The GAD-7 in one page: seven items to screen for generalized anxiety, scoring, the 5-10-15 cut-offs with their source, the Spanish version and citation.
Seven items to identify probable cases of generalized anxiety disorder and grade the severity of anxiety over the last two weeks. A sibling of the PHQ-9, free to use, with a validated Spanish adaptation.
By Víctor Ciudad-Fernández, PhD · Updated: October 6, 2026 · Leer esta ficha en español · Instruments
The GAD-7 was built to identify probable cases of generalized anxiety disorder in primary care and to measure anxiety severity. Its seven items are those that correlated best with the total score of an initial pool of thirteen —nine covering every DSM-IV criterion for the disorder and four drawn from existing anxiety scales— and they ask how often those problems have bothered you over the last two weeks.
With only seven items it discriminates as well as the full set of thirteen: the area under the ROC curve was .906. The two core DSM-IV criteria for the disorder are covered by the first three items, and the authors present it as a valid and efficient tool to screen for generalized anxiety and assess its severity, both in clinical practice and in research.
It shares its format with the PHQ-9 (the same four response options and time frame), so the two are easily given together. In the original study, factor analysis confirmed that GAD-7 anxiety and PHQ-8 depression are distinct dimensions even though they often co-occur, and each had its own effect on functional impairment.
Each item is scored from 0 (not at all) to 3 (nearly every day) according to frequency over the last two weeks, and the total is the sum of the seven items, from 0 to 21. There are no reverse-keyed items. As with the PHQ-9, the form ends with a question on how much these problems interfere with daily life, which is not part of the total.
In the Spanish adaptation, completing it took two and a half minutes on average, no one left items blank and floor and ceiling effects were negligible; only some very old participants needed help to fill it in.
The GAD-7 yields a single score. In the Spanish adaptation, exploratory factor analysis found one factor explaining 72% of the variance, and the confirmatory analysis gave an acceptable fit for the one-factor model (χ² = 32.59, df = 14, RMSEA = .080).
In the original validation, higher scores came with worse functioning on all six SF-20 scales and more disability days, and the self-report and interviewer-administered versions agreed (ICC = .83), which the authors call procedural validity.
The authors suggest reading 5, 10 and 15 as mild, moderate and severe anxiety, mirroring the PHQ-9 levels, and set 10 as a reasonable cut point for identifying generalized anxiety cases.
| Score | Interpretation | Source |
|---|---|---|
| 0-4 | Below the first cut point (5) | Spitzer et al. (2006) |
| 5-9 | Mild | Spitzer et al. (2006) |
| 10-14 | Moderate | Spitzer et al. (2006) |
| 15-21 | Severe | Spitzer et al. (2006) |
| ≥10 | Probable generalized anxiety disorder (89% sensitivity, 82% specificity) | Spitzer et al. (2006) |
| ≥10 | Same cut-off in the Spanish version (86.8% and 93.4%) | García-Campayo et al. (2010) |
In the original sample, 23% of primary care patients scored 10 or more. A cut-off of 15 comes closer to the actual prevalence of generalized anxiety disorder (9%), at the cost of missing half of the cases.
A screening questionnaire is not a diagnosis: a high score means a clinical assessment is warranted, not that a disorder is present.
The Spanish adaptation was produced by an expert panel through conceptual equivalence, with duplicate forward and back translations, and validated with 212 people, half of them diagnosed with generalized anxiety disorder. The cut-off of 10 also worked in Spanish, with higher specificity than in the original study (93.4%), and the scale correlated strongly with the Hamilton scale and the HADS.
The authors confirm content validity and the fit of the items to the Spanish cultural context, and note that very old people may need help to complete it.
License: Free to use. The footer of the official form says it explicitly: no permission is required to reproduce, translate, display or distribute it. It was developed by Spitzer, Williams, Kroenke and colleagues with an educational grant from Pfizer.
The official form is downloaded from the PHQ screeners website. The Spanish adaptation is open access in Health and Quality of Life Outcomes.
Cite the original paper and, if you use it, the Spanish adaptation:
@article{spitzer2006gad7,
author = {Spitzer, Robert L. and Kroenke, Kurt and Williams, Janet B. W. and Löwe, Bernd},
title = {A brief measure for assessing generalized anxiety disorder: The {GAD-7}},
journal = {Archives of Internal Medicine},
year = {2006},
volume = {166},
number = {10},
pages = {1092--1097},
doi = {10.1001/archinte.166.10.1092}
}If you want to check which GAD-7 cut-off works best in your sample against a diagnostic interview, you need the ROC curve, with the area under the curve and the sensitivity and specificity of each cut-off. The ROC curve calculator draws the curve from your scores and gives you the area under the curve and the optimal Youden cut-off.
It was designed and validated for generalized anxiety disorder. If your goal is to screen for another specific disorder (panic, social anxiety, post-traumatic stress), look for validity evidence of the GAD-7 for that disorder or use a specific instrument.
Yes, that is common: they share format and time frame. In the original study anxiety and depression emerged as distinct dimensions, so report them as two scores, not summed.
This fact sheet is an academic reference for information purposes: it does not reproduce any questionnaire item. Using the instrument in your research or practice may require citing its authors or asking for permission: see “How to get the instrument”.