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General Anxiety Disorder (GAD-7)

Measure severity of anxiety

ErstellerDr. Robert L. Spitzer, MD
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Anweisungen

 The GAD-7 is a screening tool used by health practitioners to determine initial symptom severity and monitor effect of treatment over time and does not replace a clinical assessment and diagnosis.

Ask: How often have you been bothered by the following over the past 2 weeks?

Introduction
Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States (Locke, Kirst & Shultz, 2015). The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 can objectively determine initial symptom severity and monitor symptom changes and the effect of treatment over time. Studies suggest 70-90% sensitivity and 80-90% specificity across anxiety disorders. Higher GAD-7 scores correlate with disability and functional impairment in measures to include work productivity and health care utilization (Spitzer, 2006 & Ruiz, 2011). The scale was originally developed and validated based on the DSM-IV criteria. However, since the publication of the DSM-V criteria, the scale remains clinically useful because the differences in GAD diagnostic criteria are minimal.

The Generalized Anxiety Disorder-7 (GAD-7) is a validated diagnostic tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant anxiety disorder, such as GAD, PD, social phobia (SP) & post-traumatic stress disorder (PTSD). GAD-7 is a 7-question assessment. A range of 0-3 points are assigned to each answer. The 8th question assesses global impairment and is not counted in the score (max score of 21 points). 

Scoring & Recommendations

The first 7 questions will answer with one of the following:

 

Answer

Points

Not at all

0

Several days

1

More than half the days

2

Nearly every day

3

 

 

Result 

Recommendation

Score

No anxiety disorder

N/A

< 5 points

Mild anxiety disorder

Monitor

5-9 points

Studies suggest a score ≥ 8 in suspected Panic Disorder, Social Phobia or PTSD may be a moderate anxiety disorder

Need for further evaluation and referral for possible clinically significant condition.

8-9 points

Moderate anxiety disorder 

Need for further evaluation and referral for possible clinically significant condition.  

10-14 points

Severe anxiety disorder 

Need for further evaluation and referral for possible clinically significant condition. Active treatment is likely warranted.

> 15 points

 

 

Additional Considerations

The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.

The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.

In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:

  • Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism

  • Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases

  • Neurologic diseases: Temporal lobe epilepsy, TIA

  • Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders

  • Substance abuse withdrawal

  • Medications: Common ones include albuterol, levothyroxine, decongestants

 

Lifestyles recommendations that may reduce anxiety-related symptoms include:

  • Identifying and removing possible triggers

    • Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.

    • Stimulants: Can include medications, supplements or caffeine products ingested in the evening.

    • Nicotine

    • Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.

    • Stress

  • Improving sleep quality and quantity

  • Physical activity

 

Therapeutic modalities that may reduce anxiety-related symptoms include:

 

Alle Fragen und möglichen Ergebnisse

InstructionsTitel nicht sichtbar
Feeling nervous, anxious, or on edge

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Not being able to stop or control worrying

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Worrying too much about different things

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly everyday
Trouble relaxing

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly everyday
Being so restless that it's hard to sit still

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Becoming easily annoyed or irritable

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Feeling afraid as if something awful might happen

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
How difficult have these problems made it to do work, take care of things at home, or get along with other people?

Optional: Not included in the final score. Helps to assess global impairment.

Select one option:

  • Not at all
  • Somewhat difficult (Several days)
  • Very difficult (More than half the days)
  • Extremely difficult (Nearly every day)
Mögliche Ergebnisse
Global impairment: Patient reports symptoms make it "very difficult" to perform life tasks
No anxiety disorder (< 5 points)
Global impairment: No limitations reported by patient
Global impairment: Patient reports symptoms make it "extremely difficult" to perform life tasks
Studies suggest a score ≥ 8 in suspected Panic Disorder, Social Phobia or PTSD may be a moderate anxiety disorder

In suspected Panic Disorder, Social Phobia or PTSD, a ≥ 8 indicates a need for further evaluation for a possible clinically significant condition. 

 

The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.

 

The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.

 

In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:

  • Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism

  • Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases

  • Neurologic diseases: Temporal lobe epilepsy, TIA

  • Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders

  • Substance abuse withdrawal

  • Medications: Common ones include albuterol, levothyroxine, decongestants

 

Lifestyles recommendations that may reduce anxiety-related symptoms include:

  • Identifying and removing possible triggers

    • Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.

