Overview of the GAD-7AdministeringandScoringCourse Contributor
Resources
References
OverviewoftheGAD-7
WhatistheGAD-7?
GeneralAnxietyDisorder-7®andGAD-7®areregisteredtrademarksofPfizer,Inc(Spitzeretal., 2006). Pfizer is neither affiliated with nor endorses this course.
TheGeneralizedAnxietyDisorder-7(GAD-7)isabriefscreeninginstrumentdesignedtoidentify the presence of seven common symptoms of generalized anxiety disorder (GAD). It also has a moderate degree of sensitivity for detecting:
- Panicdisorder
- Socialanxietydisorder
- Posttraumaticstressdisorder
TheGAD-7ismoreeffectiveasascreeningforGAD. Apositiveresult ontheGAD-7suggests “probable” cases of GAD that should be further assessed. It is not meant to replace a clinical interview by a licensed mental health provider.
WhyDoWeNeedtheGAD-7?
GADhasthelowestdiagnosticreliabilityamongtheanxietydisorders(Johnsonetal.,2019).It is often missed by clinicians despite it being one of the most common psychiatric disorders in the general population. These findings highlight the need for reliable and effective screening measures that can help clinicians recognize GAD in their clients.
UsefulnessoftheTool
Althoughdevelopedandinitiallyvalidatedwithaprimarycarepatientsample,theGAD-7has since been studied and validated for use with many clinical populations, including:
- Acutepsychiatrysettings
- Pregnantandperinatalwomen
- Peoplewithepilepsy
- Peoplesufferingfrommigraines
- Peoplewithmultiplesclerosis
- Peoplediagnosedwithsubstanceusedisorders
ManytranslationsoftheGAD-7havebeendevelopedandareaccessibleonthePHQScreener website. A link to the website can be found in the Resources section of this course.
ResearchexaminingthereliabilityandvalidityoftheGAD-7showsthat ithasgood(Johnsonet al., 2019; Toussaint et al., 2020):
- Internalconsistency
- Test-retestreliability
- Constructvalidity
- Convergentvalidity
- Sensitivitytominimalclinicalchangeovertime
AreviewoftheresearchrecommendedthattheGAD-7isalsoeffectiveinidentifyinganxiety disorders after traumatic brain injury (Sapra et al., 2020; Zachar-Tirado & Donders, 2021).
AdministeringandGAD-7 Scoring
AdministeringtheGAD-7
Theinstrumenttakes5to10minutestoadministerandisdesignedtobeself-administered, with the client completing the items themselves. Non-clinicians can also administer it. This is a plus for busy clinicians. The person rates how much they have been bothered by the symptom over the past 2-week period, using the following scale:
ScoreMeaning
- Notatall
- Severaldays
- Morethanhalfofthedays
- Nearlyevery day
Althoughtheinstrumentusesatimeframeof2weeks,validitystudiesshowthatmostpeople who score high on the GAD-7 have chronic symptoms (Johnson et al., 2019).
ToadministertheGAD-7,youhaveseveralconvenientoptionsavailable:
- Download and print a copy.You can get the instrument at no cost in the person’s chosen language and have them circle their responses directly onto the form. One benefitofthisapproachisthatyoucankeepacopyofthecompletedscreenerforthe person’s clinical record. A link to the PDF is in the Resource section of this course.
- Access the screener.The screener is available on the PHQ website,www.phqscreeners.com. Again, you can select the language preferred by the person. Scorescannotbeentereddirectlyintothewebsiteusingthismethod,butyoucaneasily calculate their score and record it in the person’s record.
- Downloadoneofthefreeapps.Yourclient cansearch“GAD-7”onGooglePlayorthe App Store on asmartphone or other device. The client can enter scores directly intothe app, which calculates their total score. Some of these apps also allow clients to email a copy of the report, for example, to the prescribing provider, other members of the care team, or to themselves so that you can file it in their record. Some of the apps track the scores over time, which may be useful for treatment planning purposes.
ScoringtheGAD-7
To score the GAD-7, simply add the values for each column, and then add each of those subtotalstoarriveat atotalscore.Theinstrumentyieldsatotalscorerangeof0to21. Scores correspond to the following severity levels:
- 5=Mildsymptoms
- 10=Moderatesymptoms,considereda“yellowflag”suggestingapossiblysignificant issuewithanxiety
- 15=Severesymptoms,considereda“redflag”indicatingthattreatmentforanxietyis warranted
Onlytrainedcliniciansshouldinterpret aperson’sscore.Ascoreof10istypicallyrecommended asthecutoffforfurtherevaluationofsymptoms.Scoreshigherthan10areoftenassociatedwith greater levels of functional impairment. Recent research suggests even lower cutoff scores ranging from 7 to 10 may accurately identify those with GAD (Byrd-Bredbenner et al., 2021; Plummer et al., 2016).
