GAD-7
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date of birth
Over the last two weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge
*
Not at all
Several days
More than half the days
Nearly every day
2. Not being able to stop or control worrying
*
Not at all
Several days
More than half the days
Nearly every day
3. Worrying too much about different things
*
Not at all
Several days
More than half the days
Nearly every day
4. Trouble relaxing
*
Not at all
Several days
More than half the days
Nearly every day
5. Being so restless that it is hard to sit still
*
Not at all
Several days
More than half the days
Nearly every day
6. Becoming easily annoyed or irritable
*
Not at all
Several days
More than half the days
Nearly every day
7. Feeling afraid, as if something awful might happen
*
Not at all
Several days
More than half the days
Nearly every day
Total score:
If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Source:
Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr. Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.Reproduced with permission
Scoring GAD-7 Anxiety Severity
This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.” GAD-7 total score for the seven items ranges from 0 to 4: minimal anxiety, 5–9: mild anxiety, 10–14: moderate anxiety, 15–21: severe anxiety.
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