Trajectories Of Psychological Distress Research Articles

Informal caregiving patterns and trajectories of psychological distress in the UK Household Longitudinal Study.

Approximately seven million people in the UK are engaged in informal caregiving. Informal caregivers are at risk of poorer mental and physical health. However, less is known about how the relationship between the informal caregiving and psychological distress changes over time. The aim of this study was to investigate longitudinal associations between the informal caregiving and psychological distress amongst UK men and women aged 16+. Data were analysed from the UK Household Longitudinal Study (UKHLS, n = 9368), a nationally representative study of UK households. Longitudinal linear mixed modelling was used to estimate associations between the longitudinal patterns of informal caregiving (non-caregiver/one episode of 1-2 years/intermittent caregiving/3+ years caregiving) and trajectories of psychological distress across seven waves of UKHLS data. Informal caregiving was not associated with psychological distress for men. Women engaged in long-term (⩾3 years) or intermittent caregiving had higher levels of psychological distress at the point of initiation, compared with women who were not caregivers throughout the study period (3+ years caregiver: regression coefficient 0.48, 95% confidence interval (CI) 0.07-0.89; intermittent caregiver: regression coefficient 0.47, 95% CI 0.02-0.92). Trajectories of psychological distress changed little over time, suggesting a plateau effect for these caregiving women. Women engaged in long-term or repeated shorter episodes of informal caregiving reported more symptoms of psychological distress than non-caregiving women. Given the increased risk of reporting psychological distress and the increasing importance of the informal care sector, the risk of poorer mental health of informal caregivers should be a priority for public health.

Trajectories of Psychological Distress in Australians Living in Urban Poverty: The Impact of Interpersonal Trauma.

Childhood maltreatment and interpersonal trauma experience is an important factor underpinning the apparent perpetuation of the cycle of social disadvantage experienced by homeless adults. This paper aimed to examine longitudinal patterns of psychological distress in a sample of 1,504 socially disadvantaged adult participants from the Journeys Home Study in Australia. The current paper utilized the "conservation of resources" theory and the concept of "risk factor caravans" to investigate the nature and implications of childhood trauma in the context of homelessness. Growth mixture modeling revealed four distinct trajectories of psychological distress as measured by the Kessler 6 across six time points (covering a period of 2.5 years): chronic, escalating, attenuating, and resistant. Our results also indicated that experiences of different types of trauma during childhood were associated with these psychological distress trajectories. In particular, adults experiencing chronic psychological distress were significantly more likely than those exhibiting distress resistance to have experienced multiple and varied childhood maltreatment, adjusted odds ratio (AOR) = 3.30, 95% CI [0.37, 6.05], p = .002. Furthermore, adult experiences of assault were found to be associated with psychological distress. These findings have important implications for mental health, as well as interventions aimed at breaking the cycle of urban poverty. Specific focus on interpersonal trauma vulnerabilities is important. Prioritizing socioecological stability, with mental health needs assessed on an individual level, may be most appropriate. This work also highlights the need to direct future attention to barriers to access and facilitation of social support services.

Predictors of Psychological Distress Trajectories in the First Year After a Breast Cancer Diagnosis

PurposePsychological distress is a significant and ongoing problem for breast cancer. These mental health problems are often neglected as they are not always properly understood. This study was performed to explore the trajectory of psychological distress over 1 year since breast cancer surgery and to identify the associated factors for the trajectory. MethodsOne hundred seventeen women who underwent surgery for breast cancer completed the psychological distress thermometer and problem lists from after surgery to 12 months after surgery. Information on their sociodemographic and clinical characteristics was also obtained. Group-based trajectory modeling was performed to identify the distinct trajectories of psychological distress. Chi-square test and logistic regression analysis were performed to determine predictors of psychological distress trajectories. ResultsA two-group linear trajectory model was optimal for modeling psychological distress (Bayesian information criterion = −777.41). Group-based trajectory modeling identified consistently high-distress (19.4%) and low-decreasing distress (80.6%) trajectories. Old age, depression, nervousness, and pain were significant predictors of consistently high-distress trajectory. ConclusionOur results indicate that distinct trajectory groups can be used as a screening tool to identify patients who may be at an increased risk of psychological distress over time. Screening for psychological distress during disease diagnosis is important and necessary to identify patients who are at an increased risk of elevated distress or at risk of experiencing psychological distress over time.

