The GAD-7 is a seven-question screening questionnaire that measures how often anxiety symptoms have bothered you over the last two weeks. It was built to detect generalised anxiety disorder and performs well as a general anxiety severity measure too. It is a screening tool, not a diagnostic test: it tells you whether a fuller assessment is worth having, not whether you have an anxiety disorder. A score of 10 or more is the threshold at which clinicians usually look further.
- What it measures
- Anxiety symptom severity over the last 2 weeks
- Length
- 7 items, each scored 0–3
- Score range
- 0–21, in four severity bands
- Referral threshold
- 10 or more warrants further evaluation
- Source
- Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.
Formula
GAD-7 (Spitzer, Kroenke & Williams 2006 severity cut-points)GAD-7 score = q1 + q2 + q3 + q4 + q5 + q6 + q7
- 0
- — Not at all
- 1
- — Several days
- 2
- — More than half the days
- 3
- — Nearly every day
Every item carries the same weight, so the maximum is 7 × 3 = 21. The severity bands are half-open — a score of exactly 10 is moderate, not mild, and exactly 15 is severe. Ten is also the operating cut-point from the original validation study, where it gave the best balance of sensitivity and specificity for generalised anxiety disorder.
GAD-7 Anxiety Test examples
| Input | Result | Category |
|---|---|---|
| Every item “Not at all” | 0 / 21 | Minimal symptoms |
| Occasional worry, no restlessness | 3 / 21 | Minimal symptoms |
| Worry and trouble relaxing several days a week | 7 / 21 | Mild symptoms |
| Persistent worry most days, irritable | 12 / 21 | Moderate symptoms |
| Daily worry with dread and restlessness | 18 / 21 | Severe symptoms |
| Every item “Nearly every day” | 21 / 21 | Severe symptoms |
What is the GAD-7?
The GAD-7 asks how often, over the last two weeks, seven common anxiety symptoms have bothered you — from being unable to stop worrying, through restlessness and irritability, to a sense that something awful is about to happen. It was published in 2006 and has since become the standard brief anxiety measure in primary care.
It was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc., and it is free to reproduce, translate, display and distribute without permission. It is often given alongside the PHQ-9, because anxiety and depression overlap heavily and treating one while missing the other rarely works.
How is the GAD-7 scored?
Each of the seven items is scored 0 to 3 on the same frequency scale: not at all is 0, several days is 1, more than half the days is 2, and nearly every day is 3. Add the seven answers for a total between 0 and 21.
| Score | Severity | Usual next step |
|---|---|---|
| 0 – 4 | Minimal | None; repeat if things change |
| 5 – 9 | Mild | Watchful waiting; repeat at follow-up |
| 10 – 14 | Moderate | Further evaluation by a clinician |
| 15 – 21 | Severe | Prompt evaluation and active treatment |
The first two items alone form the GAD-2, a two-question ultra-brief screen scored 0 to 6. A GAD-2 of 3 or more is the usual trigger to ask the remaining five questions — the same two-then-seven pattern the PHQ-2 and PHQ-9 use for depression.
What does a GAD-7 score of 10 or more mean?
Ten is the referral threshold from the original validation study: at that cut-point the questionnaire correctly identified about 89% of people with generalised anxiety disorder while correctly clearing about 82% of those without it. It is where clinicians usually stop monitoring and start assessing.
What it does not mean is that you have generalised anxiety disorder. The GAD-7 also picks up panic disorder, social anxiety and post-traumatic stress at similar cut-points, which is useful for screening and useless for telling them apart. Those conditions need different treatment, and separating them is exactly the job of the assessment a positive screen prompts.
As with the PHQ-9, a change of about 5 points is generally taken as a meaningful shift when the same person retakes it, which is why the GAD-7 is used to track treatment as well as to start it.
How is the GAD-7 different from the PHQ-9?
