GAD-7 Scoring and How to Document It in a Progress Note
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How is the GAD-7 scored?
The GAD-7 is a seven-item anxiety questionnaire. Each item is scored 0 to 3, so totals run from 0 to 21. Its developers suggested that cut points of 5, 10 and 15 might be read as mild, moderate and severe anxiety, and a score of 10 or greater as a reasonable cut point for identifying probable generalized anxiety disorder.
The Generalized Anxiety Disorder 7-item scale (GAD-7) was developed by Spitzer, Kroenke, Williams and Lowe and published in 2006. It asks how often the client has been bothered by anxiety-related problems over the past 2 weeks.
Clinicians use it to quantify anxiety at intake and to track change across treatment. This guide explains the score, what the 10-point cut point does and does not tell you, and where to put the result in a SOAP or DAP note. The questions themselves are not reproduced here: use the official form in the sources.
GAD-7 at a glance
| Detail | What the sources say |
|---|---|
| What it is | A seven-item self-report scale to identify probable cases of generalized anxiety disorder and gauge severity. |
| Developed by | Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. |
| Validation paper | Spitzer, Kroenke, Williams and Lowe, Archives of Internal Medicine, 2006;166(10):1092 to 1097. |
| Items and item scores | 7 items, each scored 0 to 3. |
| Total score | 0 to 21. |
| Time frame asked about | Symptoms in the past 2 weeks. |
| Domains covered | Nervousness, uncontrollable worry, excessive worry, trouble relaxing, restlessness, irritability, and a sense of dread. |
GAD-7 score bands
| Total score | Band | Source note |
|---|---|---|
| 0 to 4 | Below the first cut point | Below the lowest suggested cut point of 5. |
| 5 to 9 | Mild | A cut point of 5 might be read as mild. |
| 10 to 14 | Moderate | A cut point of 10 might be read as moderate, and it is the suggested case-finding cut point. |
| 15 to 21 | Severe | A cut point of 15 might be read as severe. |
What do the GAD-7 cut points mean?
The validation paper says: "Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of anxiety." The wording is deliberately tentative, so describe the bands as the developers' suggested interpretation rather than as fixed diagnostic categories.
On the 10-point cut, the paper says: "A score of 10 or greater on the GAD-7 represents a reasonable cut point for identifying cases of GAD." The abstract reports that a cut point optimized sensitivity (89%) and specificity (82%). This identifies probable cases for further evaluation. It does not establish a diagnosis.
How is the GAD-7 different from the PHQ-9?
Both are brief self-report measures from the same research group, both score each item 0 to 3, and both ask about the past 2 weeks. The GAD-7 has seven items and a 0 to 21 range, while the PHQ-9 has nine items and a 0 to 27 range, so you cannot compare totals between them. The GAD-7 has no equivalent of the PHQ-9 item 9, so a client with suicidal thoughts is not identified by the GAD-7 alone.
The paper also notes that anxiety and depression symptoms often occur together but are distinct dimensions. Clients with generalized anxiety often have both measures taken, and your note can report each score and band separately.
Is a high GAD-7 score a diagnosis of generalized anxiety disorder?
No. The authors describe the scale as a tool for screening and assessing severity. A score above the cut point means the client reported many anxiety symptoms, which can have several causes. Your Assessment should say what you think the score means after considering history, presentation and other findings, and the diagnosis is yours to make. For code choices once you have a diagnosis, see the anxiety ICD-10 codes guide.
How do you document it in a progress note?
- Step 1: State that the GAD-7 was given, the date, and how it was completed.
- Step 2: Record the total score (0 to 21) and the band.
- Step 3: Note the prior score and the trend.
- Step 4: Name the symptoms that drove the score if the client described them in session, in observable terms.
- Step 5: Put your interpretation in the Assessment and link it to a treatment plan goal.
- Step 6: State the plan: continue current interventions, change them, or repeat the scale at a stated interval.
Where the GAD-7 goes in each note format
| Note format | Where the score goes | Where the interpretation goes |
|---|---|---|
| SOAP | Objective: total, band and prior score. | Assessment: what the score and trend mean for this client. |
| DAP | Data: total, band and prior score. | Assessment: what the score and trend mean for this client. |
Example wording (fictional, for illustration only)
Objective: GAD-7 completed in session on 10/09, total 11 (moderate band), down from 16 at intake. Assessment: Anxiety symptoms are decreasing; client reports using paced breathing before work meetings and sleeping through the night three nights this week. Plan: continue exposure to worry-triggering situations as outlined in the treatment plan and repeat the GAD-7 in four weeks.
Can you use and reproduce the GAD-7 for free?
The GAD-7 form on phqscreeners.com carries the notice "Developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute." The site states the same for all PHQ and GAD-7 screeners and translations it hosts.
The site's terms of use disclaim warranties and say use is at your own risk. WellNotes links to the official form and does not reproduce the questions.
Frequently Asked Questions
What GAD-7 score is considered severe?
The developers suggested that a cut point of 15 might be interpreted as severe anxiety, so totals of 15 to 21 fall in the severe band. They described these bands as a possible interpretation, so report the number as well as the label.
What does a GAD-7 score of 10 mean?
A score of 10 or greater is described in the validation paper as a reasonable cut point for identifying probable generalized anxiety disorder. It also marks the start of the moderate band. It signals that further clinical evaluation is warranted and is not a diagnosis.
What time period does the GAD-7 cover?
The GAD-7 asks about symptoms over the past 2 weeks, so each administration describes a two-week window.
Where do I document the GAD-7 in a DAP note?
Put the total score, band and prior score in the Data section. Put your interpretation of the result and how it relates to the treatment plan in the Assessment section.
Can I use the GAD-7 in my practice without paying?
The official form on phqscreeners.com states that no permission is required to reproduce, translate, display or distribute it. Check the site's terms of use and your agency's own forms policy.
Does WellNotes score the GAD-7?
No. You score the GAD-7 yourself. WellNotes drafts your session note from what you type or dictate, and you review the note and the result you recorded.
Related references
Sources
- Spitzer, Kroenke, Williams, Lowe. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):1092-1097
- GAD-7 official form (English, phqscreeners.com)
- PHQ Screeners (Pfizer): download the PHQ-9 and GAD-7 forms
- PHQ Screeners: terms of use
This page is general reference information, not clinical, coding, or legal advice. Scoring rules and usage terms can change, so confirm them on the instrument owner's current materials and with your payer or supervisor before relying on them. WellNotes does not administer or score screening tools. The treating clinician interprets every result.
Draft the session note with the score in it
Type or dictate the session, include the score and your interpretation, and WellNotes drafts the note in SOAP, DAP, or BIRP. You review and edit every note.