Diagnosis of Anxiety Disorders

 

Primary care clinicians stive to provide the most effective for generalized anxiety disorder, however several factors may be impacting their ability to do so. Lack of knowledge and busy practice settings are substantial barriers to effective treatment. Without early recognition and treatment, patients may suffer impairment and have increased suicide risk. Generalized Anxiety Disorder 7 questions test is to assist clinicians in providing timely assessment. 

 

Generalized anxiety disorder leads to considerable morbidity and affects approximately 3 percent of patients in primary care practices.1 Social phobia (social anxiety disorder), characterized by a strong fear of social or performance situations that may lead to embarrassment or humiliation, affects 7 percent of primary care patients. Until recently, there have been few validated tools for evaluating patients for these disorders.

 

The seven-item Generalized Anxiety Disorder scale (GAD-7) is a validated diagnostic tool designed for use in the primary care setting. It was developed from an original set of 13 questions and was validated in a group of 965 primary care patients from 15 practices. The validation group answered the 13 questions and participated in a telephone interview conducted by a psychologist or psychiatric social worker, which served as the reference standard. The first two questions of the GAD-7 make up the GAD-2, which can be used as an ultra-short diagnostic instrument; both scales and their interpretations are presented in Figure 1.5 Although the GAD-7 was designed to detect generalized anxiety disorder, it is fairly accurate for panic, social anxiety, and posttraumatic stress disorders.

 

Validation study recommend a cutoff of 8 or more points for an abnormal GAD-7 result; however, a cutoff of 9 points has a higher positive likelihood ratio compared with a cutoff of 8 points (4.3 versus 3.8, respectively) and a similar negative likelihood ratio. The GAD-7 has an excellent negative predictive value, but only one half of patients with a positive screen actually have generalized anxiety disorder or panic disorder. Thus, confirmatory interviewing is needed. The GAD-7 has also been validated as a self-administered instrument.