AGuidetoAssessmentandTreatment
If thepersonratesany items as problematic(i.e., arating other than0), one additional question isasked:“Howdifficulthavetheseproblemsmadeitforyoutodoyourwork,takecareofthings at home, or get along with other people?” This question is not used to compute the final score, but it does offer qualitative information about:
- Thedegreeofaperson’simpairment
- Treatmentdecisions
GAD-7and Culture
When evaluating diverse populations, the impact of culture on the structure of the GAD-7 and how participants respond must be considered. Recent research studies have shown that the various adaptations of the GAD-7 for different cultures and languages are reliable and valid. Studiesincludedadolescentsandadultsincountriessuchas(Adjorlolo,2019;Ahnetal.,2019; Dhira et al., 2021; Budikayanti et al., 2019; Gong et al., 2021):
- Bangladesh
- Korea
- China
- Indonesia
- Ghana
Additional Information
CourseContributor
ThecontentforthiscoursewasrevisedbyAmandaL.Gayle,Ph.D.
AmandaGaylereceivedherPh.D.inCounselingPsychologyfromtheUniversityofTennessee. She completed a pre-doctoral internship at the University of Georgia in the Counseling and Testing Center. She also completed a post-doctoral fellowship at Duke University Medical Center in the Occupational Health Department working in both the internal and external employee assistance programs. She is licensed in North Carolina where she was in private practice for 15 years serving primarily adults in individual and couples counseling with many presenting issues. Her focus was on cognitive behavioral therapy to treat anxiety, mood disorders, grief, relationship difficulties, stress management, self-esteem, and parenting. She joined Relias as a subject matter expert writer for behavioral health in 2021.
Acknowledgment:MoniqueKahn,Psy.D.wasthepreviousauthorofthiseducationalactivity but did not participate in the revision of the current version of this course.
Resources
TranslationsofGAD-7canbefoundhere: https://www.phqscreeners.com/
PDFversionofGAD-7
https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf
References
- Adjorlolo,S.(2019).GeneralisedanxietydisorderinadolescentsinGhana:Examinationofthe psychometric properties of the Generalised Anxiety Disorder-7 scale. African Journal of Psychological Assessment, 1(1).
- Ahn,J.K.,Kim,Y.,&Choi,K.H.(2019).Thepsychometricpropertiesandclinicalutilityofthe Korean version of GAD-7 and GAD-2. Frontiers in psychiatry, 10, 127.
- Budikayanti, A., Larasari, A., Malik, K., Syeban, Z., Indrawati, L. A., & Octaviana, F. (2019). Screeningofgeneralizedanxietydisorderinpatientswithepilepsy:Usingavalidandreliable Indonesian version of generalized anxiety disorder-7 (GAD-7). Neurology research international, 2019.
- Byrd-Bredbenner,C.,Eck,K.,&Quick,V.(2021).GAD-7,GAD-2,andGAD-mini:Psychometric properties and norms of university students in the United States. General hospital psychiatry,69,61-66.
- Dhira,T. A., Rahman,M.A.,Sarker,A.R., &Mehareen,J.(2021).Validityandreliabilityofthe Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh. PloSone,16(12),e0261590.
- Gong,Y.,Zhou,H.,Zhang,Y.,Zhu,X.,Wang,X.,Shen,B.,...&Ding,Y.(2021).Validation of the 7-itemGeneralized Anxiety Disorder scale (GAD-7) asascreeningtool for anxiety among pregnant Chinese women. Journal of affective disorders, 282, 98-103.
- Johnson,S.U.,Ulvenes,P.G.,Øktedalen,T.,&Hoffart,A.(2019).Psychometricpropertiesof the general anxiety disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample.Frontiersinpsychology,10,1713.
- Plummer,F.,Manea,L.,Trepel,D.,&McMillan,D.(2016).Screeningforanxietydisorderswith the GAD-7 and GAD-2: a systematic review and diagnostic meta-analysis. General Hospital Psychiatry, 39: 24-31.
- Sapra,A.,Bhandari,P.,Sharma,S.,Chanpura,T.,&Lopp,L.(2020).Usinggeneralizedanxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus, 12(5).
- Spitzer,R.L.,Kroenke, K.,Williams,J.B.W.,&Lowe, B.(2006).Abriefmeasureforassessing generalized anxiety disorder - The GAD-7. Archives of Internal Medicine.166:1092-1097.
- Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item GeneralizedAnxietyDisorderQuestionnaire(GAD-7).Journalofaffectivedisorders,265,395- 401.
- Zachar-Tirado,C.N.,&Donders,J.(2021).ClinicalutilityoftheGAD-7inidentifyinganxiety disorders after traumatic brain injury. Brain injury, 35(6), 655-660.
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