4: Minimal anxiety score
• 5-9: Mild anxiety score
• 10-14: Moderate anxiety score
• 15-21: Severe anxiety score

While there is no universally agreed-upon score cut-off for diagnosing GAD, a score of 10 or higher is often used as a reasonable cut-off for identifying individuals who may have clinically significant anxiety and warrant further evaluation (Löwe et al., 2008). If you need a resource to help you in the scoring phase, check out this GAD-7 Scoring Sheet.

It's crucial to note that the GAD-7 is a screening tool, and a formal diagnosis of GAD should be made based on a comprehensive clinical evaluation.

When would you typically administer a GAD-7?

The GAD-7 is typically used in various clinical and research settings for assessing GAD and other anxiety disorders, including social anxiety disorder, panic disorder, and posttraumatic stress disorder.

• Primary care and internal medicine: In primary care or internal medicine settings, the GAD-7 is often used as a screening tool for patients presenting with symptoms suggestive of anxiety disorders.
• Mental health assessment: Mental health professionals frequently use the GAD-7 in clinical practice to assess the severity of anxiety symptoms. It's a brief clinical measure that assists in diagnosing generalized anxiety disorder and in deciding the need for a more comprehensive mental health evaluation.
• Monitoring treatment response: In both hospital anxiety and depression scale settings and general hospital psychiatry, the GAD-7 serves as a severity measure to monitor changes in anxiety severity over time, particularly in response to interventions for GAD and depression symptoms.
• Brief measure in busy settings: Due to its efficiency as a valid and efficient tool, the GAD-7 is ideal for use in busy clinical settings where a quick assessment is necessary. It's a brief self-report scale that can be easily administered in primary care settings, including in a primary care sample.
• Differential diagnosis: It aids mental health professionals in distinguishing between generalized anxiety disorder and other common anxiety disorders or common mental disorders, ensuring accurate diagnosis and appropriate treatment planning.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.

Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical care, 46(3), 266–274. https://doi.org/10.1097/MLR.0b013e318160d093

Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092