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Rocky Mountain MIRECC for Suicide Prevention

Updated: 7 July 2017


Amy Starosta, PhD
Psychology Postdoctoral Fellow
Contact information:
303.399.8020 5175
Amy Starosta earned her Ph.D. in Clinical Psychology from the University at Albany, State University of New York in 2015 following the completion of a clinical internship at Denver Health Medical Center. Dr. Starosta’s primary research interests are focused on the intersection of biopsychosocial factors that impact the experience and treatment of chronic pain across the developmental lifespan. Currently, she is conducting research examining the psychoneuroimmunological mechanisms of chronic pain, TBI, and PTSD and their impact on suicide risk. Previously, Dr. Starosta has conducted research on cancer related pain, risky sexual behavior, and prostate cancer screening.
Dr. Starosta joined the Rocky Mountain MIRECC as a Postdoctoral Fellow in September 2015. She also holds an academic appointment with the Departments of Psychiatry and Physical Medicine and Rehabilitation at the University of Colorado School of Medicine.

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Recent Publications

Brenner LA, Stearns-Yoder KA, Hoffberg AS, Penzenik ME, Starosta AJ, Hernández TD, Hadidi DA, Lowry CA. Growing literature but limited evidence: A systematic review regarding prebiotic and probiotic interventions for those with traumatic brain injury and/or posttraumatic stress disorder. Brain Behav Immun. 2017 Jun 9. pii: S0889-1591(17)30192-7. doi: 10.1016/j.bbi.2017.06.003.
Traumatic brain injury (TBI) is highly prevalent among a wide range of populations, including civilians, military personnel, and Veterans. TBI sequelae may be further exacerbated by symptoms associated with frequently occurring comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD). This is particularly true among the population of military personnel from recent conflicts in Iraq and Afghanistan, with a history of mild TBI (mTBI) and PTSD. The need for efficacious treatments for TBI and comorbid PTSD is significant, and evidence-based interventions for these frequently co-occurring conditions are limited. Based on findings suggesting that inflammation may be an underlying mechanism of both conditions, anti-inflammatory/immunoregulatory agents, including probiotics, may represent a novel strategy to treat TBI and/or PTSD-related symptoms. The focus of this systematic review was to identify and evaluate existing research regarding prebiotic and probiotic interventions for the populations of individuals with a history of TBI and/or PTSD. Only 4 studies were identified (3 severe TBI, 1 PTSD, 0 co-occurring TBI and PTSD). Although findings suggested some promise, work in this area is nascent and results to date do not support some claims within the extensive coverage of probiotics in the popular press. Published by Elsevier Inc.
KEYWORDS: Bifidobacteria; Lactobacilli; PTSD; Persistent post-concussive symptoms; Posttraumatic stress disorder; Prebiotic; Probiotic; Synbiotic; Systematic review; TBI; Traumatic brain injury
Dombi E, Baldwin A, Marcus LJ, Fisher MJ, Weiss B, Kim A, Whitcomb P, Martin S, Aschbacher-Smith LE, Rizvi TA, Wu J, Ershler R, Wolters P, Therrien J, Glod J, Belasco JB, Schorry E, Brofferio A, Starosta AJ, Gillespie A, Doyle AL, Ratner N, Widemann BC. Activity of Selumetinib in Neurofibromatosis Type 1-Related Plexiform Neurofibromas. N Engl J Med. 2016 Dec 29;375(26):2550-2560. doi:10.1056/NEJMoa1605943.
Background Effective medical therapies are lacking for the treatment of neurofibromatosis type 1-related plexiform neurofibromas, which are characterized by elevated RAS-mitogen-activated protein kinase (MAPK) signaling. Methods We conducted a phase 1 trial of selumetinib (AZD6244 or ARRY-142886), an oral selective inhibitor of MAPK kinase (MEK) 1 and 2, in children who had neurofibromatosis type 1 and inoperable plexiform neurofibromas to determine the maximum tolerated dose and to evaluate plasma pharmacokinetics. Selumetinib was administered twice daily at a dose of 20 to 30 mg per square meter of body-surface area on a continuous dosing schedule (in 28-day cycles). We also tested selumetinib using a mouse model of neurofibromatosis type 1-related neurofibroma. Response to treatment (i.e., an increase or decrease from baseline in the volume of plexiform neurofibromas) was monitored by using volumetric magnetic resonance imaging analysis to measure the change in size of the plexiform neurofibroma. Results A total of 24 children (median age, 10.9 years; range, 3.0 to 18.5) with a median tumor volume of 1205 ml (range, 29 to 8744) received selumetinib. Patients were able to receive selumetinib on a long-term basis; the median number of cycles was 30 (range, 6 to 56). The maximum tolerated dose was 25 mg per square meter (approximately 60% of the recommended adult dose). The most common toxic effects associated with selumetinib included acneiform rash, gastrointestinal effects, and asymptomatic creatine kinase elevation. The results of pharmacokinetic evaluations of selumetinib among the children in this trial were similar to those published for adults. Treatment with selumetinib resulted in confirmed partial responses (tumor volume decreases from baseline of ≥20%) in 17 of the 24 children (71%) and decreases from baseline in neurofibroma volume in 12 of 18 mice (67%). Disease progression (tumor volume increase from baseline of ≥20%) has not been observed to date. Anecdotal evidence of decreases in tumor-related pain, disfigurement, and functional impairment was observed. Conclusions Our early-phase data suggested that children with neurofibromatosis type 1 and inoperable plexiform neurofibromas benefited from long-term dose-adjusted treatment with selumetinib without having excess toxic effects. (Funded by the National Institutes of Health and others; number, NCT01362803 .).
