Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis

ObjectiveTo systematically review the accuracy of the GAD-7 and GAD-2 questionnaires for identifying anxiety disorders.MethodsA systematic review of the literature was conducted to identify studies that validated the GAD-7 or GAD-2 against a recognized gold standard diagnosis. Pooled estimates of diagnostic test accuracy were produced using random-effects bivariate metaanalysis. Heterogeneity was explored using the I2 statistic.ResultsA total of 12 samples were identified involving 5223 participants; 11 samples provided data on the accuracy of the GAD-7 for identifying generalized anxiety disorder (GAD). Pooled sensitivity and specificity values appeared acceptable at a cutoff point of 8 [sensitivity: 0.83 (95% CI 0.71–0.91), specificity: 0.84 (95% CI 0.70–0.92)] although cutoff scores 7–10 also had similar pooled estimates of sensitivity/specificity. Six samples provided data on the accuracy of the GAD-2 for identifying GAD. Pooled sensitivity and specificity values appeared acceptable at a cutoff of 3 [sensitivity: 0.76 (95% CI 0.55–0.89), specificity: 0.81 (95% CI 0.60–0.92)]. Four studies looked at the accuracy of the questionnaires for identifying any anxiety disorder.ConclusionsThe GAD-7 had acceptable properties for identifying GAD at cutoff scores 7–10. The GAD-2 had acceptable properties for identifying GAD at a cutoff score of 3. Further validation studies are needed.