Ask the patient: how often have they been bothered by the following over the past 2 weeks?

1. Feeling nervous, anxious, or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

4. Trouble relaxing

5. Being so restless that it's hard to sit still

6. Becoming easily annoyed or irritable

7. Feeling afraid as if something awful might happen

Ask the patient: how difficult have these problems made it to do work, take care of things at home, or get along with other people?

Optional, not included in final score but may help assess global impairment

0

Points

No anxiety disorder

Functionally, the patient does not report limitations due to their symptoms.

ADVICE

Final diagnosis should be made with clinical interview and mental status examination including assessment of patient’s level of distress and functional impairment.

MANAGEMENT

PHQ-9 Management Summary
Score Depression severity Comments
5-9 Mild Monitor
10*-14 Moderate Possible clinically significant condition
>15 Minimal or none Active treatment probably warranted

CRITICAL ACTIONS

  • This tool should be used for screening and monitoring symptom severity and cannot replace a clinical assessment and diagnosis.
  • Do not forget to rule out medical causes of anxiety before diagnosing an anxiety disorder (for example, EKG for arrhythmias, TSH for thyroid disease).

FORMULA

0-21 score, with 0-3 points for each of seven questions.

FACTS & FIGURES

For all questions, answer with one of the following:

  • Not at all = 0
  • Several days = +1
  • More than half the days = +2
  • Nearly every day = +3

The last question of the GAD-7 is a good indicator of patient's global impairment, though not included in the final calculation of points.

EVIDENCE APPRAISAL

Initially validated in 2149 patients as a diagnostic tool for GAD (cutoff score 10-> sensitivity 89%, specificity 82%, test-retest reliability with ICC=0.83) (Spitzer RL 2006), the GAD-7 was later also found to have reasonable sensitivity and specificity as a screener for panic disorder, social phobia and PTSD (cutoff score 8- sensitivity 77%, specificity 82%; cutoff score 10 - sensitivity 68% and specificity 88% for any anxiety disorder). (Kroenke K 2007)