Jogo patológico vem sendo considerado uma dependência comportamental com muitas semelhanças com dependência química. A escala South Oaks Gambling Screen (SOGS) é o instrumento mais utilizado para rastrear esse transtorno. A SOGS investiga prática de jogos de azar e comportamentos associados a jogo. O indivíduo que responder afirmativamente a pelo menos 5 dentre as 20 questões nucleares é classificado como \"provável jogador patológico\". O presente estudo visou verificar o desempenho da SOGS, comparado aos critérios diagnósticos do DSM IV para jogo patológico. A Amostra Total foi constituída por 54 jogadores patológicos que procuraram tratamento (Grupo Clínico), 71 representantes da população geral recrutados em estação de trem (Grupo Trem) e 116 freqüentadores de casa de bingo (Grupo Bingo). Analisaram-se propriedades psicométricas da SOGS (validade, sensibilidade, especificidade, valor preditivo e taxa de classificação incorreta), estrutura fatorial, consistência interna e correlação entre respostas nas duas escalas. Na Amostra Total foi maior a proporção de mulheres mais velhas, separadas ou viúvas, que não trabalhavam; que voltaram para recuperar dinheiro perdido; tiveram mais discussões sobre dinheiro centradas no jogo; e que jogavam para escapar de problemas ou de aliviar disforia. Mulheres jogaram mais em bingo, enquanto homens diversificaram mais os tipos de jogos. Os jogos mais praticados na vida pela amostra Total foram, em ordem decrescente, bingo, loteria, esportes, cartas e jogos eletrônicos. Bingo, loteria e jogos eletrônicos foram os jogos mais praticados no último ano e no último mês. É discutida a prevalência do bingo e de jogo eletrônico entre jogadores patológicos. Análise estatística mostrou diferença entre os grupos, atestando boa validade de construto: Clínico teve a maior pontuação para jogo patológico, Bingo foi intermediário; e Trem mostrou o menor índice de patologia. A correlação entre a pontuação na SOGS e DSM IV na Amostra Total foi alta (r = 0,854, p < 0,01) e a consistência interna da SOGS avaliada pelo alpha de Cronbach foi 0,75. A análise da estrutura da SOGS resultou em dois fatores, comportamento de jogar e fontes de dinheiro para jogo, responsáveis por 56,7% da variabilidade total. Consideradas as respostas na Amostra Total para jogo na vida, com ponto de corte 5, os índices de validade foram satisfatórios (sensibilidade=100, especificidade=74,7, valor preditivo positivo=60,7, valor preditivo negativo=100 e taxa de classificação incorreta=0,18. Ao aumentar o ponto de corte para 8, o número de falsos positivos diminuiu bastante (95,4, 89,8, 78,5 , 98, 0.09, respectivamente). Chamou atenção a diferença entre SOGS e DSM IV na classificação de jogador patológico, pois a proporção desses jogadores segundo a SOGS, no ponto de corte 5, foi muito superior à do DSM IV no Grupo Trem (8,5% e 2,8%, respectivamente) e principalmente no Grupo Bingo (44% e 12%, respectivamente). Discute-se que essa diferença pode representar um artefato do ponto de corte utilizado e sugere-se que, em pesquisas populacionais, o ponto de corte seja aumentado para 8, ou que sejam utilizados os dados referentes aos últimos 12 meses. Se for utilizado o ponto de corte original (5), os resultados devem ser depois confirmados por meio de entrevista clínica. / Pathological gambling is considered a behavioral addiction that shares similarities with drug addiction. The South Oaks Gambling Screen - SOGS is the most employed screening tool for pathological gambling. The SOGS investigates gambling games and behaviors associated to gambling. Answering at least 5 from 20 questions classifies the respondent as a probable pathological gambler. The aim of this study was to verify the performance of the SOGS in comparison to the DSM IV criteria for pathological gambling. The Total Sample comprised 54 gamblers under treatment at the Gamblers Treatment Unit of PROAD/UNIFESP (Clinical Group); 71 participants from the general population assessed in a metropolitan train station of the city of São Paulo (Train Group); and 116 subjects recruited in a bingo house (Bingo Group). Factorial structure, internal consistency and psychometric properties of SOGS (sensibility, specificity, positive predictive value, negative predictive value and misclassification