They share a scale, a stem and an author group, but they measure different things and are not interchangeable. The two are frequently given together as the PHQ-4 in ultra-brief form, or as a full pair, because roughly half of people who screen positive for one also screen positive for the other.
| GAD-7 | PHQ-9 | |
|---|---|---|
| Measures | Anxiety symptoms | Depressive symptoms |
| Items | 7 | 9 |
| Score range | 0–21 | 0–27 |
| Referral cut-point | 10 | 10 |
| Self-harm item | No | Yes — item 9 |
Because the GAD-7 has no self-harm item, a high anxiety score alone tells you nothing about risk. If anxiety ever comes with thoughts of harming yourself, take the PHQ-9 as well and use the crisis resources below.
Where does the GAD-7 fall short?
- It cannot separate anxiety disorders from one another — panic, social anxiety and PTSD all raise the score.
- Physical causes mimic it. Thyroid overactivity, arrhythmias, asthma, stimulant medication, high caffeine intake and alcohol withdrawal all produce genuine anxiety symptoms.
- It measures only two weeks, so it cannot distinguish a long-standing disorder from a reaction to something that happened last Tuesday.
- It is a self-report of frequency, not of intensity or impairment — two people at 14 can be living very different lives.
None of this makes the number useless. It makes it a starting point: something concrete to hand a clinician, and something to repeat in a month to see which direction things are moving.
What should I do with my result?
- 1.Below 5: no action needed, but retake it if something changes.
- 2.5 to 9: retake in two weeks. A stable mild score and a climbing one mean different things.
- 3.10 or more: book with a primary-care clinician or a mental health professional and bring the score with you.
- 4.Any score alongside thoughts of self-harm: call or text 988 today to reach the 988 Suicide & Crisis Lifeline, or text HOME to 741741.
- 5.Check the ordinary contributors alongside: caffeine, alcohol, sleep debt, thyroid function, and any medication started recently.
Anxiety disorders are among the most treatable conditions in mental health. Cognitive behavioural therapy has strong evidence, medication has strong evidence, and the combination has strong evidence — the hard part is almost always the first appointment rather than the treatment.
Frequently asked questions
Can the GAD-7 diagnose an anxiety disorder?
No. The GAD-7 is a screening questionnaire measuring symptom frequency over two weeks. Only a qualified clinician can diagnose an anxiety disorder, after considering duration, triggers, physical health and medication. A score of 10 or more means scores in this range usually warrant assessment, not that a diagnosis exists.
What is a normal GAD-7 score?
Scores of 0 to 4 fall in the minimal band and usually need no action. Between 5 and 9 is mild and typically calls for watchful waiting with a repeat later. From 10 upward, most guidelines suggest a fuller evaluation by a clinician rather than continued monitoring alone.
Is a GAD-7 score of 15 bad?
Fifteen and above is the severe band, which means you reported a heavy symptom burden across most items. It is not a verdict on your future — severe scores respond to treatment as well as moderate ones do. It does mean prompt evaluation is worthwhile rather than watchful waiting.
Who created the GAD-7, and is it free to use?
It was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc., and published in 2006. No permission is required to reproduce, translate, display or distribute it, so clinics and researchers use it without any licensing cost.
Should I take the GAD-7 and the PHQ-9 together?
Often, yes. Anxiety and depression overlap heavily, and roughly half of people who screen positive on one also screen positive on the other. Taking both gives a clinician a fuller picture, and the PHQ-9 includes a self-harm item that the GAD-7 does not cover at all.
How often should I retake the GAD-7?
Every two to four weeks is typical when symptoms are being tracked or treatment has recently started, since the questionnaire asks about the previous two weeks. Retaking it daily mostly measures noise. A change of about 5 points is generally considered a meaningful shift.
Sources
- A brief measure for assessing generalized anxiety disorder: the GAD-7 — Spitzer RL, Kroenke K, Williams JBW, Löwe B — Archives of Internal Medicine, 2006
- Generalized Anxiety Disorder 7-item (GAD-7) scale — instrument and scoring instructions — Agency for Healthcare Research and Quality, Academy for Integrating Behavioral Health and Primary Care
- Anxiety Disorders — health topic — National Institute of Mental Health
- 988 Suicide & Crisis Lifeline — Substance Abuse and Mental Health Services Administration
- SAMHSA National Helpline — 1-800-662-HELP (4357) — Substance Abuse and Mental Health Services Administration