Cited by 641Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingMental Health Research Topics

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Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7)

Toussaint, Anne, Hüsing, Paul, Gumz, Antje, Wingenfeld, Katja, Härter, Martin, Schramm, Elisabeth, Löwe, Bernd·2020·Journal of Affective Disorders

DOI 10.1016/j.jad.2020.01.032

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Abstract

Background Effective treatment requires regular follow-up and monitoring of symptoms. We investigated sensitivity to change and minimal clinically important difference of the Generalized Anxiety Disorder Scale (GAD-7).Methods This study included all participants from a multisite trial of chronic depression. Baseline and follow-up (12 and 48 weeks) data were used to assess treatment response. Effect sizes (ES) and standardized response means (SRM) of pre- and post-GAD-7 mean changes were calculated for subgroups of patients, who did or did not improve according to ratings in the Hamilton Rating Scale for Depression (HRSD-24).Results N = 261 patients were included in the analyses. In the subgroup of patients who improved according to HRSD-24, GAD-7 scores were significantly lower after 12 weeks (t = -6.31, df = 120, p < .001; ES = -0.51, SRM = -0.57), and 48 weeks of treatment (t = -12.68, df = 141, p < .001; ES = -1.0, SRM = -1.7), when compared to admission. In the group who worsened, GAD-7 scores were significantly higher after 12 weeks (t = 2.96, df = 41, p = .005; ES = 0.30, SRM = 0.46), and increased after 48 weeks (t = 1.99, df = 21, p = .059; ES = 0.37, SRM = 0.43), when compared to baseline. The unchanged group showed no significant difference between baseline and follow-up. MCID was estimated 4 points on the GAD-7 total score.Limitations Confirmation of these findings and further investigation of the GAD-7 in populations and trials focusing on anxiety-specific treatment is highly recommended.Conclusions Results show that the GAD-7 is sensitive to detect change in psychopathology over the course of treatment.