rate) and correlation among both instruments were verified. In the Total Sample women were older, divorced or widowed, did not work; they had chased, had had more discussions about money and had gambled to escape from problems or to relieve dysforic mood. Women bets were mostly concentrated in bingo whereas men bets were more diversified. The most frequent forms of gambling in lifetime were, in decreasing order: bingo, lotteries, sports, cards and electronic games. In the last year and last month frametime, bingo, lotteries and electronic games were the most frequent games. The prevalence of bingo and electronic games among PG is discussed. Differences in the SOGS scores among three groups were statistically significant, attesting good construct validity. The correlation between SOGS and DSM IV in the Total Sample was high (r = 0,854, p < 0.01) and the internal consistency measured by Cronbach\'s alpha was 0,75. Factor analysis resulted in a two-dimensional solution accounting for 56,7% of the total variance: a first factor composed by questions related to the gambling behavior of pathological gamblers and a second factor encompassing questions related to the sources of gambling money. Considering the Total Sample, validity measures were good: (sensibility = 100, specificity = 74,7, positive predictive value = 60,7, negative predictive value = 100 e misclassification rate =0,18). Elevating the cut score to 8 the number of false negatives is reduced (95,4, 89,8, 78,5 , 98, 0.09, respectively). The difference between the classification of pathological gamblers by SOGS and DSM IV was striking, as the proportion of pathological gamblers evaluated by SOGS, at the cut score 5, was much higher than the proportion evaluated by DSM IV in the Train Group (8,5% e 2,8%, respectively) and in Bingo Group (44% e 12%, respectively). It is argued that this difference may be an artifact of the cut score used. Thus, a suggestion is made that either the cut score should be changed from 5 to 8 or that a 12-month timeframe be employed. If the cut score 5 is maintained, then the result should be confirmed by clinical interview.

Jogo patológico vem sendo considerado uma dependência comportamental com muitas semelhanças com dependência química. A escala South Oaks Gambling Screen (SOGS) é o instrumento mais utilizado para rastrear esse transtorno. A SOGS investiga prática de jogos de azar e comportamentos associados a jogo. O indivíduo que responder afirmativamente a pelo menos 5 dentre as 20 questões nucleares é classificado como \"provável jogador patológico\". O presente estudo visou verificar o desempenho da SOGS, comparado aos critérios diagnósticos do DSM IV para jogo patológico. A Amostra Total foi constituída por 54 jogadores patológicos que procuraram tratamento (Grupo Clínico), 71 representantes da população geral recrutados em estação de trem (Grupo Trem) e 116 freqüentadores de casa de bingo (Grupo Bingo). Analisaram-se propriedades psicométricas da SOGS (validade, sensibilidade, especificidade, valor preditivo e taxa de classificação incorreta), estrutura fatorial, consistência interna e correlação entre respostas nas duas escalas. Na Amostra Total foi maior a proporção de mulheres mais velhas, separadas ou viúvas, que não trabalhavam; que voltaram para recuperar dinheiro perdido; tiveram mais discussões sobre dinheiro centradas no jogo; e que jogavam para escapar de problemas ou de aliviar disforia. Mulheres jogaram mais em bingo, enquanto homens diversificaram mais os tipos de jogos. Os jogos mais praticados na vida pela amostra Total foram, em ordem decrescente, bingo, loteria, esportes, cartas e jogos eletrônicos. Bingo, loteria e jogos eletrônicos foram os jogos mais praticados no último ano e no último mês. É discutida a prevalência do bingo e de jogo eletrônico entre jogadores patológicos. Análise estatística mostrou diferença entre os grupos, atestando boa validade de construto: Clínico teve a maior pontuação para jogo patológico, Bingo foi intermediário; e Trem mostrou o menor índice de patologia. A correlação entre a pontuação na SOGS e DSM IV na Amostra Total foi alta (r = 0,854, p < 0,01) e a consistência interna da SOGS avaliada pelo alpha de Cronbach foi 0,75. A análise da estrutura da SOGS resultou em dois