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Martin, S., Wolters, P., Toledo-Tamula, M., Nelson-Schmitt, S., Baldwin, A., Starosta, A.J., Gillespie, A., & Widemann, B. (2016). Acceptance and Commitment Therapy in Youth with Neurofibromatosis Type 1 and Chronic Pain and their Parents: A Pilot Study. American Journal of Medical Genetics Part A, 170(6), 1462-1470 doi: 10.1002/ajmg.a.37623.
Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting about 1 in 3,500 individuals. Chronic pain is commonly reported among individuals with NF1 and plexiform neurofibroma tumors (PNs). Acceptance and Commitment Therapy (ACT), an empirically supported method for addressing chronic pain, helps individuals re-focus on valued relationships and activities. This pilot study investigated the feasibility and preliminary efficacy of a brief ACT workshop in the NF1 population. Eligible participants included adolescents and young adults (AYA; 12-21 years) with NF1 and chronic pain that interfered with daily functioning and their parents. Patients and parents completed baseline measures of pain interference, pain intensity, functional disability, pain acceptance, depression, and anxiety. Then, AYA and parents participated separately in a 2-day small-group ACT workshop. A telephone booster session occurred 1 month post-intervention. Three-month post-treatment measures were completed by mail. Ten adolescents (4 males; M age = 16.9 years) and seven parents provided baseline and 3-month data. Mean satisfaction with the study was moderate to high (3.9 for patients and 4.6 for parents on a 1-5 scales). Patients and parents reported significant declines in patients' pain interference at 3 months post-treatment. Patient-reported pain intensity significantly declined from baseline to 3 months. Parents reported marginally greater acceptance of their child's pain. No changes emerged in functional ability or mood. Preliminary findings suggest that a brief ACT group intervention is feasible and may help AYA with NF1 and PNs cope with their chronic pain, although larger randomized studies are needed to confirm treatment efficacy. © 2016 Wiley Periodicals, Inc. KEYWORDS: Neurofibromatosis 1; acceptance; adolescents and young adults; mindfulness; parents
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Taylor, K.L, Hoffman, R.M., Davis, K.M., Luta, G., Leimpeter, A., Lobo, T., Kelly, S.P., Shan, J. Aaronson, D., Tomko, C.A., Starosta, A.J., Hagerman, C., and Van Den Eeden S.K. (2016). Treatment Preferences for Active Surveillance vs. Active Treatment Among Men with Low-Risk Prostate Cancer. Cancer Epidemiology, Biomarkers, & Prevention, cebp-1079 DOI: 10.1158/1055-9965.EPI-15-1079 .
BACKGROUND: Due to the concerns about the overtreatment of low-risk prostate cancer, active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making factors associated with treatment preferences. METHODS: In a longitudinal cohort study, we conducted pretreatment telephone interviews (N = 1,140, 69.3% participation) with newly diagnosed, low-risk prostate cancer patients (PSA ≤ 10, Gleason ≤ 6) from Kaiser Permanente Northern California. We assessed psychological and decision-making variables, and treatment preference [AS, AT, and No Preference (NP)]. RESULTS: Men were 61.5 (SD, 7.3) years old, 24 days (median) after diagnosis, and 81.1% white. Treatment preferences were: 39.3% AS, 30.9% AT, and 29.7% NP. Multinomial logistic regression revealed that men preferring AS (vs. AT) were older (OR, 1.64; CI, 1.07-2.51), more educated (OR, 2.05; CI, 1.12-3.74), had greater prostate cancer knowledge (OR, 1.77; CI, 1.43-2.18) and greater awareness of having low-risk cancer (OR, 3.97; CI, 1.96-8.06), but also were less certain about their treatment preference (OR, 0.57; CI, 0.41-0.8), had greater prostate cancer anxiety (OR, 1.22; CI, 1.003-1.48), and preferred a shared treatment decision (OR, 2.34; CI, 1.37-3.99). Similarly, men preferring NP (vs. AT) were less certain about treatment preference, preferred a shared decision, and had greater knowledge. CONCLUSIONS: Although a substantial proportion of men preferred AS, this was associated with anxiety and uncertainty, suggesting that this may be a difficult choice. IMPACT: Increasing the appropriate use of AS for low-risk prostate cancer will require additional reassurance and information, and reaching men almost immediately after diagnosis while the decision-making is ongoing. Cancer Epidemiol Biomarkers Prev; 25(8); 1240-50. ©2016 AACR. ©2016 American Association for Cancer Research.
