Anxiety Check (GAD-7)

What the GAD-7 Is

The Generalized Anxiety Disorder-7 (GAD-7) scale was developed by Robert Spitzer, Kurt Kroenke, Janet Williams, and Bernd Löwe and published in 2006. It was built and tested in 15 primary care clinics in the United States as a brief way to identify probable generalized anxiety disorder and to gauge how severe anxiety symptoms are (Spitzer et al., 2006). Like the PHQ-9, it was developed with an educational grant from Pfizer Inc. and is in the public domain (PHQ Screeners, n.d.).

What It Measures

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; and feeling afraid, as if something awful might happen (Spitzer et al., 2006). Although it was designed for generalized anxiety, the GAD-7 also performs reasonably well at flagging panic disorder, social anxiety disorder, and PTSD (Kroenke et al., 2007; PHQ Screeners, n.d.).

How the Self-Check Works

Time Frame and Response Scale

Each item asks how often you have been bothered by a problem over the last 2 weeks, using the same scale as the PHQ-9: 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day) (PHQ Screeners, n.d.). It usually takes only a couple of minutes.

Scoring and Severity Bands

The total score ranges from 0 to 21. Scores of 5, 10, and 15 mark the starting points for mild, moderate, and severe anxiety (PHQ Screeners, n.d.). That means 0–4 is minimal, 5–9 is mild, 10–14 is moderate, and 15–21 is severe. A score of 10 or higher is the recommended point for a follow-up conversation with a qualified professional (PHQ Screeners, n.d.).

What the Research Shows

In the original study, 2,740 adults completed the GAD-7, and 965 of them also had a telephone interview with a mental health professional. The scale showed good reliability and validity, and its recommended cut point identified 89% of people with generalized anxiety disorder while correctly ruling out 82% of those without it. Higher scores were strongly linked with problems in daily functioning and more disability days (Spitzer et al., 2006). A follow-up analysis of the same clinics found that the GAD-7 worked well as a screener for four common anxiety conditions, including PTSD (Kroenke et al., 2007).

In a nationally representative sample of 5,030 adults in Germany, the GAD-7 measured one consistent idea, worked the same way for men and women and across age groups, and had strong internal consistency (α = .89). Only about 5% of the general population scored 10 or higher, and about 1% scored 15 or higher (Löwe et al., 2008). A meta-analysis of 12 samples (5,223 participants) found acceptable accuracy for cutoff scores from 7 to 10 (Plummer et al., 2016).

The GAD-7 has also been studied with heroes. In help-seeking samples of first responders (N = 390) and veterans served outside the VA and Department of Defense (N = 493), the GAD-7 measured a single, consistent anxiety factor in both groups (Ahmadi, Galusha, et al., 2023; Ahmadi, Ponder, et al., 2023).

Limitations

This self-check is a screening self-check, not a diagnosis. It cannot tell the difference between types of anxiety on its own, and some items, like irritability and trouble relaxing, also appear on depression and trauma self-checks. The best cutoff can vary by setting (Plummer et al., 2016), and a high score may reflect a stressful season rather than a lasting pattern. The GAD-7 also does not ask about the causes of worry, such as a dangerous assignment, a loved one's deployment, or grief. Please discuss your results with a qualified professional, especially if your score is 10 or higher or if worry is getting in the way of sleep, work, or relationships.

How Healing the Hero Uses This Self-Check

Healing the Hero USA offers this self-check free of charge to veterans, first responders, corrections officers, Gold Star Families, Families of the Fallen, and the people who love them. It is confidential. Your answers are scored right on the page, and your results stay private unless you choose to share them with us. If you do choose to share, a Healing the Hero coach will connect with you within 24 hours to talk through what you are noticing and to help you find peer support or a qualified professional who fits your needs. You never have to explain yourself to a stranger first, and you are never obligated to take a next step you are not ready for.