fatores, comportamento de jogar e fontes de dinheiro para jogo, responsáveis por 56,7% da variabilidade total. Consideradas as respostas na Amostra Total para jogo na vida, com ponto de corte 5, os índices de validade foram satisfatórios (sensibilidade=100, especificidade=74,7, valor preditivo positivo=60,7, valor preditivo negativo=100 e taxa de classificação incorreta=0,18. Ao aumentar o ponto de corte para 8, o número de falsos positivos diminuiu bastante (95,4, 89,8, 78,5 , 98, 0.09, respectivamente). Chamou atenção a diferença entre SOGS e DSM IV na classificação de jogador patológico, pois a proporção desses jogadores segundo a SOGS, no ponto de corte 5, foi muito superior à do DSM IV no Grupo Trem (8,5% e 2,8%, respectivamente) e principalmente no Grupo Bingo (44% e 12%, respectivamente). Discute-se que essa diferença pode representar um artefato do ponto de corte utilizado e sugere-se que, em pesquisas populacionais, o ponto de corte seja aumentado para 8, ou que sejam utilizados os dados referentes aos últimos 12 meses. Se for utilizado o ponto de corte original (5), os resultados devem ser depois confirmados por meio de entrevista clínica. / Pathological gambling is considered a behavioral addiction that shares similarities with drug addiction. The South Oaks Gambling Screen - SOGS is the most employed screening tool for pathological gambling. The SOGS investigates gambling games and behaviors associated to gambling. Answering at least 5 from 20 questions classifies the respondent as a probable pathological gambler. The aim of this study was to verify the performance of the SOGS in comparison to the DSM IV criteria for pathological gambling. The Total Sample comprised 54 gamblers under treatment at the Gamblers Treatment Unit of PROAD/UNIFESP (Clinical Group); 71 participants from the general population assessed in a metropolitan train station of the city of São Paulo (Train Group); and 116 subjects recruited in a bingo house (Bingo Group). Factorial structure, internal consistency and psychometric properties of SOGS (sensibility, specificity, positive predictive value, negative predictive value and misclassification rate) and correlation among both instruments were verified. In the Total Sample women were older, divorced or widowed, did not work; they had chased, had had more discussions about money and had gambled to escape from problems or to relieve dysforic mood. Women bets were mostly concentrated in bingo whereas men bets were more diversified. The most frequent forms of gambling in lifetime were, in decreasing order: bingo, lotteries, sports, cards and electronic games. In the last year and last month frametime, bingo, lotteries and electronic games were the most frequent games. The prevalence of bingo and electronic games among PG is discussed. Differences in the SOGS scores among three groups were statistically significant, attesting good construct validity. The correlation between SOGS and DSM IV in the Total Sample was high (r = 0,854, p < 0.01) and the internal consistency measured by Cronbach\'s alpha was 0,75. Factor analysis resulted in a two-dimensional solution accounting for 56,7% of the total variance: a first factor composed by questions related to the gambling behavior of pathological gamblers and a second factor encompassing questions related to the sources of gambling money. Considering the Total Sample, validity measures were good: (sensibility = 100, specificity = 74,7, positive predictive value = 60,7, negative predictive value = 100 e misclassification rate =0,18). Elevating the cut score to 8 the number of false negatives is reduced (95,4, 89,8, 78,5 , 98, 0.09, respectively). The difference between the classification of pathological gamblers by SOGS and DSM IV was striking, as the proportion of pathological gamblers evaluated by SOGS, at the cut score 5, was much higher than the proportion evaluated by DSM IV in the Train Group (8,5% e 2,8%, respectively) and in Bingo Group (44% e 12%, respectively). It is argued that this difference may be an artifact of the cut score used. Thus, a suggestion is made that either the cut score should be changed from 5 to 8 or that a 12-month timeframe be employed. If the cut score 5 is maintained, then the result should be confirmed by clinical interview.

