Occupational Medicine 2014;64:224
doi:10.1093/occmed/kqt161
Questionnaire Review
The GAD-7 questionnaire
The Generalized Anxiety Disorder (GAD-7) question-
naire is a seven-item, self-report anxiety questionnaire
designed to assess the patient’s health status during the
previous 2 weeks. The items enquire about the degree
to which the patient has been bothered by feeling nerv-
ous, anxious or on edge, not being able to stop or con-
trol worrying, worrying too much about different things,
having trouble relaxing, being so restless that it is hard to
sit still, becoming easily annoyed or irritable and feeling
afraid as if something might happen.
Authors
The questionnaire was designed by Spitzer et al. [1] and
published in 2006. It is quick to administer and is now
used in research and clinical settings.
Usage
The copyright is held by Pfizer Inc. but the question-
naire is free to use. The questionnaire has been validated
for use as a screening tool and severity measure [1,2], in
primary care [3] and in general populations [4].
Interpretation
Scores of 0, 1 or 2 are given for experiencing symptoms
‘not at all’, for ‘several days’, for ‘more than half the days’
and for ‘nearly every day’, respectively. The scores are
then totalled and presented from 0 to 21. Scores of 5, 10
and 15 represent cut-off points for mild, moderate and
severe anxiety, respectively. When screening for an anxi-
ety disorder, a recommended cut-off point for referral for
further evaluation is 10 or greater.
Validation
Using the threshold score of 10, the GAD-7 has sensitiv-
ity of 89% and specificity of 82% for generalized anxi-
ety disorder. It is also moderately good at screening for
other anxiety disorders—panic disorder (sensitivity 74%,
specificity 81%), social anxiety disorder (sensitivity 72%,
specificity 80%) and post-traumatic stress disorder (sen-
sitivity 66%, specificity 81%) [5].
© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: journals.permissions@oup.com
Comparisons
The GAD-7 has been compared with other anxi-
ety questionnaires such as the Penn State Worry
Questionnaire for Measuring Response (PSWQMR)
during Treatment of Generalized Anxiety Disorders,
which is widely used in the USA. The GAD-7 was
found, when compared with the PSWQMR to be more
sensitive in detecting change in status, in the clinical
Downloaded from https://academic.oup.com/occmed/article/64/3/224/1437718 by guest on 06 April 2023
setting. Both questionnaires had internal consistency
(Cronbach’s alpha 0.79–0.91 (GAD-7) and 0.86–0.91
(PSWQMR), respectively) [6].
Nerys Williams
Independent Consultant
Occupational Physician,
Solihull, UK
e-mail: neryswilliams1443@gmail.com
References
1. Spitzer RL, Kroenke K, Williams JB et al. A brief measure
for assessing generalized anxiety disorder: the GAD-7. Arch
Intern Med 2006;166:1092–1097.
2. Swinson RP. The GAD-7 scale was accurate for diag-
nosing generalised anxiety disorder. Evid Based Med
2006;11:184.
3. Ruiz MA, Zamorano E, Garcia-Campayo J et  al. 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;128:277–286.
4. Lowe B, Decker O, Muller S et  al. Validation and
standardization of the Generalized Anxiety Disorder
Screener (GAD-7) in the General Population. Med Care
2008;46:266–274.
5. Kroenke K, Spitzer RL, Williams JB et al. Anxiety disorders
in primary care: prevalence, impairment, comorbidity, and
detection. Ann Intern Med 2007;146:317–325.
6. Psychometric comparison of the Generalized Anxiety
Disorder Scale-7 and the Penn State Worry Questionnaire
for Measuring Response during Treatment of Generalized
Anxiety Disorder. http://www.bioportfolio.com/resources/
pmarticle/210987/Psychometric-Comparison-of-the-
generalized-anxiety-disorder-scale-7-and-the-Penn.html
(21 October 2013, date last accessed).