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GAD-7 Questionnaire

Patient Info

Patient Health Questionnaire-9 (PHQ-9)

Formulario en español

Over the last 2 weeks, how often have you been bothered by the following problems?	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things	+1	+2	+3
2. Feeling down, depressed, or hopeless	+1	+2	+3
3. Trouble falling asleep, staying asleep, or sleeping too much	+1	+2	+3
4. Feeling tired or having little energy	+1	+2	+3
5. Poor appetite or overeating	+1	+2	+3
6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down	+1	+2	+3
7. Trouble concentrating on things, such as reading the newspaper or watching television	+1	+2	+3
8. Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual	+1	+2	+3
9. Thoughts that you would be better off dead or of hurting yourself in some way	+1	+2	+3

PHQ-9 score obtained by adding score for each question (total points)

Interpretation

Provisional Diagnosis and Proposed Treatment Actions
PHQ-9 Score	Depression Severity	Proposed Treatment Actions

Over the last 2 weeks, how often have you been bothered by the following problems?	Several days	More than half the days	Nearly every day
Feeling nervous, anxious or on edge	+1	+2	+3
Not being able to stop or control worrying	+1	+2	+3
Worrying too much about different things	+1	+2	+3
Trouble relaxing	+1	+2	+3
Being so restless that it is hard to sit still	+1	+2	+3
Becoming easily annoyed or irritable	+1	+2	+3
Feeling afraid as if something awful might happen	+1	+2	+3

Interpretation

Although designed as a screening tool for generalized anxiety, the GAD-7 is also performs reasonably well as a screening tool for three other common anxiety disorders—Panic Disorder, Social Anxiety Disorder, and Posttraumatic Stress Disorder.

Performance as Screening Tool for Anxiety Disorders
Test	Sensitivity	Specificity	Positive Likelihood Ratio

Disclaimer: Your results indicate that you may be experiencing some signs of mild anxiety.These results are not meant to be a diagnosis. You can meet with a doctor or therapist to get a diagnosis and/or access therapy or medications. Sharing these results with someone you trust can be a great place to start.

Substance	Yes	No
a. Cannabis (marijuana, pot, grass, hash, etc.)	3	0
b. Cocaine (coke, crack, etc.)	3	0
c. Prescription stimulants just for the feeling, more than prescribed, or that were not prescribed for you. (Ritalin, Adderall, diet pills, etc.)	3	0
d. Methamphetamine (meth, crystal, speed, ecstasy, molly, etc.)	3	0
e. Inhalants (nitrous, glue, paint thinner, poppers, whippets, etc.)	3	0
f. Sedatives just for the feeling, more than prescribed, or that were not prescribed for you. (sleeping pills, Valium, Xanax, tranquilizers, benzos, etc.)	3	0
g. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, ecstasy, etc.)	3	0
h. Street opioids (heroin, opium, etc.)	3	0
i. Prescription opioids just for the feeling, more than prescribed, or that were not prescribed for you. (Fentanyl, Oxycodone, OxyContin, Percocet, Vicodin, methadone, Buprenorphine, etc.)	3	0
j. Any other drugs to get high. Specify:	3	0

Score	Indicated response
0–3	(0 – 4 for cannabis)
4 – 26	(5 – 26 for cannabis)
27+	(offer options that include treatment)

Score Sheet

Score	Indicated response
0–3/(0 – 4 for cannabis)	Brief education
4 – 26/(5 – 26 for cannabis)	Brief intervention
27+	Brief intervention (offer options that include treatment)

Note: Patients who have injected drugs (non-medical use) in the last three months, but no more than once per week or never more than three days in a row, should receive a brief intervention. All other patients who have injected drugs in the last three months should receive a brief intervention that includes options for treatment.

Patient Info

Patient Health Questionnaire-9 (PHQ-9)

Generalized Anxiety Disorder 7-item (GAD-7)

ASSIST Screening Tool

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

Question 9

Your total score for questions #2–7 for each substance

Total score for questions #2–7 for each substance