Outcome Measure
Generalised Anxiety 7-Item
What it measures?
- The symptoms of Generalized Anxiety Disorder, as outlined in the Diagnostic and Statistical Manual of Psychological Disorders, 4th Edition, Text Revision (DSM-IV-TR).
- Symptoms assessed include subjective anxiety, worry, difficulty relaxing, restlessness, irritability and fear of negative outcomes.
Who is it for?
Adolescents and adults aged 14 years +
Instrument Quality
- The GAD-7 has well-established psychometric properties and is among the most common screening instruments used to assess generalized anxiety (for systematic reviews, see Kroenke, Spitzer, Williams & Löwe, 2010; Plummer, Manea, Trepel & McMillan, 2015; van Ballegooijen, Riper, Cuijpers, Oppen & Smit, 2016).
Structure
- 7 items
- 4-point Likert scale
- Respondents indicate how frequently (0 = "Not at all"; 3 = "Nearly every day") they have been bothered by the problems listed in each item (e.g. "Feeling nervous, anxious or on edge")
Scoring instructions
- Sum item responses to derive a total score.
| Subscale | Item number |
|---|---|
Full-scale (GAD-7) |
1,2,3,4,5,6,7 |
Score Interpretation
What higher scores mean?
- More severe generalized anxiety symptoms during the previous 2 weeks., Greater likelihood of meeting criteria for Generalized Anxiety Disorder or another anxiety disorder (e.g. Panic Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder). Optimal cut-off scores will vary across settings and populations. As general guidelines, authors recommended that a cut-off score of 10 (Kroenke, Spitzer, Williams & Löwe, 2010) or 8 (Plummer, Manea, Trepel & McMillan, 2015) be employed to identify the presence of any anxiety disorder. They suggest that clinicians undertake a thorough diagnostic evalutation for anxiety disorders when an individual's responses fall above the recommended cut-off score.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Minimal | 0 | |
| Mild | 5 | |
| Anxiety Disorder | >=10 | Provisional Diagnosis |
| Moderate | 10 | |
| Severe | 15 | |
| Maximum | 21 |
Instrument developers
- 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.
Refrences
Bischoff, T., Anderson, S. R., Heafner, J., & Tambling, R. (2020). Establishment of a reliable change index for the GAD-7 Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):345-59. doi: 10.1016/j.genhosppsych.2010.03.006. Epub 2010 May 7. PMID: 20633738. Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016 Mar-Apr;39:24-31. doi: 10.1016/j.genhosppsych.2015.11.005. Epub 2015 Nov 18. PMID: 26719105. Sequeira, S. L., Morrow, K. E., Silk, J. S., Kolko, D. J., Pilkonis, P. A., & Lindhiem, O. (2021). National Norms and Correlates of the PHQ-8 and GAD-7 in Parents of School-age Children. Journal of Child & Family Studies, 30(9), 2303–2314. https://doi.org/10.1007/s10826-021-02026-x Spitzer RL, Kroenke K, Williams JBW, Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092
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Severity ranges
The range values corresponding to ‘minimal’, ‘mild’, ‘moderate’ and ‘severe’ were identified by the instrument developer, and reliably distinguished patients across measures of mental, social, occupational, pain-based, physical and general functioning (Spitzer, Kroenke, Williams & Löwe, 2006). These ranges are widely used in clinical practice.
Provisional diagnosis
The scale developers (Löwe et al., 2008) report that in the general population, approximately 5% of individuals obtain a GAD-7 score of 10 or higher. In a primary care validation study, scores at or above 10 were associated with positive likelihood ratios for the presence of generalized anxiety disorder of 5.1, and 5.5 for any anxiety disorder.
Reliable change and clinically significant improvement
Bischoff et al (2020) calculated the amount of change in score from pretest to posttest that would be statistically significant at the p = .05 level for the GAD-7. They employed the method of Jacobson & Truax (1991), using the mean and standard deviation from a clinical sample (N = 332) and the test-retest reliability (0.87) from a community sample. This yielded a raw score change value of 5.59, which the authors recommended rounding up to 6 for practical use.
Mean
Standard Deviation
Reliability