Prevalence studies around the world show that men are the largest group at risk of becoming problem gamblers and that men gamble more than women. However, gambling research has long been gender blind. The gambling market is rapidly changing, with the Internet making gambling more accessible. Further, despite the well-documented presence of health, social and financial problems among the concerned significant others (CSOs) of someone close with gambling problems in clinical and help-seeking samples, there is little research investigating on this population. This thesis aims to examine the relation between gender and problem gambling among regular gamblers and CSOs, and to determine whether there was a convergence of men’s and women’s gambling behavior between 1997/98 and 2009/10 in Sweden. A further aim is to examine health problems associated with Internet gambling and CSOs. The data collections were taken from three different but linked gambling and health representative national population based studies in Sweden, all using the same methods: telephone interviews supplemented by questionnaires. The studies are as follows: 1) prevalence study 1997/98, age 15-74 years, n = 10,000, response rate 72% (n = 7,139) 2) prevalence study 2008/09, age 16-84 years, n = 15,000, response rate 63% (n = 8,165); and 3) incident study 2009/10, the 8,165 participants from the 2008/09 prevalence study were contacted again, response rate 74% (n = 6,021). Gambling was generally merged into domains based on the axis chance-strategy and public-domestic. The dichotomy of public and private spheres is relevant in since there is a link between the public sphere and notions of masculinity and a link between the private and femininity. Further, the literature suggests that men are attracted to gambling that involves features of strategy, whereas women generally prefer game of chance. Problem gambling was measured using SOGS-R and PGSI. Health variables included measures such as self-reported health, psychological stress, social support, alcohol consumption, and financial situation as a determinant of health. There were very few indications of a convergence between men’s and women’s gambling behavior. Men and women generally gambled in different domains. Men gambled more than women and dominated all domains except the domain of chance-domestic, a domain associated with less risk and Internet gambling. However, men and women who gambled regularly were just as likely to be problem gamblers. No gender differences were found in the score from separate PGSI analyses in the chance-public domain (games of chance in public spaces, such as gambling machines and bingo in halls). This domain was also the only domain associated with problem gambling for women who gambled regularly. Men and women were just as likely to report that they were CSOs and they constituted a large proportion of the Swedish population (18%). CSOs experienced a range of social, economic and health related problems including psychological stress, risky alcohol consumption, exposure to violence, and separations. For women who were CSOs, no relation with own problem gambling was found. This thesis suggests that the presence of gambling machines must be addressed to prevent problem gambling and that separate analyses for men and women are required to identify important differences between genders. The findings indicate that gambling domains produce and reinforce gender. Further, to be able to prevent problem gambling we require further knowledge about these gendered processes. However, it is also important to see the overall similarities between men and women to avoid reinforcing stereotypical images of gender which would have an negative impact on the preventive work. Male and female gamblers are both very heterogeneous categories where the specific gambling site, context and life circumstances must be acknowledged. Prevention, research and interventions should also target CSOs if a public health approach is applied because they require help and support in their own right. CSOs also play an important to the problem gambler. More qualitative research is required to understand gendered processes in gambling, as well as further research on interventions that go beyond the individual and address gambling and problem gambling at various levels. When addressing the harmful effects of gambling from a public health perspective, it is imperative to recognize the ethical principles of justice, autonomy, doing no harm and beneficence. / -

