Use when screening for anxiety symptoms (excessive worry, restlessness, difficulty concentrating, muscle tension, panic attacks), differentiating anxiety disorders, assessing treatment response, or patient reports overwhelming fear or avoidance behaviors. Provides GAD-7 (comprehensive) and GAD-2 (brief) assessments.
This skill helps administer and interpret validated anxiety screening instruments. The GAD-2 serves as a brief initial screener, while the GAD-7 provides comprehensive assessment of generalized anxiety severity.
Clinical Context: These tools help quantify anxiety symptoms, track treatment response, and support clinical decision-making. The GAD-7 also screens reasonably well for panic disorder, social anxiety, and PTSD. These are support tools that supplement, not replace, comprehensive clinical evaluation.
| Assessment | Items | Time | Purpose | Cutoff | When to Use |
|---|---|---|---|---|---|
| GAD-2 | 2 | <1 min | Brief screening | ≥3 → Full GAD-7 | Time-limited settings, universal screening |
| GAD-7 | 7 |
| 2-3 min |
| Severity assessment |
| ≥10 = Moderate+ |
| Comprehensive assessment, treatment monitoring |
For detailed comparison: See references/screening-comparison.md
| Score | Severity | First-Line Treatment | Follow-up |
|---|---|---|---|
| 0-4 | Minimal | Monitor, psychoeducation | Annual or as needed |
| 5-9 | Mild | Relaxation/stress management | 2-4 weeks |
| 10-14 | Moderate | Therapy or medication | 2-4 weeks |
| 15-21 | Severe | Combination therapy, specialty referral | 1-2 weeks |
For detailed severity interpretations: See references/severity-levels.md
For treatment recommendations: See references/clinical-decision-trees.md
Use this mode when the clinician says "start" or "administer" the GAD-2/GAD-7.
Complete assessment with items, scoring, and documentation: → assets/gad-7.md
Key Facts:
Complete assessment with items, scoring, and documentation: → assets/gad-2.md
Key Facts:
When to use GAD-2 vs GAD-7: See references/screening-comparison.md
digraph assessment_selection {
rankdir=LR;
node [shape=box, style=rounded];
start [label="Patient\nPresentation", shape=ellipse];
time_check [label="Time-limited\nencounter?", shape=diamond];
purpose_check [label="Treatment\nmonitoring?", shape=diamond];
gad2 [label="Start with\nGAD-2", style="filled", fillcolor=lightblue];
gad2_score [label="GAD-2\nscore ≥3?", shape=diamond];
gad7 [label="Administer\nGAD-7", style="filled", fillcolor=lightgreen];
monitor [label="Negative\nscreen", style="filled", fillcolor=gray90];
start -> time_check;
time_check -> gad2 [label="yes\n(primary care,\nER)"];
time_check -> purpose_check [label="no"];
purpose_check -> gad7 [label="yes"];
purpose_check -> gad7 [label="no\n(suspected\nanxiety)"];
gad2 -> gad2_score;
gad2_score -> gad7 [label="yes"];
gad2_score -> monitor [label="no"];
}
GAD-2: assets/gad-2.md - 2 items, <1 minute GAD-7: assets/gad-7.md - 7 items, 2-3 minutes
Scoring:
Interpretation:
Follow clinical decision trees: references/clinical-decision-trees.md
General pathways:
Use documentation templates in:
Documentation standards: ../../docs/references/documentation-standards.md
Use GAD-7 to track progress:
Do NOT use GAD-2 for treatment monitoring - insufficient detail
Important: Unlike PHQ-9, GAD-7 has no safety item
When to assess suicidal ideation:
How to assess:
Always assess:
Crisis Resources:
Universal crisis protocols: ../../docs/references/crisis-protocols.md
digraph differential_diagnosis {
rankdir=TB;
node [shape=box, style=rounded];
high_gad7 [label="GAD-7 ≥10", shape=ellipse, style="filled", fillcolor=yellow];
assess_type [label="Assess Anxiety\nPresentation", style="filled", fillcolor=lightblue];
chronic_worry [label="Chronic worry\nabout multiple\nthings?", shape=diamond];
panic_attacks [label="Recurrent panic\nattacks?", shape=diamond];
social_fears [label="Fear of social\nsituations?", shape=diamond];
trauma_hx [label="Trauma\nhistory?", shape=diamond];
gad [label="Likely GAD\n(Generalized\nAnxiety)", style="filled", fillcolor=lightgreen];
panic [label="Likely\nPanic Disorder", style="filled", fillcolor=lightgreen];
social [label="Likely Social\nAnxiety", style="filled", fillcolor=lightgreen];
ptsd [label="Screen for\nPTSD", style="filled", fillcolor=orange];
other [label="Consider:\n• Health anxiety\n• OCD\n• Medical causes", style="filled", fillcolor=lightyellow];
further [label="Further\nClinical Assessment\nRequired", style="filled", fillcolor=lightblue];
high_gad7 -> assess_type;
assess_type -> chronic_worry;
chronic_worry -> gad [label="yes"];
chronic_worry -> panic_attacks [label="no"];
panic_attacks -> panic [label="yes"];
panic_attacks -> social_fears [label="no"];
social_fears -> social [label="yes"];
social_fears -> trauma_hx [label="no"];
trauma_hx -> ptsd [label="yes"];
trauma_hx -> other [label="no"];
gad -> further;
panic -> further;
social -> further;
ptsd -> further;
other -> further;
}
Note: GAD-7 screens for anxiety severity but does not differentiate specific disorders. Further clinical assessment required for diagnosis.
Immediate/Urgent:
Routine:
Complete referral guidance: ../../docs/references/referral-guidelines.md
Screening tools, not diagnostic instruments. Do not replace clinical assessment; do not differentiate specific anxiety disorders. Clinical judgment supersedes scores. Potential issues: false positives (medical conditions, substances), false negatives (minimization), cultural/linguistic factors.
Example requests: "Administer GAD-7", "Screen for anxiety", "Score GAD-7", "Treatment for score 17", "Screen anxiety and depression together?"
Primary Literature:
Clinical Guidelines:
No copyright restrictions - GAD-2 and GAD-7 are freely available for clinical and research use