The GAD-7 (Generalized Anxiety Disorder-7) is a free, public-domain, 7-item self-report questionnaire that measures the severity of anxiety symptoms over the previous two weeks. Each item is rated 0 to 3 for a total of 0 to 21. Developed by Spitzer, Kroenke, Williams, and Löwe and published in 2006, it is among the most widely used brief anxiety measures in primary care and behavioral health.
How is the GAD-7 scored?
Each item is rated 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day), for the past two weeks. The seven ratings are summed for a total between 0 and 21. Like the PHQ-9, the GAD-7 closes with an unscored functional-impairment question — how difficult the symptoms have made work, home life, and relationships — that is recorded but not added to the total.
| Total score | Severity | Typical clinical response |
|---|---|---|
| 0-4 | Minimal | No further action usually indicated |
| 5-9 | Mild | Monitor; repeat at follow-up |
| 10-14 | Moderate | Further evaluation; treatment plan considered |
| 15-21 | Severe | Active treatment warranted |
What the seven items ask about
- 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 is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
Because the GAD-7 is in the public domain, these items can be reproduced and translated freely — a meaningful practical difference from licensed anxiety instruments such as the Beck Anxiety Inventory, which requires a publisher license.
Should you use a cutoff of 8 or 10?
Ten is the original cutoff. In the 2006 validation study, a score of 10 or higher gave a sensitivity of 89% and a specificity of 82% for generalized anxiety disorder. That pair of figures is quoted almost everywhere the GAD-7 is described.
Two later analyses complicate it. A 2016 systematic review and meta-analysis of 12 samples found that a cutoff of 8 performed better overall, with sensitivity of 0.83 and specificity of 0.84, and 8 is now commonly recommended for screening. The USPSTF's 2023 pooled re-analysis at a cutoff of 10 produced a lower sensitivity of 0.79 with a higher specificity of 0.89.
The trade-off is the usual one, and the confidence intervals overlap: a threshold of 8 detects more cases at the cost of more false positives, while 10 is more specific and functions better as a severity marker than as a first-pass screen. Which threshold a practice flags at is a protocol decision, and it is worth making deliberately rather than inheriting it from whichever PDF was printed first.
What the GAD-7 does not measure well
The GAD-7 was validated for generalized anxiety disorder. Kroenke and colleagues later examined its performance as a general anxiety screen and found it detects panic disorder, social anxiety disorder, and PTSD less reliably than it detects GAD. A negative GAD-7 does not rule those conditions out. Practices screening for them generally reach for instruments built for the purpose, such as the PCL-5 for PTSD.
Is the GAD-7 free to use?
Yes. Pfizer released the GAD-7 alongside the PHQ family into the public domain on July 21, 2010. No permission is required to reproduce, translate, display, or distribute it in clinical care, research, or commercial software, and no license fee applies.
Some circulating copies still print a Copyright © Pfizer Inc. line predating the release. It does not restrict use. This is a real difference from licensed alternatives: the Beck Anxiety Inventory carries publisher licensing terms and per-administration fees, while the GAD-7 carries none.
GAD-7 vs GAD-2
| Instrument | Items | Range | Positive at | Typical use |
|---|---|---|---|---|
| GAD-2 | 2 | 0-6 | 3 or higher | First-pass screen at check-in |
| GAD-7 | 7 | 0-21 | 8 or 10 or higher | Screening, severity grading, monitoring |
The GAD-2 is simply the first two GAD-7 items. A stepped workflow sends the GAD-2 to everyone and branches to the full GAD-7 when the short screen is positive. In the USPSTF's pooled analysis the two performed comparably — the GAD-2 was somewhat more sensitive at a cutoff of 3, the GAD-7 somewhat more specific at a cutoff of 10 — so choosing between them is largely a workflow question rather than an accuracy one. The GAD-7 has the advantage of producing a severity band that can be tracked over time; the GAD-2 only tells you whether to keep asking.
How often should the GAD-7 be repeated?
The two-week recall window supports re-administration every two weeks during active treatment. The published minimal clinically important difference for the GAD-7 is roughly 4 points, so shorter intervals rarely produce interpretable movement. Serial scores are what turn the GAD-7 from a screening checkbox into a treatment-response measure.
Screening guidance and where reporting stands
In June 2023 the US Preventive Services Task Force issued its first recommendation on anxiety screening in adults: Grade B for adults aged 19 to 64, including during pregnancy and postpartum, and Grade I (insufficient evidence) for adults 65 and older. A separate 2022 recommendation covers children and adolescents aged 8 to 18. Grade B brings adult anxiety screening within Affordable Care Act preventive coverage, so most commercial plans cover it without cost sharing.
Unlike depression, anxiety screening has no dedicated HEDIS measure as of 2026, and no widely reported MIPS screening measure. The screening is recommended and covered, but nothing reports it for you — the documentation burden sits entirely with the practice, which is an argument for capturing a discrete, dated score whether or not a measure currently asks for one.
Pairing the GAD-7 with the PHQ-9
Anxiety and depression co-occur often enough that the PHQ-9 and the GAD-7 are usually sent as a pair. Together they take about five minutes and cover both of the conditions the USPSTF recommends screening adults for. Sending them before the visit means the clinician opens the chart with both scores already banded, rather than spending the first minutes of the session administering questionnaires.
For context on what a normal distribution looks like, the 2019 National Health Interview Survey (NCHS Data Brief 378) placed roughly 84% of US adults in the 0-4 minimal band, with about 6% scoring 10 or higher. A practice seeing markedly higher rates is usually seeing a selected population, not a miscalibrated instrument.
How Zentake handles the GAD-7
- Auto-scoring on submit. Totals and severity bands calculated at submission, with the flag threshold set to 8 or 10 as your protocol requires.
- Bundled with the PHQ-9. Send both in one packet so both scores are in the chart before the session begins.
- Stepped GAD-2 logic. Conditional branching expands to the full seven items only when the short screen is positive.
- Trend over time. Re-send on a schedule and read the 4-point change threshold off a trend line instead of a stack of paper.
- Discrete write-back. Total, severity band, and item responses land in the chart as structured values rather than an attachment.
- HIPAA-ready. Encrypted in transit and at rest with a signed BAA on every plan. See how it fits mental health intake.
References
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24-31.
Toussaint A, Hüsing P, Gumz A, et al. Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). J Affect Disord. 2020;265:395-401.
US Preventive Services Task Force. Anxiety Disorders in Adults: Screening. June 20, 2023.
Official instrument, scoring card, and translations: phqscreeners.com.
Last updated: August 2026. This page describes how the GAD-7 is used clinically and is not medical advice.