Maternal psychological distress and child decision-making

BackgroundThere is much research to suggest that maternal psychological distress is associated with many adverse outcomes in children. This study examined, for the first time, if it is related to children's affective decision-making. MethodsUsing data from 12,080 families of the Millennium Cohort Study, we modelled the effect of trajectories of maternal psychological distress in early-to-middle childhood (3–11 years) on child affective decision-making, measured with a gambling task at age 11. ResultsLatent class analysis showed four longitudinal types of maternal psychological distress (chronically high, consistently low, moderate-accelerating and moderate-decelerating). Maternal distress typology predicted decision-making but only in girls. Specifically, compared to girls growing up in families with never-distressed mothers, those exposed to chronically high maternal psychological distress showed more risk-taking, bet more and exhibited poorer risk-adjustment, even after correction for confounding. Most of these effects on girls’ decision-making were not robust to additional controls for concurrent internalising and externalising problems, but chronically high maternal psychological distress was associated positively with risk-taking even after this adjustment. Importantly, this association was similar for those who had reached puberty and those who had not. LimitationsGiven the study design, causality cannot be inferred. Therefore, we cannot propose that treating chronic maternal psychological distress will reduce decision-making pathology in young females. ConclusionsOur study suggests that young daughters of chronically distressed mothers tend to be particularly reckless decision-makers.

Coronary heart disease and risk factors as predictors of trajectories of psychological distress from midlife to old age.

ObjectiveTo examine coronary heart disease (CHD) and its risk factors as predictors of long-term trajectories of psychological distress from midlife to old age.MethodsIn the Whitehall II cohort study, 6890 participants (4814 men, 2076 women; mean age 49.5 years) had up to seven repeat assessments of psychological distress over 21 years (mean follow-up 19 years). CHD and its risk factors (lifestyle-related risk factors, diabetes, hypertension and cholesterol) were assessed at baseline. Group-based trajectory modelling was used to identify clusters of individuals with a similar pattern of psychological distress over time.ResultsWe identified four trajectories of psychological distress over the follow-up: ‘persistently low’ (69% of the participants), ‘persistently intermediate’ (13%), ‘intermediate to low’ (12%) and ‘persistently high’ (7%). The corresponding proportions were 60%, 16%, 13% and 11% among participants with CHD; 63%, 15%, 12% and 10% among smokers and 63%, 16%, 12% and 10% among obese participants. In multivariable adjusted multinomial regression analyses comparing other trajectories to persistently low trajectory, prevalent CHD was associated with intermediate to low (OR 1.70, 95% CI 1.08 to 2.68) and persistently high (OR 1.92, 95% CI 1.16 to 3.19) trajectories. Smoking (OR 1.33, 95% CI 1.07 to 1.64; OR 1.55, 95% CI 1.19 to 2.04) and obesity (OR 1.33, 95% CI 1.04 to 1.70; OR 1.47, 95% CI 1.07 to 2.01) were associated with persistently intermediate and persistently high trajectories, respectively.ConclusionCHD, smoking and obesity may have a role in the development of long-lasting psychological distress from midlife to old age.

Maternal Psychological Distress and Offspring Psychological Adjustment in Emerging Adulthood: Findings from Over 18 Years.

To examine the long-term prediction of psychological maladaptive (i.e., symptoms of anxiety and depression) and adaptive adjustment (i.e., self-efficacy) in emerging adult offspring from trajectories of maternal psychological distress from toddlerhood to adolescence. Trajectories of maternal psychological distress (low, moderate, high, and low-rising patterns) from toddlerhood (age 1.5 years) to adolescence (age 14.5 years) were used to predict psychological adjustment in emerging adult offspring (age 18-20 years) (n = 400). Adverse maternal distress trajectories during childhood were linked to maladaptive and adaptive adjustment in adult offspring. Consistently high maternal distress levels experienced across childhood predicted higher symptoms of anxiety and depression and lower self-efficacy than low maternal distress trajectories. Two other adverse maternal distress trajectories (consistently moderate and low-rising patterns) compared with the low trajectory predicted higher offspring depressive symptoms. The findings persisted when adjusting for potential confounders: offspring gender and maternal education, relationship status, language, and economy. The current study showed longitudinal multi-informant impact from adverse maternal distress trajectories to adult offspring maladjustment over 18 years, emphasizing the importance of early identification and prevention.