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Dunn, T. M., Gibbs, J., Whitney, N. and Starosta, A. (2016). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eating and Weight Disorders: Studies in Anorexia, Bulimia and Obesity, 1-8. DOI: 10.1007/s40519-016-0258-8.
PURPOSE: Orthorexia nervosa, or pathological dieting based on being "healthy," has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample. METHOD: The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health. RESULTS: While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category. CONCLUSION: As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition. KEYWORDS: Eating disorders; ORTO-15; Orthorexia nervosa; Pathological healthful eating
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Driskell, L. D., Starosta, A. J., & Brenner, L. A. (2016) Clinical Utility and Measurement Characteristics of the Hospital Anxiety and Depression Scale for Individuals with Traumatic Brain Injury. Rehabilitation Psychology, 61(2), 112-113. DOI: 10.1037/rep0000079
This Rehabilitation Measures Database summary provides a review of the psychometric properties of the HADS in individuals with TBI. A full review of the HADS as well as reviews of over 330 other instruments can be found at © 2016 APA, all rights reserved).
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Starosta, A. J., Cranston, E., & Earleywine, M. (2015). Safer Sex in a Digital World: A Web-based Motivational Enhancement Intervention to Increase Condom Use Among College Women. Journal of American College Health, 64(3), 184-193. DOI: 10.1080/07448481.2015.1107835
OBJECTIVE: This study is a randomized trial of a Web-based intervention to increase condom use among college women. PARTICIPANTS: From October 2012 to March 2013, N = 422 completed baseline questionnaires and intervention procedures. n = 216 completed 3-month follow-up. METHODS: Participants completed a decisional balance exercise examining their sex acts over the past 3 months and wrote an essay encouraging young girls to use condoms. All procedures were conducted online. RESULTS: The intervention improved intentions to use and attitudes towards condoms for 3 subscales of condom attitudes. Attitudes following the intervention significantly predicted condom use at 3-month follow-up, and this relationship was mediated by condom intentions immediately post intervention. The relationship between intentions and condom use was moderated by group. CONCLUSIONS: The intervention improved condom attitudes and intentions immediately post intervention, and immediately post intervention intentions had a greater impact on condom use at 3-month follow-up among those in the condom intervention compared with those in the control group. KEYWORDS: Condom use; health education; online interventions; safer sex
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Starosta, A.J., Luta, G., Tomko, C.A., Schwartz, M.D., & Taylor K.L. (2015). Baseline attitudes about prostate cancer screening moderate the impact of decision aids on screening rates. Annals of Behavioral Medicine, 49(5), 762-768. DOI: 10.1007/s12160-015-9692-5
BACKGROUND: The impact of decision aids on prostate cancer screening outcomes has been inconsistent. PURPOSE: We assessed whether pre-existing attitudes moderated the impact of decision aids on screening. METHODS: Men aged 45-70 (56.2% Caucasian, 39.9% African-American) were randomly assigned to a print decision aid (N = 630), a web decision aid (N = 631), or usual care (N = 632). Telephone interviews assessed pro/con screening attitudes and screening behaviors at baseline, 1-month and 13-months post-randomization. RESULTS: Logistic regression analyses revealed significant arm by attitude interactions: Higher baseline cons scores predicted lower screening in the print (OR = 0.60 (95% CI: 0.40, 0.92)) and web (OR = 0.61 (95% CI: 0.40, 0.91)) arms but not in usual care (OR = 1.34 (95% CI: 0.90, 2.00)). CONCLUSIONS: The decision aids amplified the impact of men's baseline attitudes about limitations of screening: Compared to the usual care arm, men in both decision aid arms were less likely to be screened when they perceived more limitations of screening.
