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Generalized Anxiety Disorder (GAD-7)
Availability
The instrument is freely available here: Generalized Anxiety Disorder Instrument
Classification
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure for mood/anxiety.
 
Supplemental- Highly Recommended: Epilepsy in studies assessing anxiety, Headache
 
Supplemental: Mitochondrial Diseases (Mito), Spinal Cord Injury (SCI), Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post-concussion)
 
Exploratory: SCI-Pediatric (ages 12 and older, but currently there is no pediatric data), Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH), and Stroke
Short Description of Instrument
Purpose: The Generalized Anxiety Disorder (GAD-7) is a scale that can be used for assessing anxiety severity in clinical practices and in research.
 
Description: This is a brief scale with good reliability. Questions relate to the frequency of anxiety-related symptoms over the past two weeks.  
 
Time Estimates: 5-10 minutes.
 
Intended Respondent: Patient
Comments/Special Instructions
Comments: The GAD-7 is based on a large sample size, can be used in diverse clinical and research settings and it can be generalized to primary care. But it focuses only on one anxiety disorder, though many more exist, and further evaluation of the patient should be considered for diagnosis. However, the same cut-off score has been shown to be good at detecting other anxiety disorders.  
 
Increasing scores are associated with multiple domains of functional impairments, supporting its construct validity. Adult patients (n=965) recruited from 15 primary health clinics participated in a study (Spitzer et al., 2006) investigating the psychometric properties of the GAD-7. The GAD-7 demonstrated excellent internal consistency (Cronbach alpha=.92) and test-retest reliability (intraclass correlation = 0.83). Most patients diagnosed with Generalized Anxiety Disorder (GAD) (89%) were above the cut-off point of 10, and most patients without GAD (82%) were below 10. At a cut point of 10 or greater, sensitivity and specificity both exceed 0.80. Thus, a score of 10 represents a reasonable cut-off point for identifying cases of GAD, whereas the scoring ranges of 5-9, 10-14, and 15-21 could represent mild, moderate and severe GAD.  
 
NeuroRehab Specific: Applicable to the following populations spinal cord injury, stroke, and post-concussion syndrome.  
Scoring and Psychometric Properties
Scoring: 7; scoring ranging from 0-3 for each. Total Score (0-21).
 
Psychometric data in SCI populations is mostly lacking.  However, a recent study (Kisala et al., 2015) compared the GAD-7 with the SCI-QOL Anxiety and found a correlation of 0.67 and reliability of 0.85 for the GAD-7 providing some support of its use after SCI.  
 
SCI-Pediatric specific: Normative data is with the adult population.
References
Kisala PA, Tulsky DS, Kalpakjian CZ, Heinemann AW, Pohlig RT, Carle A, & Choi SW. Measuring anxiety after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Anxiety item bank and linkage with GAD-7. J Spinal Cord Med. 2015;38(3):315-325.
 
Kroenke K, Spitzer RL, Williams JB, & Lowe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345-359.
 
Schmid AA, Arnold SE, Jones VA, Ritter MJ, Sapp SA, Van Puymbroeck M. Fear of Falling in People with Chronic Stroke. Am J Occup Ther. 2015;69(2): 6903350020p1-6903350020p5.
 
Schmid AA, Yaggi HK, Burrus NB, McClain V, Austin C, Ferguson J, Fragoso C, Sico JJ, Miech EJ, Matthias MS, Williams LS, Bravata DM. Circumstances and consequences of falls among people with chronic stroke. J Rehabil Res Dev. 2013;50(9):1277-1286.
 
Spitzer RL, Kroenke K. Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
 
NeuroRehab Specific References:
King PR, Donnelly KT, Donnelly JP, Dunnam M, Warner G, Kittleson CJ, Bradshaw CB, Alt M, Meier ST. Psychometric study of the Neurobehavioral Symptom Inventory. J Rehabil Res Dev. 2012;49(6):879-88.
 
Lima CA, Oliveira RC, Oliveira SAG, Silva MASD, Lima AA, Andrade MS, Pinho CM. Quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease. Rev Bras Enferm. 2020;73 Suppl 1:e20190423. Portuguese, English. Epub 2020 Jul 10.
 
Document last updated January 2022