GAD-7

GAD-7 overview 

The Generalized Anxiety Disorder 7 (GAD-7) is a seven item questionnaire used to assess symptom categories associated with stress or anxiety. Use of the tool will help you better understand the frequency, intensity and impact to functioning of any symptoms your client may be experiencing. By using the questionnaire and noting the results over time, you will be able to understand the patient's overall level of anxiety symptoms, changes to their symptoms and the impact of those symptoms on their functioning, and whether self-reported symptoms may reach a significant impact. When considering a diagnosis, you will still need to use clinical interviewing skills to determine whether the symptoms are causing clinically significant distress or impairment, and whether those symptoms are not better explained or attributed to other conditions the client is experiencing.
 

Scoring 

0-3 item rating

• 0= not at all
• 1= several days
• 2= more than half the days
• 3= nearly everyday 

Total score- 0-21 point scale 

• 0-4= no notable anxiety symptoms
• 5-9= mild
• 10-14= moderate
• 15+= severe

Treatment considerations based on score: (1)

Measuring change

Good clinical care requires that clinicians monitor client progress. Scores of less than five twice in a row, at least two weeks apart, can serve as an indication that maintenance treatment may be appropriate. Scores that demonstrate a 50% or greater improvement compared to pretreatment score indicate a reliable change.

Potential interventions based on individual GAD-7 items

1. Clinicians may also find it helpful to consider treatment interventions and focus based on elevated responses to specific symptom categories. 
2. Some possible intervention, tools, and considerations (2)

SonderMind’s guidelines for providers

As a mental health professional, client care decisions are up to your discretion. However, we recommend attention to the following scenarios related to GAD-7:

A total score of 15+ which indicates severe symptoms:

• Discussion with your client about their score.
• Development of a treatment plan to address.
• Anxiety can lead to suicidal thoughts and therefore a thorough risk assessment and associated safety plan is encouraged.  Consider additional support resources that might be clinically appropriate.

An increased change in score by 10+ points

• Discussion with your client about the change in their score.
• Collaborative discussion of current treatment plan with consideration of what adjustments might be needed.
• Evaluation of alternative or additional professional services might be needed. 

References

1. Source: Spitzer RL, Kroenke K, Williams JB, et al; A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. GAD-7 ‍
2. https://www.mirecc.va.gov/cih-visn2/Documents/Clinical/GAD_with_Info_Sheet.pdf