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Starosta, A. J. & Earleywine, M. (2014). Assessing base rates of sexual behavior using the unmatched count technique. Health Psychology and Behavioral Medicine: an Open Access Journal, 2(1), 198-210. DOI: 10.1080/21642850.2014.886957
Estimating the prevalence of sexual behaviors is difficult because of self-report biases. This is particularly relevant in assessing high-risk sexual behaviors for the purpose of reducing the transmission and acquisition of sexually transmitted infections (STIs) and HIV/AIDS. The present study employed the unmatched count technique (UCT), which provides estimates of the prevalence of risky sexual behaviors without requiring participants to confess to socially undesirable or stigmatized behaviors. Compared to a standard, anonymous self-report questionnaire, the UCT protocol revealed that people were less likely to notify their partners about STIs or discuss their history of sexual experiences. Effects were particularly large in women suggesting that women may be more likely to misrepresent their sexual behaviors. The findings suggest that conventional, anonymous self-report questionnaire data of base rates of risky sexual behavior and sexual communication are consistently inaccurate. These discrepant base rates suggest that the UCT might provide a better estimate of the frequency of these behaviors. Results suggest that inconsistent sexual behavior is more rampant than anonymous questionnaires suggest. They also underscore the need for improvements in the anonymity of assessment of sexual behaviors, which could in turn improve the targeting of prevention efforts. Results have important public health implications because accurate assessment of sexual behaviors is crucial for developing effective STI prevention interventions among target populations. KEYWORDS: HIV/AIDS; mixed-methods research; sexual and reproductive health
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Starosta, A. J., Berghoff, C., & Earleywine, M. (2014). Factor Structure and Gender Stability in the Multidimensional Condom Attitudes Scale. Assessment 22(3), 374-384. DOI: 10.1177/1073191114547887
Sexually transmitted infections continue to trouble the United States and can be attenuated through increased condom use. Attitudes about condoms are an important multidimensional factor that can affect sexual health choices and have been successfully measured using the Multidimensional Condom Attitudes Scale (MCAS). Such attitudes have the potential to vary between men and women, yet little work has been undertaken to identify if the MCAS accurately captures attitudes without being influenced by underlying gender biases. We examined the factor structure and gender invariance on the MCAS using confirmatory factor analysis and item response theory, within-subscale differential item functioning analyses. More than 770 participants provided data via the Internet. Results of differential item functioning analyses identified three items as differentially functioning between the genders, and removal of these items is recommended. Findings confirmed the previously hypothesized multidimensional nature of condom attitudes and the five-factor structure of the MCAS even after the removal of the three problematic items. In general, comparisons across genders using the MCAS seem reasonable from a methodological standpoint. Results are discussed in terms of improving sexual health research and interventions. ©The Author(s) 2014. KEYWORDS: Multidimensional Condom Attitudes Scale; condom attitudes; condoms; confirmatory factor analysis; differential item functioning (DIF)
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Hobkirk, A., Starosta, A. J., De Leo, J. Marra, C. M., Earleywine, M. & the CHARTER Group (2014). Psychometric validation of the BDI-II among HIV-positive CHARTER Study participants. Psychological Assessment, 27(2), 457-466. DOI: 10.1037/pas0000040
Rates of depression are high among individuals living with HIV. Accurate assessment of depressive symptoms among this population is important for ensuring proper diagnosis and treatment. The Beck Depression Inventory-II (BDI-II) is a widely used measure for assessing depression, however its psychometric properties have not yet been investigated for use with HIV-positive populations in the United States. The current study was the first to assess the psychometric properties of the BDI-II among a large cohort of HIV-positive participants sampled at multiple sites across the United States as part of the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. The BDI-II test scores showed good internal consistency (α = .93) and adequate test-retest reliability (internal consistency coefficient = 0.83) over a 6-mo period. Using a "gold standard" of major depressive disorder determined by the Composite International Diagnostic Interview, sensitivity and specificity were maximized at a total cut-off score of 17 and a receiver operating characteristic analysis confirmed that the BDI-II is an adequate diagnostic measure for the sample (area under the curve = 0.83). The sensitivity and specificity of each score are provided graphically. Confirmatory factor analyses confirmed the best fit for a three-factor model over one-factor and two-factor models and models with a higher-order factor included. The results suggest that the BDI-II is an adequate measure for assessing depressive symptoms among U.S. HIV-positive patients. Cut-off scores should be adjusted to enhance sensitivity or specificity as needed and the measure can be differentiated into cognitive, affective, and somatic depressive symptoms. © 2015 APA, all rights reserved).
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Research Projects

Immune Activation and the Polytrauma Clinical Triad Research Study
Research Study Leader: Amy Starosta, PhD
Research Study Co-Leader: Lisa Brenner, PhD
Description: This a cross-sectional study examining the relationship between inflammation and symptoms of chronic pain, post-traumatic stress disorder, and persistent post concussive symptoms following traumatic brain injury. We are seeking male Veterans between the ages of 18-45 to attend one study session at the Denver VA. Participants will complete questionnaires and provide a blood sample.
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