vertical amplitude of the head (FD: M=35.28 mm, SD=8.80;ND: M=40.08 mm, SD=7.23, t[50]=−2.16, Pb.05). Incontrast, differences in arm swing, posture, and lateralbody sway were small and nonsignificant.

Dependent t tests revealed that posttreatment patientshad normalized their walking speed (baseline: M=1.16,SD=0.12; posttreatment: M=1.21, SD=0.13, t[19]=2.64,Pb.01) and showed reduced lateral body sway (baseline:M=36.55, SD=10.26; posttreatment: M=34.46, SD=10.37,t[19]=3.39, Pb.01). The increase in vertical movements ofthe upper body showed a marginally significant trend(baseline: M=35.60, SD=8.95; posttreatment: M=37.72,SD=9.20, t[19]=1.52, Pb.08). Changes in arm swing andposture were small and nonsignificant.

Our results revealed that FD individuals continued toshow deviations in two of the five characteristics moststrongly differentiating gait of currently and ND individuals[6]. Limitations of our study should be noted. First, the smallsample size might have reduced the power to detect moresubtle changes in gait characteristics. Moreover, because ofthe uncontrolled nature of our design, changes in gaitpatterns cannot be attributed unambiguously to the effectof MBCT.

Keeping these methodological limitations in mind, weconclude that our study provides preliminary evidence thatMBCT has normalizing effects on gait patterns of FDindividuals. Even though the sizes of these changes weresmall, FD patients approximately halved the discrepancybetween their performance and that of normal controls withregard to speed and vertical head movements. Thisnormalization might be part of the causal chain that helpspatients deescalate mood/body vicious cycles that lead todepressive relapse.

Johannes MichalakRuhr-University Bochum

GermanyE-mail address: johannes.michalak@rub.de

Nikolaus F. TrojeQueen's College

Kingston, Ontario, Canada

Thomas HeidenreichUniversity of Applied Sciences

Esslingen, Germany

doi:10.1016/j.jpsychores.2010.01.004

References

[1] Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitivetherapy for depression: a new approach to preventing relapse. NewYork: Guilford Press; 2002.

[2] Teasdale JD, Segal ZV, Williams JMG, Ridgeway VA, Soulsby J, LauMA. Prevention of relapse/recurrence in major depression bymindfulness-based cognitive therapy. J Consul Clin Psychol 2000;68:615–23.

[3] Ma SH, Teasdale JD. Mindfulness-based cognitive therapy fordepression: replication and exploration of differential relapse preven-tion effects. J Consul Clin Psychol 2004;72:31–40.

[4] Kuyken W, Byford S, Taylor RS, Watkins E, Holden E, White K,et al. Mindfulness-based cognitive therapy to prevent relapse inrecurrent depression. J Consul Clin Psychol 2008;76:966–78.

[5] Niedenthal PM. Embodying emotion. Science 2007;316:1002–5.[6] Michalak J, Troje N, Fischer J, Vollmar P, Heidenreich T,

Schulte D. The embodiment of sadness and depression—gaitpatterns associated with dysphoric mood. Psychosom Med 2009;71:580–7.

[7] Michalak J, Heidenreich T, Meibert P, Schulte D. Mindfulnesspredicts relapse/recurrence in major depressive disorder followingmindfulness-based cognitive therapy. J Nerv Ment Dis 2008;196:630–3.

[8] Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M. SKID I.Strukturiertes klinisches interview für DSM-IV. Göttingen: Hogrefe;1997.

[9] Troje NF. Decomposing biological motion: a framework foranalysis and synthesis of human gait patterns. J Vis 2002;2:371–87.

[10] Troje NF. Retrieving information from human movement patterns. In:Shipley TF, Zacks JM, editors. Understanding events: how humanssee, represent, and act on events. New York: Oxford University Press,2008. p. 308–34.

The HSCL-20: One questionnaire, two versions

To the Editor:

The Hopkins Symptom Checklist Depression Scale(HSCL-20) is a widely used 20-item self-rated measureof depression severity, often assumed to be a subscale ofthe HSCL-90 [1]. Patients complete the HSCL-20 byreporting how distressed they have been by each of thelisted symptoms over the preceding 2 weeks, using a five-point scale that ranges from “not at all” to “extremely.” Itsease of administration and face validity have made theHSCL-20 a popular choice for researchers, and it has beenused as a measure of depression severity in a number ofmajor clinical trials of depression management, particularlythose carried out in primary care and in nonpsychiatricsettings [2–6].