O presente estudo teve como objetivo caracterizar o comportamento de jogadores que frequentam casas de bingo, videopoker e Jockey Club. Foram pesquisados 171 sujeitos, sendo 63 no Jockey Club, 65 em casas de bingo e 43 em casas de videopoker. Em cada categoria de jogo obtiveram-se 25 questionários classificados como jogadores patológicos pela escala SOGS. A maioria dos entrevistados eram de sexo masculino, casados, de religião católica, tinham 2o. grau ou superior completo e trabalhava em período integral. A média de idade foi de 40 anos e a mediana da renda foi R$ 4.000,00. Em ordem decrescente, os jogos mais praticados pelo menos uma vez na vida pelos jogadores pesquisados foram: loteria, bingo, cartas e corridas de cavalo. Jogadores patológicos e jogadores não patológicos não se diferenciaram quanto a nenhuma das características socio-demográficas pesquisadas, mas se diferenciaram quanto à prática de alguns jogos. Na vida, mais jogadores patológicos jogaram carta, em corridas de cavalo, videopoker e dados do que os não patológicos. Nos últimos 12 meses e nos últimos 30 dias, jogadores patológicos se diferenciaram por jogar mais videopoker. Esses jogadores também utilizaram mais dinheiro para apostar em um só dia, além declararem ter ganho quantias maiores de dinheiro no jogo. Quanto ao estado emocional relativo ao jogo, jogadores patológicos tendem a ficar mais ficam tensos antes de jogar e relatam sentimentos negativos durante e depois do jogo. Não patológicos sentem-se bem e tranquilos antes, relatam sentimentos neutros durante e positivos depois de jogar. Quando pararam de jogar por um tempo, jogadores patológicos relataram sentimentos negativos enquanto que os não patológicos relataram sentimentos neutros. Jogadores patológicos sentem mais falta do jogo quando param de jogar, mas poucos procuraram ajuda devido a problemas associados ao jogo. Pais de jogadores patológicos não se diferenciaram quanto ao fato de jogarem ou beberem demais de pais de jogadores não patológicos . Quando se analisa o uso de álcool e outras drogas, a única diferença significativa encontrada foi maior uso de tabaco na vida pelos jogadores patológicos. Os jogadores patológicos pesquisados no bingo, videopoker e Jockey Club foram também comparados entre si. As únicas diferenças significativas encontradas foram: presença de mais jogadores casados no bingo e jovens no videopoker; no Jockey Club, maior frequência de apostas em esportes, de discussão familiar por causa do dinheiro gasto no jogo e de empréstimo por agiotas. / In this study sociodemographic variables and gambling behavior of videopoker, bingo and horse-race gamblers were examined. One hundred seventy one subjects, 63 from the Jockey-Club of São Paulo, 65 from bingo clubs and 43 from videopoker clubs were administered a questionnaire adapted from the South Oacks Gambling Screen - SOGS, and 25 individuals of each group were classified as pathological gamblers. The majority of subjects were married catholic males, who had at least a high school degree and full-time jobs. Mean age was 40 years and median income was U$ 4000.00. In descending order, lottery, bingo, card games, and horse-race were the most frequent types of games played at least once by the subjects. Comparisons between pathological and non-pathological gamblers revealed no significant difference in any sociodemographic variables, but the two groups differed in their gambling activities. Pathological gamblers had played significantly more cards, bet on horses, played videopoker and dice games in their lives than the other group. Pathological gamblers also played significantly more videopoker in the previous month and previous year than non-pathological gamblers. They also bet more money in one day of gambling and also reported making more money from this activity than non-pathological gamblers. With respect to gambling-related emotions, pathological gamblers reported feeling tense before gambling and negative affects during and after gambling. The non-pathological group reported a sense of well being before gambling and neutral affects during and after it. Pathological-gamblers reported negative affects during periods when they stopped gambling, while neutral feelings were reported by the non-pathological group. The former also missed this activity more than the non-pathological group, but few sought help for problems associated with gambling. Gambling habits and alcohol use between parents of pathological and non-pathological gamblers were not significantly different. The two groups also did not differ in their use of alcohol and other drugs but tobacco, which was significantly more consumed in a lifetime by the pathological gambling subjects. Comparisons between bingo, videopoker and horse-race subgroups evidenced few significant differences. There were more married subjects in the bingo group and younger individuals in the videopoker group. The pathological gamblers interviewed at the Jockey Club reported higher frequency of bets in sports, of family arguments between family members because of the amount of money spent on gambling and more credit lines with bookies.