Families Matter: Social Support and Mental Health Trajectories Among Lesbian, Gay, Bisexual, and Transgender Youth

PurposeLesbian, gay, bisexual, and transgender (LGBT) adolescents are at greater risk for mental health problems than their heterosexual peers, in part due to victimization. Social support, particularly from families, has been identified as an important promotive factor. However, little is known about how LGBT youth experience multiple forms of support or how early support predicts mental health across adolescence and into young adulthood. MethodsIn an analytic sample of 232 LGBT youth aged 16–20 years at baseline across 5.5 years, we compared developmental trajectories of psychological distress between three empirically derived social support cluster types at baseline: those who reported uniformly low support, those who reported uniformly high support, and those who reported nonfamily support (i.e., high peer and significant other but low family support). ResultsLongitudinal multilevel modeling, controlling for age, victimization, and social support at each wave, indicated key differences between cluster types. Youth in the low and nonfamily support clusters reported greater distress across all time points relative to youth in the high support cluster; however, they also showed a sharper decline in distress. Youth in the nonfamily cluster gained family support across adolescence, such that they resembled youth in the high support cluster by early adulthood. ConclusionsFindings underscore the importance of family support for LGBT youth. Youth who lack family support, but who have other forms of support, report a decrease in psychological distress and an increase in family support across adolescence. Youth who are low in all forms of support continue to exhibit high distress.

Predictors of severe psychological distress trajectory after nuclear disaster: evidence from the Fukushima Health Management Survey

ObjectivesThe Fukushima Daiichi Nuclear Power Plant accident, which occurred after the Great East Japan Earthquake and Tsunami in March 2011, may have a considerable long-term impact on the lives of...

How do social activities mitigate informal caregivers' psychological distress? Evidence from a nine-year panel survey in Japan.

BackgroundIt is well known that informal caregiving negatively affects caregivers’ mental health, while social activities improve mental health outcomes among middle-aged and elderly individuals. The goal of the present study was to examine how participation in social activities affected the trajectory of an informal caregiver’s psychological distress.MethodsWe used the data from a nationwide nine-wave panel survey of the middle-aged individuals (aged 50–59 years at baseline) in Japan conducted in 2005–13 (N = 24,193 individuals;12,352 women and 11,841 men), mainly focusing on the respondents beginning to provide informal caregiving during the survey period. We employed linear mixed-effects models to explain how the trajectory of psychological distress, measured by Kessler 6 (K6) scores, was associated with caregiving commencement and duration, as well as social activity participation.ResultsParticipation in social activities was associated with mitigated K6 scores at caregiving commencement by 66.2 and 58.2 % for women and men, respectively. After caregiving started, participation in social activities reduced the average rise in K6 scores, per year, by 65.6 and 89.6 % for women and men, respectively. We observed similar results when focusing on participation before caregiving commencement to avoid endogeneity problems.ConclusionResults suggest that participation in social activities can alleviate caregivers’ psychological distress. Policy measures to support social activities are recommended for the health and well-being of current and potential caregivers.

The influences of perceived social support and personality on trajectories of subsequent depressive symptoms in Taiwanese youth

Little is known about the combined effect of personality and social support on trajectories of depressive symptoms among youth. This study aims to investigate the influence of social support in different contexts on the development of depressive symptoms during adolescence and whether the association is moderated by adolescents' personality. The data using in this study is selected from the Taiwan Educational Panel Survey (TEPS), a longitudinal panel study since the year 2000 (at age 13) and three more waves (at ages 15, 17, and 18). A total of four waves of students' data (N = 4163) are analyzed using the latent growth models. The results indicate that the depressive symptom trajectory of Taiwan adolescents gradually grows in a quadratic curve. Social support in family context rather than school context was associated with depressive symptoms, while only a positive association is found between maternal support and depressive symptoms at the start. Meanwhile, increased extroversion personality is associated with the decreased initial level, increased linear changes, and decreased non-linear quadratic changes of adolescents' depressive symptoms. Further analyses show that a significant interaction between maternal support and extroversion personality is associated with increased non-linear quadratic growth curve of adolescents' depressive symptoms. In conclusion, adolescents' extroversion personality might moderate the effect of maternal support on developmental trajectory of depressive symptoms. Intervention that improves social support should take account for adolescent's personality, which may alter trajectory of psychological distress during adolescence.

Trajectories of psychological distress after prison release: implications for mental health service need in ex-prisoners.

Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community. The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage. We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours. For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.

A Longitudinal Study of Post-Traumatic Growth and Psychological Distress in Colorectal Cancer Survivors.

