Generalized Anxiety Disorder 7: Difference between revisions
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GAD-7 has seven items, which measure severity of various signs of GAD according to reported response categories with assigned points.<ref name="Lowe" /> The GAD-7 items include: 1) nervousness; 2) inability to stop worrying; 3) excessive worry; 4) restlessness; 5) difficulty in relaxing; 6) easy irritation; and 7) fear of something awful happening.<ref>{{cite journal | vauthors = Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA | title = Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women | journal = PLOS ONE | volume = 10 | issue = 4 | pages = e0125096 | date = 2015-04-27 | pmid = 25915929 | pmc = 4411061 | doi = 10.1371/journal.pone.0125096 | bibcode = 2015PLoSO..1025096Z | doi-access = free }}</ref> Assessment is indicated by the total score, which is made up by adding together the scores for the scale of all seven items.<ref>{{cite journal | vauthors = Swinson RP | title = The GAD-7 scale was accurate for diagnosing generalised anxiety disorder | journal = Evidence-Based Medicine | volume = 11 | issue = 6 | pages = 184 | date = December 2006 | pmid = 17213178 | doi = 10.1136/ebm.11.6.184 | s2cid = 42283551 | url = https://ebm.bmj.com/content/11/6/184 | url-access = subscription }}</ref> The GAD-7 was originally validated in a primary care sample and a cutoff score of 10 (which the authors considered optimal) had a sensitivity value of 0.89 and a specificity value of 0.82 for identifying GAD. The authors of the questionnaire also found acceptable sensitivity and specificity values when the questionnaire was used as a general screen to identify other anxiety disorders (Panic Disorder, Social Anxiety, and PTSD) (GAD-7, score ≥ 8: sensitivity: 0.77, specificity: 0.82).<ref>{{cite journal | vauthors = Plummer F, Manea L, Trepel D, McMillan D | title = Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis | journal = General Hospital Psychiatry | volume = 39 | pages = 24–31 | date = 2016-03-01 | pmid = 26719105 | doi = 10.1016/j.genhosppsych.2015.11.005 | url = http://www.sciencedirect.com/science/article/pii/S0163834315002406 }}</ref> |
GAD-7 has seven items, which measure severity of various signs of GAD according to reported response categories with assigned points.<ref name="Lowe" /> The GAD-7 items include: 1) nervousness; 2) inability to stop worrying; 3) excessive worry; 4) restlessness; 5) difficulty in relaxing; 6) easy irritation; and 7) fear of something awful happening.<ref>{{cite journal | vauthors = Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA | title = Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women | journal = PLOS ONE | volume = 10 | issue = 4 | pages = e0125096 | date = 2015-04-27 | pmid = 25915929 | pmc = 4411061 | doi = 10.1371/journal.pone.0125096 | bibcode = 2015PLoSO..1025096Z | doi-access = free }}</ref> Assessment is indicated by the total score, which is made up by adding together the scores for the scale of all seven items.<ref>{{cite journal | vauthors = Swinson RP | title = The GAD-7 scale was accurate for diagnosing generalised anxiety disorder | journal = Evidence-Based Medicine | volume = 11 | issue = 6 | pages = 184 | date = December 2006 | pmid = 17213178 | doi = 10.1136/ebm.11.6.184 | s2cid = 42283551 | url = https://ebm.bmj.com/content/11/6/184 | url-access = subscription }}</ref> The GAD-7 was originally validated in a primary care sample and a cutoff score of 10 (which the authors considered optimal) had a sensitivity value of 0.89 and a specificity value of 0.82 for identifying GAD. The authors of the questionnaire also found acceptable sensitivity and specificity values when the questionnaire was used as a general screen to identify other anxiety disorders (Panic Disorder, Social Anxiety, and PTSD) (GAD-7, score ≥ 8: sensitivity: 0.77, specificity: 0.82).<ref>{{cite journal | vauthors = Plummer F, Manea L, Trepel D, McMillan D | title = Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis | journal = General Hospital Psychiatry | volume = 39 | pages = 24–31 | date = 2016-03-01 | pmid = 26719105 | doi = 10.1016/j.genhosppsych.2015.11.005 | url = http://www.sciencedirect.com/science/article/pii/S0163834315002406 }}</ref> |