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Meng, P., Pan, C., Qin, X., Cai, Q., Zhao, Y., Wei, W., Cheng, S., Yang, X., Cheng, B., Liu, L., et al. (2024) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2024.117121 · Cited by 11
Study on anxiety, depression, and sleep conditions and their interrelations among vocational college students during the COVID-19 pandemic management normalization
Gao, R., Wang, H., Liu, S., Wang, X., Song, S., & Wang, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1385639 · Cited by 10
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Zhu, Y., Chen, Y., Tang, Y., Zhang, X., Shen, Q., Li, F., Wang, H., & Zheng, X. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1483021 · Cited by 10
The relationship between stress, anxiety, and health literacy in parents of children with chronic gastroenterological diseases: a multi-center cross-sectional study
Pacut, A., Duplaga, M., Więcek, S., Murzyn, I., Gronowicz, G., Krzesiek, E., Stalony, N., & Kowalska‐Duplaga, K. (2025) · BMC Public Health · doi:10.1186/s12889-025-24329-0 · Cited by 14
The Role of Physical Activity in the Reduction of Generalised Anxiety Disorder in Young Adults in the Context of COVID-19 Pandemic
Czenczek‐Lewandowska, E., Leszczak, J., Wyszyńska, J., Baran, J., Weres, A., & Lewandowski, B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191711086 · Cited by 12
Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression (GLAD Study): A Randomized Double-Blind Placebo-Controlled Study
Wang, C., Huan, N., Wang, P.-L., Geng, Q., Ma, W., Ma, L., Jiang, H.-Y., Meng, X., Zhang, D., Gou, X.-J., et al. (2022) · Chinese Journal of Integrative Medicine · doi:10.1007/s11655-022-3688-3 · Cited by 10
“The PHQ-9((16)) and GAD-7((17)) scoring criteria were based on the quantitative evaluation criteria recommended in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association.”
Method
The IBER study: a feasibility randomised controlled trial of imagery based emotion regulation for the treatment of anxiety in bipolar disorder
Steel, C., Wright, K. A., Goodwin, G. M., Simon, J., Morant, N. J., Taylor, R. S., Brown, M. C., Jennings, S., Hales, S. A., Regan, J. L., et al. (2023) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00305-8 · Cited by 11
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Yin, L., Rong, T., Zhang, Y., & Gao, J. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.10.005 · Cited by 10
UK Medical Cannabis Registry: An analysis of clinical outcomes of medicinal cannabis therapy for attention‐deficit/hyperactivity disorder
Ittiphakorn, P., Erridge, S., Holvey, C., Coomber, R., Rucker, J., & Sodergren, M. H. (2023) · Neuropsychopharmacology Reports · doi:10.1002/npr2.12400 · Cited by 9
“60 The Single-Item Sleep Quality Scale (SQS) is a scale used to evaluate self-reported sleep quality over the previous 7 days, with 0 being “terrible” sleep quality and 10 being “excellent”.”
Method
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Roos, L. G., Henson, S. J. S., Castro, C. M., Chamberlain, C. E. W., & Smith, B. J. (2024) · JMIR mhealth and uhealth · doi:10.2196/48298 · Cited by 10
“The clinical cutoff score for probable anxiety disorder (“high risk”) is ≥ 8 [20], and improvement was indicated when participants’ scores decreased by >4 points [21].”
Background
Assessment of anxiety and depression symptoms in the Albanian general population during the outbreak of COVID-19 pandemic
Elezi, F., Tafani, G., Sotiri, E., Agaj, H., & Kola, K. (2020) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_842_20 · Cited by 10
“The GAD-7 has been previously applied in research related to MERS[4] and Ebola outbreak,[10] in recent studies in China,[5] and it has been approved to be a well-valuated screening instrument.[11,12] In this study, it has demonstrated excellent internal consistency (Cronbach’s α = 0.”
Method
The challenge of addressing obesity in people with poorly controlled asthma
Dixon, A. E., Blake, K., DiMango, E., Dransfield, M. T., Feemster, L. C., Johnson, O., Roy, G., Hazucha, H., Harvey, J. R., McCormack, M. C., et al. (2021) · Obesity Science & Practice · doi:10.1002/osp4.533 · Cited by 10
“The score changed minimally over the two study visits (median score of 2 [IQR 0–4] and 1 [IQR 0–3] at baseline and follow‐up), which is less than the minimal clinically important difference of 4.(26)”
Background
Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students
Royal, S., Keeling, S., Kelsall, N., Price, L. R., Fordham, R. J., Xydopoulos, G., Dawson, G. R., Kingslake, J., & Morriss, R. K. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01681-3 · Cited by 10
“Change in thresholds for a minimally important change (improvement or deterioration) of 4 points or more on the GAD-7 [23] and 6 points or more on the PHQ-9 [24] from baseline to 8 weeks are reported descriptively.”
Method
Effect of pain neuroscience education and transcutaneous electrical nerve stimulation on trigeminal postherpetic neuralgia. A case report
Barone, M., Imaz, F., Bordachar, D., Ferreira, I. C., & Intelangelo, L. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1878567 · Cited by 9
“- 66–1.02 kgf/cm2) (Mutlu and Ozdincler, 2015; Waller et al., 2015).”
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UK Medical Cannabis Registry: a case series analyzing clinical outcomes of medical cannabis therapy for generalized anxiety disorder patients
Li, A. Y., Erridge, S., Holvey, C., Coomber, R., Barros, D. A. R., Bhoskar, U., Crews, M., Donnelly, L., Imran, M., Korb, L., et al. (2024) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000536 · Cited by 10
“A minimal clinically important difference (MCID) is determined as a reduction of 4 points or more (Toussaint et al ., 2020).”
Background
Improvements in Sleep Quality in Patients With Major Depressive and Generalized Anxiety Disorders Treated With Individualized, Parcel‐Guided Transcranial Magnetic Stimulation
Tang, S. J., Holle, J., Mor, S., Dadario, N. B., Ryan, M., Teo, C., Sughrue, M. E., & Yeung, J. T. (2024) · Brain and Behavior · doi:10.1002/brb3.70088 · Cited by 9
“The minimal clinically important difference (MCID) in GAD-7 is four points (Toussaint et al. 2020).”
Background
Statistical methods to adjust for the effects on intervention compliance in randomized clinical trials where precision treatment rules are being developed
Zainal, N. H., Benjet, C. L., Albor, Y., Núñez-Delgado, M. J., Cruz, R. Z., Contreras‐Ibáñez, C. C., Cudris–Torres, L., de la Peña, F. R., González, N., Guerrero-López, B., et al. (2025) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.70005 · Cited by 9
