Reliability Validity and Cut Scores of the South

Authors: Catherine Sokum Tang Anise M S Wu Joe Y C Tang Elsie C W Yan

Publish Date: 2009/08/13

Volume: 26, Issue: 1, Pages: 145-158

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Abstract

We examined the reliability validity and classification accuracy of the South Oaks Gambling Screen SOGS when adopted for use in Chinese The DSMIV criteria for pathological gambling served as the standard against which the classification accuracy of the SOGS was tested A total of 283 Chinese adults in the community and 94 Chinese treatmentseeking gamblers were recruited The internal reliability of the SOGS was satisfactory for the general sample and acceptable for the gambling sample The SOGS was correlated with the DSMIV criteria items as well as psychosocial and gamblingrelated problems Relative to the DSMIV criteria the SOGS tended to overestimate the number of pathological gamblers in both samples In general we were relatively confident that individuals were not pathological gamblers if the SOGS scores were between 0 and 4 and were pathological gamblers if the SOGS were between 11 and 20 There was about 50–50 chance of being pathological gamblers if the SOGS scores were between 8 and 10 However the probability of individuals being pathological gamblers was about 030 if the SOGS scores were between 5 and 7 We proposed a SOGS cut score of 8 to screen for probable pathological gambling in Chinese societiesGambling research conducted in the United States Canada and Australia indicates that with greater access to new forms of gambling there will be more individuals who have gamblingrelated problems and who are seeking help Ladoucer et al 1994 Shaffer et al 1997 Victorian Casino and Gambling Authority 1997 This also happens in Chinese societies With the expansion of legalized gambling in Chinese societies of Macau Hong Kong Taiwan and Singapore Chinese nowadays have more opportunities to engage in new forms of gambling such as betting on sports and internet games in addition to traditional gambling activities in casinos and mahjong games Chinese gamblers nowadays tend to take high risks while gambling to seek instant rewards either for quick profits or for satisfying strong immediate sensations and excitement Lau and Ranyard 2005 Vong 2007 Furthermore Chinese tend to have difficulty in admitting their gambling problems and in seeking professional help for fear of losing face Loo et al 2008 Consequently Chinese gamblers typically experience severe financial family and work difficulties as a result of their gambling by the time they seek services at gambling treatment centers in Hong Kong Tang et al 2007 and Singapore Teo et al 2007 This poses great challenge to the effectiveness of gambling treatment programs In order to tackle problem gambling in Chinese societies public education programs are urgently in need to enhance people’s awareness of individual and societal consequences of disruptive gambling These programs will also aim to destigmatize people with gamblingrelated problems and to emphasize the importance of early treatment At the same time a reliable and valid screening instrument is also essential for early identification of individuals who may require subsequent referrals and treatmentIn Western psychiatric taxonomy such as the DSM system pathological gambling refers to destructive and recurring gambling behavior that interferes with many life domains American Psychiatric Association 1994 The 20item South Oaks Gambling Screen SOGS is a commonly used instrument to screen for probable pathological gambling Lesieur and Blume 1987 A cut score of 5 or more is typically used to indicate that the individual is a probable pathological gambler Lesieur and Blume 1987 Psychometric scrutiny of the SOGS tends to yield satisfactory test–retest reliability and internal consistency among Western general populations and clinical samples eg Lesieur and Blume 1987 Petry 2005 Stinchfield 2002 The SOGS also shows good agreement with the DSMIV criteria for pathological gambling Stinchfield 2002 However various shortcomings of the SOGS have also been identified Lesieur 1994 Ladouceur et al 2000 First the SOGS tends to overestimate gambling problems when lifetime estimates are used as about onethird of the everafflicted individuals may have already resolved their gambling problems during the survey period Shaffer et al 1997 One suggested solution is to change the time frame from lifetime to a more current period such as the past year Stinchfield 2002 Second the SOGS tends to yield inflated prevalence estimates with high false positives relative to the DSM criteria when used with community samples Ladouceur et al 2000 Shaffer et al 1997 Stinchfield 2002 One suggestion to address this concern is by raising the cut score Duvarci et al 1997 but this will at the same time increase the false negative error rate An alternative solution is to have a twostage assessment with the SOGS as the initial screening tool to be followed by a clinical interview Dickerson 1993 or to supplement the SOGS with a second diagnostic test such as the DSMIV criteria for pathological gambling Gambino and Lesieur 2006 Third some items are easily misinterpreted and subject to acquiescence bias Ladouceur et al 2000 A possible solution is to have the research personnel available to clarify and explain the SOGS items to respondents or to followup with interviewsThe SOGS has been translated into many languages for use in different countries It has also been used with Chinese immigrants in developed countries of Canada Australia and the United States as well as with Chinese residing in Chinese societies Loo et al 2008 Tang et al 2007 To the best of our knowledge only one published study has examined the psychometric properties of the SOGS when it was used in Chinese societies In a recent study conducted in Singapore Arthur et al 2008 the English version of the SOGS was administered to 148 undergraduate students of which 82 were Chinese and the remaining was of Malay Indian and other ethnic groups The SOGS was found to be internally consistent with an alpha value of 083 Three factors were identified that accounted for 46 of the total variance The SOGS also had high correlations with other gambling measures such as the Gamblers Anonymous 20 r = 074 the Canadian Problem Gambling Index r = 079 and the DSMIV criteria for pathological gambling r = 060 However it should be noted that in this study the SOGS was administered in English to a small sample of college students in SingaporeFor the present study we aimed to determine the usefulness of the SOGS in Chinese societies in terms of identifying probable pathological gamblers for subsequent referrals and treatment Psychometric properties of the Chinese version of the SOGS when adopted for use with Chinese samples would be examined in detail We first investigated the reliability and validity of the SOGS among Chinese adults in the community as well as among Chinese treatmentseeking gamblers We then examined the usefulness of various SOGS cut scores in identifying individuals whose gambling behavior significantly interfered with their personal familial and occupational functioning We tested the classification accuracy of SOGS cut scores against the DSMIV criteria for pathological gamblingFor the general community sample about 70 of participants aged between 20 and 29 About 70 of them reported at least one form of gambling activities in their lifetime and the gambling debt incurred at the time of the study was typically below US 1200 The commonest forms of gambling activities were mahjong games lottery cards and betting on horse races A local survey with a large sample of 2004 community adults also showed similar pattern of gambling activities Hong Kong Home Affairs Bureau 2002 Table 1For the gambling treatment sample the majority of participants aged between 30 and 39 About 135 of them had gambled for 5 years or less 188 for 6–10 years 386 for 11–20 years and 261 for more than 20 years Only 63 of them did not have a gambling debt at the time of the study and about 25 were indebted to less than US1200 40 were indebted between US1200 and US5100 and 25 were indebted to more than US5100 The commonest forms of gambling activities were betting on horse races gambling in casinos and betting on soccer games The present gambling treatment sample showed similar demographic and gambling characteristics as compared to a large sample of 952 gamblers who seek services from a local gambling treatment center Tang et al 2007 Table 1

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