The GAD-7 is a seven-question screener for generalized anxiety disorder, widely used in primary care and psychiatry. Scores range from 0 to 21: 0 to 4 minimal anxiety, 5 to 9 mild, 10 to 14 moderate, 15 to 21 severe. A score of 10 or higher suggests the need for clinical evaluation. The GAD-7 is a screening tool, not a diagnostic instrument; the diagnosis is made by a clinician based on history.
The GAD-7 is the most widely used anxiety screening tool in primary care worldwide. It was developed in 2006 by Spitzer, Kroenke, and colleagues, and has since been validated across populations, settings, and translations. Knowing what it is and how it's used demystifies a tool that many patients encounter without explanation.
The seven questions
Over the last two weeks, how often have you been bothered by the following problems? Each item is rated 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day).
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it's hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
Total score ranges from 0 to 21.
What the score categories mean
0 to 4: Minimal anxiety. Within normal range. Treatment usually not needed.
5 to 9: Mild anxiety. Some symptoms. Often manageable with self-care, lifestyle adjustments, or brief therapy.
10 to 14: Moderate anxiety. Significant symptoms. Clinical evaluation recommended. Often responsive to therapy, medication, or both.
15 to 21: Severe anxiety. Substantial symptoms. Clinical evaluation strongly recommended. Combined treatment often warranted.
A score of 10 or higher is the most common threshold used for considering treatment. The score doesn't establish a diagnosis; a clinician interprets it alongside history, current life context, and other clinical information.
What the GAD-7 is good for
Screening in primary care. The tool was specifically designed for primary care, where physicians have limited time and need a reliable way to identify patients who might benefit from further evaluation.
Tracking change over time. Repeating the GAD-7 every few weeks during treatment gives a quantitative measure of progress. Many psychiatrists administer it at each visit.
Triage in mental health settings. A patient's GAD-7 score helps a clinician decide on intensity of follow-up and treatment options.
Research and quality measurement. The GAD-7 is used in clinical trials and in measurement-based care programs across health systems.
What it isn't
The GAD-7 isn't a diagnostic tool. A high score doesn't establish generalized anxiety disorder, and a low score doesn't rule out other anxiety conditions. Panic disorder, social anxiety disorder, OCD, and PTSD have their own screening tools and diagnostic criteria.
The GAD-7 is also not a measure of anxiety type. A patient with predominantly physical symptoms might score lower than the underlying condition warrants because the questions emphasize cognitive and emotional features.
How it's used in measurement-based care
A common pattern in modern psychiatric practice. The patient completes the GAD-7 at intake. Baseline score is recorded. The patient repeats it at follow-up visits, typically every two to four weeks early in treatment. Treatment decisions are guided in part by score trajectory. A patient whose score has dropped from 15 to 8 over six weeks is responding. A patient whose score has held steady is a candidate for treatment adjustment. The patient and clinician share the score data and use it to make decisions together. The visible trajectory often helps patients see progress that subjective experience might miss.
External references
The original GAD-7 validation paper (Spitzer et al., 2006, Archives of Internal Medicine) is the canonical source. The tool itself is in the public domain. The NIMH overview of generalized anxiety disorder covers the underlying condition the GAD-7 screens for.
Important note: This article is educational. It isn't a screening service. We don't host an interactive version of the GAD-7 because using a screener without a clinician to interpret it isn't the intended use case. If you would like to take the GAD-7, see your primary care physician or a mental health clinician.
If your score has you wondering about next steps, see how to tell whether you need a shrink on shrinkMD. (shrinkMD is part of The Shrink Network, founded by Shariq Refai, MD, MBA.)
Related: Generalized anxiety disorder · The PHQ-9 · How CBT and SSRIs actually work for anxiety