The stability of post-traumatic growth over time and the relationship between post-traumatic growth and traditional distress outcomes remains unclear. We tracked post-traumatic growth in a population-based sample of colorectal cancer patients from soon after diagnosis to five years subsequently to assess the heterogeneity of a post-traumatic growth response to cancer over time and describe the simultaneous and longitudinal relationships between post-traumatic growth and psychological distress. 1966 colorectal patients who were five months post diagnosis were assessed six times over a five year period. There was considerable heterogeneity associated with both psychological distress and benefit finding scores over time. However, both for benefit finding and psychological distress, the variation in individual scores suggested an underlying positive linear trend and both lagged and lagged change components. Specifically, benefit finding and psychological distress are mutual leading indicators of each other. First, benefit finding served as a leading indicator of distress, in that increases in reported benefit finding from year to year predicted higher future increases in psychological distress. As well, in an inverse relationship, psychological distress served as a leading indicator of benefit finding, such that increases in reported distress from year to year predicted lower future increases in benefit finding. Post-traumatic growth may reflect patients coping efforts to enhance perceptions of wellbeing in response to escalating cancer–related threats, acting as harbinger of increasing trajectories of psychological distress. This explanation is consistent with a cognitive dissonance response in which threats to the integrity of the self then lead to a tendency to accentuate positive aspects of the self.

Depressed Spousal Caregivers Have Psychological Stress Unrelated to the Progression of Alzheimer Disease: A 3-Year Follow-Up Report, Kuopio ALSOVA Study.

To explore family caregiver (FC) long-term psychological distress after Alzheimer disease (AD) diagnosis in a family member. FC (n = 236) and patients with AD were prospectively followed up to 36 months after AD diagnosis. FC psychological distress was evaluated using the General Health Questionnaire (GHQ). Furthermore, caregiver depressive symptoms and sense of coherence, along with AD patient measurements, were measured at baseline and annually. Generalized estimating equation models were applied to study associations of these baseline factors to caregiver GHQ. After 36 months of follow-up, spousal caregivers (SCs) GHQ was significantly higher (P < .001) than in the nonspousal caregivers (NSCs). The difference in GHQ scores was associated by depressive symptoms (P < .001) at baseline, and the depressed SCs have more severe distress than NSCs over the observation period. During longitudinal caregiving, spousal and depressed caregivers of patients with AD report higher and increasing psychological stress than nonspousal and nondepressed caregivers. Spousal relationship, caregivers' depressive symptoms, and the severity of patients' neuropsychological symptoms at the time of AD diagnosis predict the trajectory of psychological distress. The current study highlights the need for evaluating AD caregiver mental health and level of coping.

Understanding Resilience and Other Trajectories of Psychological Distress: a Mixed-Methods Study of Low-Income Mothers Who Survived Hurricane Katrina

Recent longitudinal studies in the aftermath of natural disasters have shown that resilience, defined as a trajectory of consistently low symptoms, is the modal experience, although other trajectories representing adverse responses, including chronic or delayed symptom elevations, occur in a substantial minority of survivors. Although these studies have provided insight into the prototypical patterns of postdisaster mental health, the factors that account for these patterns remain unclear. In the current analysis, we aimed to fill this gap through a mixed-methods study of female participants in the Resilience in Survivors of Katrina (RISK) study. Latent class growth analysis identified six trajectories of psychological distress in the quantitative sample (n=386). Qualitative analysis of in-depth interviews with 54 participants identified predisaster, disaster-related and postdisaster experiences that could account for the trends in the quantitative data. In particular, preexisting and gains in psychosocial resources (e.g., emotion regulation, religiosity) and positive postdisaster impacts (e.g., greater neighborhood satisfaction, improved employment opportunities) were found to underlie resilience and other positive mental health outcomes. Conversely, experiences of childhood trauma, and pre and postdisaster stressors (e.g., difficulties in intimate partner relationships) were common among participants in trajectories representing adverse psychological responses. Illustrative case studies that exemplify each trajectory are presented. The results demonstrate the utility of mixed-methods analysis to provide a richer picture of processes underlying postdisaster mental health.

Lean on me: susceptibility to partner affect attenuates psychological distress over a 12-month period.

Symptoms of psychological distress are associated with the experience of heightened negative affect, and the inability to successfully regulate one's emotions. Romantic partners can, however, influence and regulate each other's emotional experiences, especially during times of distress. Using daily diary measures taken 4 times per day over a 10-day period, we examined whether susceptibility to partner affect was associated with levels and trajectories of psychological distress over 12 months. Results from both partners of 103 committed relationships (206 individuals) found that men and women showed decreased levels of distress over the year when they were more susceptible to their partner's positive affect, but the degree of susceptibility varied with respect to negative affect. Examining susceptibility to partner affect may be a valuable complementary approach to studying relational contributions to the social regulation of emotions, especially in understanding the progression of psychological distress.