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GAD-7 is a sensitive self-administrated test to assess generalized anxiety disorder,<ref>{{cite journal | vauthors = Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B | title = Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection | journal = Annals of Internal Medicine | volume = 146 | issue = 5 | pages = 317–25 | date = March 2007 | pmid = 17339617 | doi = 10.7326/0003-4819-146-5-200703060-00004 | hdl-access = free | hdl = 2027.42/151274 | s2cid = 28019277 }}</ref> normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.<ref name=Lowe>{{cite journal | vauthors = Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY | title = Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population | journal = Medical Care | volume = 46 | issue = 3 | pages = 266–74 | date = March 2008 | pmid = 18388841 | doi = 10.1097/mlr.0b013e318160d093 | s2cid = 16052239 }}</ref> The normative data enable users of the GAD-7 to discern whether an individual's anxiety score is normal, or mildly, moderately, or severely elevated.<ref>{{cite journal | vauthors = Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY | title = Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population | journal = Medical Care | volume = 46 | issue = 3 | pages = 266–74 | date = March 2008 | pmid = 18388841 | doi = 10.1097/MLR.0b013e318160d093 | jstor = 40221654 | s2cid = 16052239 }}</ref> However, it cannot be used as replacement for [[Psychological evaluation|clinical assessment]] and additional evaluation should be used to confirm a [[diagnosis]] of GAD.{{ |
GAD-7 is a sensitive self-administrated test to assess generalized anxiety disorder,<ref>{{cite journal | vauthors = Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B | title = Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection | journal = Annals of Internal Medicine | volume = 146 | issue = 5 | pages = 317–25 | date = March 2007 | pmid = 17339617 | doi = 10.7326/0003-4819-146-5-200703060-00004 | hdl-access = free | hdl = 2027.42/151274 | s2cid = 28019277 }}</ref> normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.<ref name=Lowe>{{cite journal | vauthors = Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY | title = Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population | journal = Medical Care | volume = 46 | issue = 3 | pages = 266–74 | date = March 2008 | pmid = 18388841 | doi = 10.1097/mlr.0b013e318160d093 | s2cid = 16052239 }}</ref> The normative data enable users of the GAD-7 to discern whether an individual's anxiety score is normal, or mildly, moderately, or severely elevated.<ref>{{cite journal | vauthors = Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY | title = Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population | journal = Medical Care | volume = 46 | issue = 3 | pages = 266–74 | date = March 2008 | pmid = 18388841 | doi = 10.1097/MLR.0b013e318160d093 | jstor = 40221654 | s2cid = 16052239 }}</ref> However, it cannot be used as replacement for [[Psychological evaluation|clinical assessment]] and additional evaluation should be used to confirm a [[diagnosis]] of GAD.<ref>{{Citation |last=Dugas |first=Michel J. |title=Generalized Anxiety Disorder (2nd ed.) |date=2018 |url=http://dx.doi.org/10.1093/med-psych/9780190492243.003.0014 |work=A Guide to Assessments That Work |pages=293–310 |publisher=Oxford University Press |access-date=2022-11-30 |last2=Charette |first2=Catherine A. |last3=Gervais |first3=Nicole J.}}</ref> |
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The scale |
The scale score adds each of the 7 items, with responses getting 0 to 3 points. An additional question at the end asks for a global rating of the severity of the patient's anxiety over the past 2 weeks.<ref name= Lowe /> |
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*Not at all (0 points) |
*Not at all (0 points) |
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== Reliability and validity == |
== Reliability and validity == |
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The GAD-7 |
The GAD-7 has shown adequate internal consistency reliability and validity for assessing anxiety across a wide range of samples and settings. It has been used in more than 2500 peer reviewed publications indexed in PubMed (current search [https://pubmed.ncbi.nlm.nih.gov/?term=%28%22anxiety%22%5BMeSH+Terms%5D+OR+%22anxiety%22%5BAll+Fields%5D+OR+%22anxieties%22%5BAll+Fields%5D+OR+%22anxiety+s%22%5BAll+Fields%5D%29+AND+%22gad7%22%5BAll+Fields%5D&sort= here]). The consensus is that it can efficient tool for screening for GAD and assessing its severity in clinical practice and research.<ref>{{cite journal | vauthors = Spitzer RL, Kroenke K, Williams JB, Löwe B | title = A brief measure for assessing generalized anxiety disorder: the GAD-7 | journal = Archives of Internal Medicine | volume = 166 | issue = 10 | pages = 1092–7 | date = May 2006 | pmid = 16717171 | doi = 10.1001/archinte.166.10.1092 | doi-access = free }}</ref> |
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== See also == |
== See also == |
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Revision as of 22:30, 30 November 2022