Screening for anxiety in patients with cancer: Diagnostic accuracy of GAD-7 items considering lowered GAD-7 cut-offs
Grapp, M., Bugaj, T. J., Terhoeven, V., Friederich, H., & Maatouk, I. (2025) · PLoS ONE · doi:10.1371/journal.pone.0316853 · Cited by 9
Analysis of risk factors for depression and anxiety in women with polycystic ovary syndrome
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Physical activity and sleep quality among Chinese college students: the serial mediating roles of anxiety and depression
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Students' Anxiety during the COVID-19 Pandemic in Saudi Arabia
AL-Shahrani, A. M. (2021) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_46_21 · Cited by 9
“It analyses the 7-core symptoms and examines the frequency of these symptoms within the last two weeks.[15] The GAD-7 questionnaire was modified to test GAD and assess its severity in clinical study and practice.”
Method
Decreased food allergy-specific anxiety and increased general anxiety in parents of children with food allergies during the coronavirus disease 2019 pandemic
Westwell-Roper, C. Y., To, S., Soller, L., Chan, E. S., & Stewart, S. E. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.04.012 · Cited by 9
“Survey components included demographic information, allergy history, and the General Anxiety Disorder—7, a measure of generalized anxiety symptoms.(8) Furthermore, current and pre−COVID-19 aspects of FAA were queried using a 28item questionnaire undergoing validation, the Impairment Measure for Parental food Allergy-r…”
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(2020) · The Annals of Clinical and Analytical Medicine · doi:10.4328/acam.20358 · Cited by 9
“The General Anxiety Disorder Scale (GAD7), which is one of the most commonly used tools for detecting and screening anxiety disorders and developed to assist in the diagnostic process of certain diseases, is the first self-reported questionnaire [14].”
Method
Depression and Insomnia of Front-Line Medical Staff During the COVID-19 Outbreak in China: An On-Line Cross-Sectional Study
Zhang, D., Luo, H., Xiao, L., Zhang, Z., Huang, J., Li, X., Zhu, H., & Lai, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.897896 · Cited by 10
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SFF-DA: Spatiotemporal Feature Fusion for Nonintrusively Detecting Anxiety
Mo, H., Li, Y., Han, P., Liao, X., Zhang, W., & Ding, S. (2023) · IEEE Transactions on Instrumentation and Measurement · doi:10.1109/tim.2023.3341132 · Cited by 8
“1) Traditional Anxiety Detection Methods: Psychological scales, such as the self-rating anxiety scale (SAS) [25] and generalized anxiety disorder-7 (GAD-7) item scale [26], are commonly used in conventional mental health assessments to determine whether patients are experiencing anxiety.”
Background
Mental well-being and sleep quality among vocational college students in Sichuan, China during standardized COVID-19 management measures
Gao, R., Wang, H., Liu, S., Wang, X., Xiong, X., Song, S., & Wang, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1387247 · Cited by 8
Comparing the Efficacy of Electronically Delivered Cognitive Behavioral Therapy (e-CBT) to Weekly Online Mental Health Check-Ins for Generalized Anxiety Disorder—A Randomized Controlled Trial: Comparaison de l'efficacité de la thérapie cognitivo-comportementale délivrée par voie électronique (e-TCC) aux contrôles hebdomadaires en ligne de santé mentale pour le trouble d'anxiété généralisée - un essai randomisé contrôlé
Chermahini, M. B., Eadie, J., Agarwal, A., Stephenson, C., Malakouti, N., Nikjoo, N., Jagayat, J., Jarabana, V., Shirazi, A., Kumar, A., et al. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241261933 · Cited by 7
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“With regard to clinical signi ﬁ cance of these changes, the minimum clinically important difference (MCID) for the PHQ-9 and GAD-7 are estimated to be 3.7 and 4.0, respectively 88,89 ; there is no established MCID for the HDQoL or CFQ-13, which limit our ability to fully interpret these changes.”
Influential
Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients
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“Additionally, it has been noted to be sensitive in detecting changes in psychopathology over the course of treatment [37].”
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“…that may have contributed to our measures ’ relative stability overtime, it is important to remain mindful that screeners such as the GAD-7 and PHQ-8 or PHQ-9 are often utilized as outcome measures in clinical settings, to track treatment progress (Shin et al., 2019; Toussaint et al., 2020).”
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Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China.
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Comparison of the efficacy of pulsed radiofrequency in treating acute herpetic neuralgia and postherpetic neuralgia in the thoracic segment
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MiR-124 Regulates IQGAP1 and Participates in the Relationship Between Morphine Dependence Susceptibility and Cognition
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Authors: Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B.
Affiliations: University Medical Center Hamburg-Eppendorf (DE)
Charité – Universitätsmedizin Berlin (DE)
University of Freiburg (DE)
Corresponding author: Toussaint, Anne
ORCID: Toussaint, Anne
Hüsing, Paul
Gumz, Antje
Wingenfeld, Katja
Härter, Martin
Schramm, Elisabeth
Löwe, Bernd
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2020-03
Volume: 265
Pages: 395-401
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2020.01.032
OpenAlex: W3000661394
Cited by: 641
References: 68
Citations by year: 2026: 134 · 2025: 138 · 2024: 113 · 2023: 99 · 2022: 68 · 2021: 59 · 2020: 30
FWCI: 61.87
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: Deutsche Forschungsgemeinschaft
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: GAD-7, Generalized Anxiety Disorder Scale, anxiety symptoms, chronic depression, sensitivity to change, minimal clinically important difference, standardized response mean, treatment response monitoring, Hamilton Depression Rating Scale
MeSH terms: Minimal Clinically Important Difference, Patient Health Questionnaire, Anxiety Disorders, Depression, Humans, Treatment Outcome

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Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7)

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