GAD-7: seven questions, two weeks, one number
Worry is normal. Worry you cannot switch off is what the GAD-7 is looking for. Seven items, each rated 0 to 3 for the past two weeks, total 0 to 21.
Spitzer and colleagues published it in 2006 as the anxiety counterpart to the PHQ-9, from the same primary care programme. The seven items cover nervousness, being unable to stop or control worrying, worrying too much about different things, trouble relaxing, restlessness, irritability, and fear that something awful might happen.
Scoring and bands
Sum the seven ratings. The bands are the same ones used in the original paper.
| Total | Band |
|---|---|
| 0-4 | Minimal anxiety |
| 5-9 | Mild anxiety |
| 10-14 | Moderate anxiety |
| 15-21 | Severe anxiety |
The cutoffs, and why 10 is not the only option
In the original validation, 10 or above gave sensitivity .89 and specificity .82, with AUC .91. Dropping to 8 lifts sensitivity to 92% and cuts specificity to 76%. Chinese samples support a cutoff of 7, where sensitivity is .86 and specificity .83, again with AUC .91. A positive screen is meant to be followed by a structured interview, not treated as an answer.
What the numbers say about the scale
Internal consistency runs .88 to .93 in general population samples, and was .92 in the original paper. Retest reliability over one to two weeks is r = .78 to .91, which is steadier than either the Beck Anxiety Inventory or the STAI manages.
A single factor fits in every group it has been tested in, with CFI between .95 and .99, so the seven items behave as one dimension of anxiety severity. Correlations with other instruments show where it sits: .60 to .80 with the Beck Anxiety Inventory, .65 to .80 with the state scale of the STAI, .70 to .80 with the anxiety dimension of the SCL-90, .50 to .70 with the PHQ-9, .45 to .60 with the PSS-10, and -.30 to -.50 with the mental health component of the SF-12. Anxiety and depression share symptoms, so some overlap with a depression scale is expected rather than a flaw.
What it does not cover
GAD-7 screens for generalised anxiety. It is not a panic disorder scale and not a social anxiety scale, though people with either condition often score high on it, which is a limit of the tool rather than a finding about you. It also cannot diagnose anything. If anxiety is getting in the way of work, sleep or relationships, a score is a starting point for a conversation with someone qualified. This page is not a diagnosis and does not replace one.