GAD-7: Generalized Anxiety Disorder 7-Item Scale
The GAD-7 is a validated 7-item self-report questionnaire for screening and measuring the severity of generalised anxiety disorder, routinely administered alongside the PHQ-9 in primary care and behavioural health settings.
What is the GAD-7?
The Generalized Anxiety Disorder 7-item scale (GAD-7) was developed by Spitzer et al. (2006) as a brief, efficient tool for detecting generalised anxiety disorder (GAD) and assessing its severity. Each of the 7 items asks patients how often they have been bothered by a specific anxiety symptom over the past 2 weeks, using the same 4-point response scale as the PHQ-9 (0–3), producing a total score of 0–21.
GAD-7 Score Interpretation
- 0–4: Minimal anxiety — no action required beyond reassurance
- 5–9: Mild anxiety — watchful waiting, lifestyle counselling
- 10–14: Moderate anxiety — consider pharmacotherapy, CBT referral, and follow-up GAD-7
- 15–21: Severe anxiety — active treatment required; assess for panic disorder, social anxiety disorder, PTSD
A cut-point of ≥10 on the GAD-7 has a sensitivity of 89% and specificity of 82% for detecting GAD, making it one of the most efficient screening tools available in primary care. The GAD-7 also has demonstrated validity for screening panic disorder, social anxiety disorder, and PTSD — though its primary validation is for GAD.
GAD-7 and Post-COVID Anxiety
Population-level GAD-7 scores increased dramatically during and after the COVID-19 pandemic, with national surveys showing clinically meaningful anxiety (GAD-7 ≥10) in approximately 20–30% of adults during 2020–2022, compared to a pre-pandemic baseline of roughly 7–9%. Long COVID syndrome is associated with persistent anxiety symptoms even after acute illness resolution. Practices managing post-COVID patients should ensure systematic GAD-7 screening is integrated into follow-up workflows.
Integrated PHQ-9 and GAD-7 Screening
Most primary care and PCMH practices administer PHQ-9 and GAD-7 together as a combined behavioural health screen, often at each annual wellness visit and at intervals for high-risk patients. The two tools together take approximately 4 minutes to complete and score. Analytics tracking screening completion rates, score distributions, and follow-up documentation rates provide the foundation for systematic behavioural health integration.