What tool is used to assess the severity of anxiety?

Tools for Assessing Anxiety Severity

The Generalized Anxiety Disorder 7-item scale (GAD-7) is the most validated and recommended tool for assessing anxiety severity in clinical practice. 1, 2

Primary Assessment Tools for Anxiety

GAD-7 (First-Line)

• 7-item self-report questionnaire specifically designed for anxiety assessment
• Scoring interpretation:
  • 0-4: Minimal anxiety
  • 5-9: Mild anxiety
  • 10-14: Moderate anxiety
  • 15-21: Severe anxiety
• Cut-off score of ≥10 has good sensitivity (89%) and specificity (82%) 3
• Takes approximately 2-3 minutes to complete
• Validated across multiple languages and populations 4

GAD-2 (Ultra-Brief Screening)

• 2-item version (first two questions of GAD-7)
• Scoring interpretation: ≥3 indicates possible anxiety disorder
• Similar diagnostic accuracy to GAD-7 but more efficient for initial screening 5, 4
• Questions assess:
  1. Feeling nervous, anxious, or on edge
  2. Not being able to stop or control worrying

Alternative Assessment Tools

When GAD-7 is not available or for specific clinical scenarios, consider these alternatives:

Hospital Anxiety and Depression Scale (HADS)

• 14-item self-report measure with separate anxiety and depression subscales
• Score ≥8 on anxiety subscale indicates significant anxiety symptoms 1, 2
• Advantage: Excludes physical symptom items that might be confounded by medical conditions

Beck Anxiety Inventory (BAI)

• 21-item self-report scale focused on somatic symptoms of anxiety
• Scoring: ≥10 suggests mild anxiety; ≥19 suggests moderate anxiety 1
• Specifically designed to discriminate anxiety from depression symptoms
• Focuses on physical symptoms of autonomic arousal and panic

Penn State Worry Questionnaire (PSWQ)

• 16-item scale (8-item abbreviated form available)
• Specifically assesses worry severity, the primary symptom of GAD 1
• Useful when worry is the predominant symptom

Spielberger State-Trait Anxiety Inventory (STAI)

• Assesses both state (current) and trait (general) anxiety
• 20 items for each type of anxiety
• Useful for distinguishing between situational anxiety and chronic anxiety traits 1

Implementation in Clinical Practice

1. Initial screening: Use GAD-2 for rapid assessment
2. Comprehensive assessment: Follow positive GAD-2 with full GAD-7
3. Severity monitoring: Use GAD-7 to track treatment response at 4 and 8 weeks 2

Special Considerations

• For elderly patients: Consider Geriatric Depression Scale (GDS) which includes anxiety assessment 1
• For patients with specific medical conditions: HADS may be preferred as it excludes somatic symptoms 1
• For social anxiety assessment: Mini-SPIN (3-item Social Phobia Inventory) with cutoff ≥6 points has 89% sensitivity and 90% specificity 1

Common Pitfalls to Avoid

• Relying solely on symptom counts without considering functional impairment 2
• Overlooking medical causes of anxiety symptoms (thyroid disorders, caffeinism, cardiac conditions) 2
• Failing to follow up on positive screening results with proper diagnostic assessment 2
• Not reassessing regularly during treatment to monitor progress 2

The GAD-7 has been extensively validated and offers the best balance of brevity, sensitivity, and specificity for assessing anxiety severity in clinical practice, making it the preferred tool for both initial assessment and ongoing monitoring.