The GAD-7 Anxiety Questionnaire: Scoring and What Your Score Means

The GAD-7 is a seven-question anxiety questionnaire. For each symptom you mark how often it has bothered you over the last two weeks, scored 0 (“not at all”) to 3 (“nearly every day”), then add them up. Totals run from 0 to 21: 0–4 minimal, 5–9 mild, 10–14 moderate and 15–21 severe. A score of 10 or more is the commonly recommended point for a fuller evaluation. The GAD-7 measures how loud anxiety is right now. It does not name the type of anxiety or its cause. Here are the seven questions, how to read a score, and the gaps worth knowing about.

Where the GAD-7 came from

The GAD-7 comes from the same team that created the PHQ-9: Robert Spitzer, Kurt Kroenke, Janet Williams and Bernd Löwe. They published it in the Archives of Internal Medicine in 2006. Its name stands for Generalized Anxiety Disorder 7-item scale, because its first job was to pick out generalized anxiety disorder, the condition of persistent, hard-to-control worry about many things.

The team tested it in 15 primary care clinics across the United States. Of 2,740 adults who filled it out, 965 also had a phone interview with a mental health professional who did not see their answers. At the best cut point it found 89% of people with generalized anxiety disorder and correctly cleared 82% of those without it. Anxiety and depression symptoms often appeared together in that study, but statistically they behaved as two distinct dimensions, each adding its own share of disability. That is why the two questionnaires are usually given as a pair.

Like the PHQ-9, it is free. The official PHQ Screeners site says no permission is needed to reproduce, translate, display or distribute the GAD-7.

The seven questions

Like the PHQ-9, the GAD-7 asks how often each problem has bothered you over the last two weeks, with the same four answer choices.

Scoring is 0 for “not at all”, 1 for “several days”, 2 for “more than half the days” and 3 for “nearly every day”. Some versions add the same difficulty question as the PHQ-9 (how hard these problems have made work, home life and relationships). As with the PHQ-9, it is not part of the total but helps a clinician judge impact.

The first two items on their own make up the GAD-2, an ultra-short screener scored 0 to 6. A GAD-2 of 3 or more is the signal to complete the full GAD-7 and talk with a clinician.

Scoring and what the ranges mean

Add the seven numbers. An illustrative example (not a real patient): nervous 2, can’t stop worrying 3, worrying about many things 3, trouble relaxing 2, restless 1, irritable 2, dread 1. The total is 14, the top of the moderate range.

The 5, 10 and 15 cutpoints and the advice that 10 or more warrants further evaluation both come from the PHQ and GAD-7 instruction manual. In the 2006 study, higher totals went along with worse functioning across all six areas of a standard health survey and with more days lost to disability, so the number reflects real-world impact, not just discomfort.

Clinicians also look at which items carry the score. Points concentrated in items 2 and 3 (worry that won’t stop, about many things) look like generalized anxiety. Points mostly in restlessness and irritability, with little worry, raise other questions, covered below.

What the GAD-7 picks up beyond generalized anxiety

Although it was designed around one diagnosis, the GAD-7 turned out to be broader. A 2007 follow-up in the same primary care sample found that nearly one in five patients had at least one anxiety disorder, that 41% of them were getting no treatment, and that the GAD-7 and its two-item version performed well as screeners for four conditions:

• generalized anxiety disorder
• panic disorder (sudden surges of intense fear with physical symptoms; see treatment for panic attacks)
• social anxiety disorder (fear of being judged or embarrassed)
• post-traumatic stress disorder (see our PTSD page)

The instruction manual describes this as “moderately good” performance for panic, social anxiety and PTSD. So a high GAD-7 is a reason to ask which kind of anxiety is present, not proof of generalized anxiety disorder in particular.

What it misses, and what can push it up

Questions it never asks

• Obsessions and compulsions. There is no item on intrusive unwanted thoughts or rituals, and OCD was not among the conditions the 2007 study tested. Someone with significant OCD can score modestly.
• Panic attacks themselves, avoidance and specific fears. The items ask about tension and worry, not about attacks, avoided places or phobias, so a person whose life has shrunk around avoidance may not score as high as their impairment suggests.
• Physical anxiety. Racing heart, stomach upset and shortness of breath are not asked about directly. Our page on physical symptoms of anxiety covers them.
• Trauma history and flashbacks. The GAD-7 may flag PTSD, but it can’t describe it.

Things that raise the score without an anxiety disorder

• An overactive thyroid, heart rhythm problems and other medical conditions; see conditions that mimic mental illness.
• Caffeine, nicotine, alcohol withdrawal, cannabis and some prescription and over-the-counter medicines.
• Depression, which often comes with worry and irritability. That is why the GAD-7 and PHQ-9 are usually read together.
• ADHD, where restlessness (item 5) and irritability (item 6) can reflect attention and impulsivity rather than fear. The ASRS asks about that side.
• A genuinely stressful fortnight. The questionnaire can’t tell a reasonable reaction to a layoff or a sick parent from a disorder; the history can.

Teens and the GAD-7

Creyos labels its GAD-7 for ages 12 and up. Research in teenagers is thinner than in adults. In one small study of 40 adolescents with generalized anxiety disorder, scores of 11 and 17 best marked moderate and severe anxiety, a little higher than the adult cutpoints. For parents, the practical point is the same as for adults: a high score is a reason to talk with your teen and arrange an evaluation, and normal teenage worry can look different from an anxiety disorder. Our guide to teen anxiety versus normal worry walks through the difference.

Where the GAD-7 shows up, and what to do with yours

You will usually meet the GAD-7 next to the PHQ-9: on a primary care intake form, in a portal before a telehealth visit, or in a computerized assessment. Creyos lists the GAD-7 among the standardized questionnaires clinicians can send with its cognitive tasks; our overview of Creyos questionnaires covers the full set, and the Creyos cognitive assessment guide explains how the tasks differ from questionnaires.

If you are using the GAD-7 to see whether treatment is helping, the rules for repeating it are explained in how to tell whether your psychiatric medication is working and in our page on measurement-based psychiatric care. For whether a single score is enough to act on, see online mental health quizzes versus a real diagnosis.

If your score is 10 or more, or anxiety is shaping your days whatever the number, the next step is an evaluation. At Willow & Stone, Dr. Stacey Forbes, PMHNP-BC, starts with a 90-minute integrative psychiatric evaluation that looks at sleep, caffeine, hormones and medical history alongside the anxiety itself. Read about the practice’s approach to anxiety and integrative psychiatry for anxiety, or book a consultation.

Common Questions

Sources & Further Reading

• Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006 (PubMed)
• Kroenke K et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med, 2007 (PubMed)
• PHQ Screeners — official GAD-7 download, licensing and instruction manual
• Mossman SA et al. The GAD-7 in adolescents with generalized anxiety disorder. Ann Clin Psychiatry, 2017 (PMC)
• Creyos — Standardized Questionnaires list (PDF)

This article is general education, not a diagnosis or advice for your situation. Creyos results support, and never replace, a clinical evaluation; only a clinician who has evaluated you can diagnose a condition or recommend treatment. Do not start, stop, or change a medication without talking to the clinician who prescribes it.