Psychiatry
GAD-2 (Anxiety Screen)
Two-item anxiety screen.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The GAD-2 is an ultra-brief, two-item screen for generalised anxiety, drawn from the seven-item Generalised Anxiety Disorder scale. It asks how often, over the past two weeks, the person has been bothered by feeling nervous, anxious or on edge, and by not being able to stop or control worrying, each scored 0–3 for a total of 0–6. The two items capture the core features of anxious arousal and uncontrollable worry. It is intended as a first-step filter rather than a diagnostic tool.
Interpreting the result
A total of 0–2 is a negative screen and 3 or more is positive, the point at which a fuller assessment such as the GAD-7 or a clinical interview is recommended. The cut-off favours sensitivity, so a positive result identifies people needing further evaluation rather than confirming a diagnosis. Although designed for generalised anxiety, an elevated GAD-2 may also flag panic, social anxiety or post-traumatic stress, which the fuller assessment helps distinguish.
Worked example
A patient reports feeling nervous or on edge nearly every day (+3) and being unable to stop worrying for more than half the days (+2), totalling 5. This is a positive screen, prompting a fuller assessment such as the GAD-7 and consideration of other anxiety disorders.
Pearls / pitfalls
- It is a screen, not a diagnosis — confirm with a fuller assessment such as the GAD-7 and a clinical interview before treating.
- A positive GAD-2 may reflect panic, social anxiety or post-traumatic stress rather than generalised anxiety; the broader assessment clarifies which.
- The cut-off of 3 prioritises sensitivity, so some false positives are expected and acceptable for a filtering test.
- Anxiety and depression often co-exist, so a positive anxiety screen should prompt consideration of a depression screen too.
Evidence & validation
Derived from the GAD-7 by Kroenke, Spitzer, Williams and colleagues in 2007, the GAD-2 showed good sensitivity for generalised anxiety disorder, and reasonable sensitivity for other anxiety disorders, at a cut-off of 3. It is widely used as a first-line anxiety screen in primary care, usually followed by the GAD-7 when positive.
Frequently asked questions
What GAD-2 score is positive?
A total of 3 or more out of 6 is a positive screen and should prompt a fuller assessment such as the GAD-7. Scores of 0–2 are negative.
Does a positive GAD-2 confirm generalised anxiety disorder?
No. It only indicates the need for further evaluation. A fuller assessment or clinical interview is needed to confirm the diagnosis and distinguish it from other anxiety disorders.
Can the GAD-2 detect other anxiety disorders?
It is most sensitive for generalised anxiety but also flags many cases of panic, social anxiety and post-traumatic stress disorder. The subsequent assessment helps tell these apart.
What should follow a positive GAD-2?
Proceed to a more detailed tool such as the GAD-7 or a clinical assessment to gauge severity and confirm the diagnosis. Consider screening for co-existing depression as well.
Can a negative GAD-2 rule out an anxiety disorder?
It makes one less likely but does not exclude it. If clinical concern persists, continue to a fuller assessment despite a negative screen.
References
- Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection (GAD-7 and GAD-2). Ann Intern Med. 2007;146(5):317–325.
- NICE CG113: Generalised anxiety disorder and panic disorder in adults: management. 2011 (updated).
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