During the course of our own research, we havediscovered that two different versions of this scale are inuse; 14 items are common to both but six differ. Table 1shows the items included in each version and the origin ofeach item. Both versions have discriminated betweentreatment groups in clinical trials and have been shown tohave reasonably good psychometric characteristics whencompared to another commonly used depression measure[7,8]. However, we are unaware of any studies that havecompared the two versions directly.

Meaningful comparisons of psychiatric research, partic-ularly those that use data-pooling meta-analysis, rely on theuse of standardized measures. We therefore recommend thatresearchers are clear which version they are using and

313Letters to the Editor / Journal of Psychosomatic Research 68 (2010) 311–314

suggest referring to the scale as SCL-20 version “A” or “B”by reference to the table shown here.

Jane WalkerMichael Sharpe

Psychological Medicine ResearchThe University of Edinburgh, UK

E-mail address: jane.walker@ed.ac.uk

Kurt KroenkeRegenstrief Institute Indiana University, USA

Gordon MurrayPublic Health Sciences

The University of Edinburgh, UK

doi:10.1016/j.jpsychores.2009.11.002

References

[1] Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. TheHopkins Symptom Checklist (HSCL). A measure of primary symptomdimensions. Mod Probl Pharmacopsychiatry 1974;7:79–110.

[2] Williams JW, Barrett J, Oxman T, Frank E, Katon W, Sullivan M, et al.Treatment of dysthymia and minor depression in primary care:A randomized controlled trial in older adults. JAMA 2000;284:1519–26.

[3] Dietrich AJ, Oxman TE, Williams JW, Schulberg HC, Bruce ML,Lee PW, et al. Re-engineering systems for the treatment ofdepression in primary care: cluster randomised controlled trial.BMJ 2004;329:602.

[4] Kroenke K, Bair M, Damush T, Hoke S, Nicholas G, Kempf C, et al.Stepped Care for Affective Disorders and Musculoskeletal Pain(SCAMP) study: design and practical implications of an interventionfor comorbid pain and depression. Gen Hosp Psychiatry 2007;29:506–17.

[5] Unutzer J, KatonW, CallahanCM,Williams JW,Hunkeler E, Harpole L,et al. Collaborative care management of late-life depression in theprimary care setting: a randomized controlled trial. JAMA 2002;288:2836–45.

[6] Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, et al.Management of depression for people with cancer (SMaRT oncology 1):a randomised trial. Lancet 2008;372:40–8.

[7] Lee PW, Schulberg HC, Raue PJ, Kroenke K. Concordance between thePHQ-9 and the HSCL-20 in depressed primary care patients. J AffectDisord 2007;99:139–45.

[8] Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoringdepression treatment outcomes with the patient health questionnaire-9.Med Care 2004;42:1194–201.

Table 1Two versions of the HSCL-20

Common items Different items

Feeling hopeless about the future a Version AFeeling no interest in things a Feeling lonely a

Thoughts of ending your life a Feeling blue a

Feeling low in energy or slowed down a Loss of sexual interest or pleasure a

Feeling everything is an effort a Crying easily a

Blaming yourself for things a Feeling of being trapped or caught a

Feelings of worthlessness a Worrying too much about things a

Feelings of guilt b Version BPoor appetite b Trouble concentrating c

Overeating b Difficulty making decisions c

Trouble falling asleep b Feeling so restless you could not sit still c

Awakening in the early morning b Feeling lonely or blue d

Sleep that is restless or disturbed b Inability to take pleasure in things e

Thoughts of death or dying b Thinking, speaking, and moving at a slower pace e

a Items from depression dimension of HSCL-90.b “Additional items” from HSCL-90-revised.c Items from anxiety and obsessive–compulsive dimensions of HSCL-90.d Item combining two depression dimension items from HSCL-90.e Items from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for major depression (not part of HSCL-90).

314 Letters to the Editor / Journal of Psychosomatic Research 68 (2010) 311–314