Diagnosis of Anxiety Disorders in Primary Care
Primary care clinicians strive to provide the most effective care for generalized anxiety disorder (GAD), however several factors can hinder their ability to do so. Lack of knowledge and busy practice settings are substantial barriers to effective treatment. Without early recognition and appropriate treatment, patients may suffer significant impairment and have increased suicide risk.
Generalized anxiety disorder leads to considerable morbidity and affects approximately 3% of patients in primary care practices. Social phobia (social anxiety disorder), characterized by a strong fear of social or performance situations that may lead to embarrassment or humiliation, affects 7% of primary care patients.
Until recently, there were few validated tools for evaluating patients for anxiety disorders in a busy primary care setting. The GAD-7 changes that.
About the GAD-7 Scale
The seven-item Generalized Anxiety Disorder scale (GAD-7) is a validated diagnostic tool designed specifically for use in primary care. It was developed from an original set of 13 questions and validated in a group of 965 primary care patients across 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.
GAD-2: The Ultra-Short Screen
The first two questions of the GAD-7 make up the GAD-2, which can be used as an ultra-short diagnostic instrument. If a patient screens positive on the GAD-2, the full GAD-7 is administered for a comprehensive evaluation.
Scoring and Interpretation
- A cutoff of 8 or more points indicates an abnormal GAD-7 result
- A cutoff of 9 points has a higher positive likelihood ratio (4.3 vs. 3.8)
- The GAD-7 has an excellent negative predictive value
- Only about half of patients with a positive screen have confirmed GAD or panic disorder — confirmatory interviewing is required
Conditions Detected
Although designed to detect generalized anxiety disorder, the GAD-7 is also fairly accurate for:
- Panic disorder
- Social anxiety disorder
- Post-traumatic stress disorder (PTSD)
Memento's GAD-7 implementation presents the questionnaire on a tablet before the physician enters the room. Risk color-coded results are inserted directly into the patient note, giving the clinician immediate context for the encounter.