[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Olfson  MFireman  BWeissman  MMLeon  ACSheehan  DVKathol  RG Mental disorders and disability among patients in a primary care group practice.  Am J Psychiatry 1997;1541734- 1740PubMedGoogle Scholar
Roy-Byrne  PPWagner  A Primary care perspectives on generalized anxiety disorder.  J Clin Psychiatry 2004;65 ((suppl 13)) 20- 26PubMedGoogle Scholar
Leon  ACOlfson  MBroadhead  WE  et al.  Prevalence of mental disorders in primary care: implications for screening.  Arch Fam Med 1995;4857- 861PubMedGoogle ScholarCrossref
Wittchen  HUZhao  SKessler  RCEaton  WW DSM-III-R generalized anxiety disorder in the National Comorbidity Survey.  Arch Gen Psychiatry 1994;51355- 364PubMedGoogle ScholarCrossref
Kessler  RCBrandenburg  NLane  M  et al.  Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication.  Psychol Med 2005;351073- 1082PubMedGoogle ScholarCrossref
Kessler  RCKeller  MBWittchen  HU The epidemiology of generalized anxiety disorder.  Psychiatr Clin North Am 2001;2419- 39PubMedGoogle ScholarCrossref
Williams  JWPignone  MRamirez  GPerez  SC Identifying depression in primary care: a literature synthesis of case-finding instruments.  Gen Hosp Psychiatry 2002;24225- 237PubMedGoogle ScholarCrossref
Löwe  BSpitzer  RLGräfe  K  et al.  Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses.  J Affect Disord 2004;78131- 140PubMedGoogle ScholarCrossref
Spitzer  RLKroenke  KWilliams  JBPatient Health Questionnaire Primary Care Study Group, Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.  JAMA 1999;2821737- 1744PubMedGoogle ScholarCrossref
Kroenke  KSpitzer  RLWilliams  JB The PHQ-9: validity of a brief depression severity measure.  J Gen Intern Med 2001;16606- 613PubMedGoogle ScholarCrossref
Löwe  BGräfe  KZipfel  SWitte  SLoerch  BHerzog  W Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire.  Psychother Psychosom 2004;73386- 390PubMedGoogle ScholarCrossref
Fricchione  G Clinical practice: generalized anxiety disorder.  N Engl J Med 2004;351675- 682PubMedGoogle ScholarCrossref
Westen  DMorrison  K A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies.  J Consult Clin Psychol 2001;69875- 899PubMedGoogle ScholarCrossref
Beck  ATEpstein  NBrown  GSteer  RA An inventory for measuring clinical anxiety: psychometric properties.  J Consult Clin Psychol 1988;56893- 897PubMedGoogle ScholarCrossref
Zimmerman  MMattia  JI A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire.  Arch Gen Psychiatry 2001;58787- 794PubMedGoogle ScholarCrossref
Derogatis  LRLipman  RSRickels  KUhlenhuth  EHCovi  L The Hopkins Symptom Checklist (HSCL): a measure of primary symptom dimensions.  Mod Probl Pharmacopsychiatry 1974;779- 110PubMedGoogle Scholar
Bjelland  IDahl  AAHaug  TTNeckelmann  D The validity of the Hospital Anxiety and Depression Scale: an updated literature review.  J Psychosom Res 2002;5269- 77PubMedGoogle ScholarCrossref
Hamilton  M The assessment of anxiety states by rating.  Br J Med Psychol 1959;3250- 55Google ScholarCrossref
Antony  MMedOrsillo  SMedRoemer  Led Practitioner's Guide to Empirically Based Measures of Anxiety.  New York, NY Kluwer Academic/Plenum Publishers2001;
Stewart  ALHays  RDWare  JE  Jr The MOS short-form general health survey: reliability and validity in a patient population.  Med Care 1988;26724- 735PubMedGoogle ScholarCrossref
Ware  JESherbourne  CD The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection.  Med Care 1992;30473- 483PubMedGoogle ScholarCrossref
Kroenke  KSpitzer  RL The PHQ-9: a new depression diagnostic and severity measure.  Psychiatr Ann 2002;91- 7Google Scholar
First  MBSpitzer  RLWilliams  JBWGibbon  M Structured Clinical Interview for DSM-IV (SCID).  Washington, DC American Psychiatric Association1995;
Pinto-Meza  ASerrano-Blanco  APenarrubia  MTBlanco  EHaro  JM Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone?  J Gen Intern Med 2005;20738- 742PubMedGoogle ScholarCrossref
Deyo  RADiehr  PPatrick  DL Reproducibility and responsiveness of health status measures: statistics and strategies for evaluation.  Control Clin Trials 1991;12142S- 158SPubMedGoogle ScholarCrossref
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). 4th ed. Washington, DC American Psychiatric Association2000;
Kazis  LEAnderson  JJMeenan  RF Effect sizes for interpreting changes in health status.  Med Care 1989;27S178- S189PubMedGoogle ScholarCrossref
Carter  RMWittchen  HUPfister  HKessler  RC One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample.  Depress Anxiety 2001;1378- 88PubMedGoogle ScholarCrossref
Clark  DASteer  RABeck  AT Common and specific dimensions of self-reported anxiety and depression: implications for the cognitive and tripartite models.  J Abnorm Psychol 1994;103645- 654PubMedGoogle ScholarCrossref
Löwe  BUnützer  JCallahan  CMPerkins  AJKroenke  K Monitoring depression treatment outcomes with the Patient Health Questionnaire-9.  Med Care 2004;421194- 1201PubMedGoogle ScholarCrossref
Löwe  BKroenke  KGräfe  K Detecting and monitoring depression with a 2-item questionnaire (PHQ-2).  J Psychosom Res 2005;58163- 171PubMedGoogle ScholarCrossref
Klinkman  MS Competing demands in psychosocial care: a model for the identification and treatment of depressive disorders in primary care.  Gen Hosp Psychiatry 1997;1998- 111PubMedGoogle ScholarCrossref
Original Investigation
May 22, 2006

A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7

Author Affiliations

Author Affiliations: Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Drs Spitzer and Williams); Regenstrief Institute for Health Care and Department of Medicine, Indiana University, Indianapolis (Dr Kroenke); and Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany (Dr Löwe).

Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092

Background  Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.

Methods  A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.

Results  A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.

Conclusion  The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.