| Generalized Anxiety Disorder 7 item | |
|---|---|
| Synonyms | GAD-7 |
| LOINC | 69737-5 |
Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD).[1] GAD-7 has seven items, which measure severity of various signs of GAD according to reported response categories with assigned points.[2] The GAD-7 items include: 1) nervousness; 2) inability to stop worrying; 3) excessive worry; 4) restlessness; 5) difficulty in relaxing; 6) easy irritation; and 7) fear of something awful happening.[3] Assessment is indicated by the total score, which is made up by adding together the scores for the scale of all seven items.[4] The GAD-7 was originally validated in a primary care sample and a cutoff score of 10 (which the authors considered optimal) had a sensitivity value of 0.89 and a specificity value of 0.82 for identifying GAD. The authors of the questionnaire also found acceptable sensitivity and specificity values when the questionnaire was used as a general screen to identify other anxiety disorders (Panic Disorder, Social Anxiety, and PTSD) (GAD-7, score ≥ 8: sensitivity: 0.77, specificity: 0.82).[5]
GAD-7 is a sensitive self-administrated test to assess generalized anxiety disorder,[6] normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.[2] The normative data enable users of the GAD-7 to discern whether an individual's anxiety score is normal, or mildly, moderately, or severely elevated.[7] However, it cannot be used as replacement for clinical assessment and additional evaluation should be used to confirm a diagnosis of GAD.[8]
The scale score adds each of the 7 items, with responses getting 0 to 3 points. An additional question at the end asks for a global rating of the severity of the patient's anxiety over the past 2 weeks.[2]
- Not at all (0 points)
- Several days (1 point)
- More than half the days (2 points)
- Nearly every day (3 points)
| Score | Risk Level | Suggested Intervention |
|---|---|---|
| 0-4 | No to Low risk | None |
| 5-9 | Mild | Repeat on follow-up |
| 10-14 | Moderate | Further evaluation required. Consider adjusting treatment plan. |
| 15+ | Severe | Adjust treatment plan. Higher level of care needed. Pharmacology re-evaluation. |
Reliability and validity
The GAD-7 has shown adequate internal consistency reliability and validity for assessing anxiety across a wide range of samples and settings. It has been used in more than 2500 peer reviewed publications indexed in PubMed (current search here). The consensus is that it can efficient tool for screening for GAD and assessing its severity in clinical practice and research.[9]
See also
References
- ^ Spitzer RL, Kroenke K, Williams JB, Löwe B (May 2006). "A brief measure for assessing generalized anxiety disorder: the GAD-7". Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
- ^ a b c Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY (March 2008). "Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population". Medical Care. 46 (3): 266–74. doi:10.1097/mlr.0b013e318160d093. PMID 18388841. S2CID 16052239.
- ^ Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, Williams MA (2015-04-27). "Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women". PLOS ONE. 10 (4): e0125096. Bibcode:2015PLoSO..1025096Z. doi:10.1371/journal.pone.0125096. PMC 4411061. PMID 25915929.
- ^ Swinson RP (December 2006). "The GAD-7 scale was accurate for diagnosing generalised anxiety disorder". Evidence-Based Medicine. 11 (6): 184. doi:10.1136/ebm.11.6.184. PMID 17213178. S2CID 42283551.
- ^ Plummer F, Manea L, Trepel D, McMillan D (2016-03-01). "Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis". General Hospital Psychiatry. 39: 24–31. doi:10.1016/j.genhosppsych.2015.11.005. PMID 26719105.
- ^ Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B (March 2007). "Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection". Annals of Internal Medicine. 146 (5): 317–25. doi:10.7326/0003-4819-146-5-200703060-00004. hdl:2027.42/151274. PMID 17339617. S2CID 28019277.
- ^ Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY (March 2008). "Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population". Medical Care. 46 (3): 266–74. doi:10.1097/MLR.0b013e318160d093. JSTOR 40221654. PMID 18388841. S2CID 16052239.
- ^ Dugas, Michel J.; Charette, Catherine A.; Gervais, Nicole J. (2018), "Generalized Anxiety Disorder (2nd ed.)", A Guide to Assessments That Work, Oxford University Press, pp. 293–310, retrieved 2022-11-30
- ^ Spitzer RL, Kroenke K, Williams JB, Löwe B (May 2006). "A brief measure for assessing generalized anxiety disorder: the GAD-7". Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
External links
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