    • Stimulants: Can include medications, supplements or caffeine products ingested in the evening.

    • Nicotine

    • Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.

    • Stress

  • Improving sleep quality and quantity

  • Physical activity

 

Therapeutic modalities that may reduce anxiety-related symptoms include:

 

Mild anxiety disorder (5-9 points)

In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:

  • Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism

  • Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases

  • Neurologic diseases: Temporal lobe epilepsy, TIA

  • Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders

  • Substance abuse withdrawal

  • Medications: Common ones include albuterol, levothyroxine, decongestants

 

Lifestyles recommendations that may reduce anxiety-related symptoms include:

  • Identifying and removing possible triggers

    • Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.

    • Stimulants: Can include medications, supplements or caffeine products ingested in the evening.

    • Nicotine

    • Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.

    • Stress

  • Improving sleep quality and quantity

  • Physical activity

 

Therapeutic modalities that may reduce anxiety-related symptoms include:

 

 

Global impairment: Patient reports symptoms make it "somewhat" difficult to perform life tasks
Severe anxiety disorder (> 15 points)

When screening for anxiety disorders, a score > 15 indicates a need for further evaluation and referral for possible clinically significant condition. Active treatment is likely warranted.

 

The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.

 

The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.

 

In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:

  • Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism

  • Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases

  • Neurologic diseases: Temporal lobe epilepsy, TIA

  • Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders

  • Substance abuse withdrawal

  • Medications: Common ones include albuterol, levothyroxine, decongestants

 

Lifestyles recommendations that may reduce anxiety-related symptoms include:

  • Identifying and removing possible triggers

    • Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.

    • Stimulants: Can include medications, supplements or caffeine products ingested in the evening.

    • Nicotine

    • Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.

    • Stress

  • Improving sleep quality and quantity

  • Physical activity

 

Therapeutic modalities that may reduce anxiety-related symptoms include:

 

 

Moderate anxiety disorder (10-14 points)

When screening for anxiety disorders, a score > 9 indicates a need for further evaluation and referral for possible clinically significant condition.

 

The PRO-MIS Emotional Distress - Anxiety - Short Form for Adults and the Severity Measure for Generalized Anxiety Disorder - Adult can aid clinical evaluation of generalized anxiety disorders and monitor treatment effectiveness.

 

The Severity Measure for Panic Disorder - Adult is an assessment scale that can complement the clinical assessment of patients with panic disorder.

 

In a suspected anxiety disorder, medical conditions with similar presentations ought to be excluded, such as:

  • Endocrine conditions: Hyperthyroidism, pheochromocytoma, hyperparathyroidism

  • Cardiopulmonary conditions: Arrhythmia, obstructive pulmonary diseases

  • Neurologic diseases: Temporal lobe epilepsy, TIA

  • Other psychiatric disorders: Major depressive disorder, bipolar disorder, other anxiety disorders

  • Substance abuse withdrawal

  • Medications: Common ones include albuterol, levothyroxine, decongestants

 

Lifestyles recommendations that may reduce anxiety-related symptoms include:

  • Identifying and removing possible triggers

    • Caffeine: Consider increase sensitivity to caffeine (slow metabolizer) due to genetic polymorphisms in adenosine receptors.

    • Stimulants: Can include medications, supplements or caffeine products ingested in the evening.

    • Nicotine

    • Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.

    • Stress

  • Improving sleep quality and quantity

  • Physical activity

 

Therapeutic modalities that may reduce anxiety-related symptoms include:

 

 

Zitat

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092. PMID: 16717171.

Literatur

  • A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.

    Spitzer RL, Kroenke K, Williams JB, Löwe B.

    https://pubmed.ncbi.nlm.nih.gov/16717171/

  • Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. J Affect Disord. 2011 Feb;128(3):277-86.

    Ruiz MA, Zamorano E, García-Campayo J, Pardo A, Freire O, Rejas J.

    https://pubmed.ncbi.nlm.nih.gov/20692043/

  • Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 1;91(9):617-24.

    Locke AB, Kirst N, Shultz CG.

    https://pubmed.ncbi.nlm.nih.gov/25955736/

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