Recommended Tools for Quick Anxiety Screening
The Generalized Anxiety Disorder-2 (GAD-2) scale is the recommended tool for quick anxiety screening in primary care settings due to its brevity, strong diagnostic accuracy, and comparable performance to longer measures. 1, 2
GAD-2: The Optimal Quick Screening Tool
The GAD-2 consists of just two questions from the longer GAD-7 scale:
- Over the past two weeks, how often have you been bothered by feeling nervous, anxious, or on edge?
- Over the past two weeks, how often have you been bothered by not being able to stop or control worrying?
Each item is scored:
- 0 = Not at all
- 1 = Several days
- 2 = More than half the days
- 3 = Nearly every day
Advantages of GAD-2:
- Time-efficient: Takes less than 1 minute to complete 1
- Strong diagnostic accuracy: Sensitivity of 68% and specificity of 86% for detecting generalized anxiety disorder 3
- Validated in multiple settings: Primary care, specialty clinics, and web-based formats 4, 5
- Comparable performance: Research shows GAD-2 has similar diagnostic accuracy to the longer GAD-7 3, 4
Interpretation:
- Score ≥3: Positive screen requiring further assessment 1, 2
- Scores of 0-2: Minimal anxiety symptoms, likely not requiring intervention
When to Use GAD-2 vs. GAD-7
- Initial screening: Use GAD-2 for rapid assessment in busy clinical settings 4
- Follow-up assessment: If GAD-2 is positive (≥3), administer the full GAD-7 for more comprehensive evaluation 1, 2
- Monitoring treatment response: GAD-7 is preferred for tracking changes over time 2
GAD-7: Comprehensive Assessment
If GAD-2 screening is positive, the full GAD-7 provides more detailed assessment:
- 7 questions scored 0-3 (same scoring as GAD-2)
- Total score ranges from 0-21
- Interpretation:
Other Validated Screening Options
While GAD-2 is recommended for quick screening, other validated options include:
- Mini-SPIN: 3-item screening tool specifically for social anxiety disorder 1
- Hospital Anxiety and Depression Scale: 14-item tool that screens for both anxiety and depression 1
Implementation Tips
- Electronic integration: Implement these tools in electronic health records for efficient administration
- Regular screening: Screen at initial visits and at appropriate intervals, especially during transitions of care 1
- Combined screening: Consider screening for anxiety alongside depression due to high comorbidity 2, 6
Common Pitfalls to Avoid
- Overlooking physical causes: Always rule out medical conditions that can mimic anxiety symptoms
- Missing comorbidities: Anxiety often co-occurs with depression and other mental health conditions 2
- Inadequate follow-up: Positive screens require proper assessment and treatment planning 2
The GAD-2 represents the optimal balance between brevity and accuracy for quick anxiety screening in clinical practice, with strong evidence supporting its use as a first-line screening tool.