Identifying the prevalence, trajectory, and determinants of psychological distress in extremity sarcoma.

Objective. Extremity sarcoma (ES) is a rare cancer that presents with unique challenges. This study was performed to identify the prevalence, trajectory, and determinants of distress and characterise sources of stress in this cohort. Methods. Consecutive patients with ES were prospectively recruited between May 2011 and December 2012. Questionnaires were administered during initial diagnosis and then six months and one year after surgery. Results. Distress was reported by about a third of our cohort and associated with poorer physical function, poorer quality of life, and pain. In addition to fears regarding mortality and life role changes, the most common sources of stress were centered on dissatisfaction with the healthcare system, such as frustrations with a lack of communication with the hospital regarding appointments and lack of education regarding management and outcomes. Conclusions. Psychological distress presents early in the cancer journey and persists up to one year after surgery. Distress is associated with negative outcomes. Active screening and effective interventions are necessary to improve outcomes. Sources of stress have been identified that may be amenable to targeted interventions.

The influence of early sexual debut and pubertal timing on psychological distress among Taiwanese adolescents

This study examined the relative influence of early sexual debut (ESD) and pubertal timing on psychological distress from adolescence to young adulthood in Taiwan, a non-Western society with a distinct cultural and family context. Data were from a cohort sample of 15-year-olds (N = 2595) first interviewed in 2000, with four follow-ups during a 7-year period. Psychological distress was assessed by a reduced form of the Symptom Checklist-90 Revised. ESD was defined by first intercourse at age 15 or younger. Multivariate analyses via growth curve modeling found a greater increase in psychological distress over time in adolescents with ESD (β = .28, p < .05). Early-pubertal adolescents were at greater risk for the onset of psychological distress (β = .46, p < .05). Further, early pubertal adolescents with an ESD appeared to be especially likely to be distressed (β = 3.39, p < .05). In addition, analyses showed a non-linear trajectory of psychological distress between the ages of 15 and 22, with distress escalating (β = .45, p < .001) as age increased before tapering off as adolescents became young adults (β = −.03, p < .001). Results suggest the contributing influence of both ESD and pubertal timing on distress trajectories, independent of parental and family characteristics.

Beyond involvements in romantic and sexual relationships: effects of self-esteem and parental distress on trajectories of adolescent psychological distress

Adolescent psychological problems have often been associated with subsequent depression that contributes to the global disease burden. We propose initial levels of psychological distress and subsequent changes over the period between late adolescence and young adulthood are partly a consequence of adolescent self-esteem and parental distress, both of which may be at least as influential as teen involvement in romantic and sexual relationships. Data were from longitudinal surveys of Taiwanese adolescents at age 16 with three follow-ups over a 6-year time period (n = 2314). Psychological distress was assessed by Symptom Checklist-90 Revised. Growth curve models were used to predict the relationships between adolescent self-esteem, parental distress, and trajectories of adolescent distress, after taking early involvement in romantic and sexual relationships, risky behaviors, and influence of peers, school, and family into account. After a wide range of adjustments, the multivariate analyses indicated that positive self-esteem was associated with diminished initial levels of psychological distress in adolescents (β = −0.04, p < 0.05) and also ameliorates their psychological distress over time (β = −0.01, p < 0.01). In contrast, parental distress was not significantly associated with initial measurement of adolescent distress, but parental distress did exacerbate adolescent distress over time (β = 0.01, p < 0.001). In addition, living with both biological parents and having a high level of family cohesion were associated with lower levels of psychological distress. Early involvement in sexual and romantic relationships and risky behaviors of adolescents and their close friends were strongly related to higher levels of psychological distress. These results underscore the importance of an integrated psychosocial perspective. Policies and educational interventions aimed at promoting adolescent psychological well-being are recommended.

Neurobehaviour between birth and 40 weeks' gestation in infants born

BackgroundInfants born <30 weeks’ gestation are at increased risk of long term neurodevelopmental problems compared with term born peers. The predictive value of neurobehavioural examinations at term equivalent age in very preterm infants has been reported for subsequent impairment. Yet there is little knowledge surrounding earlier neurobehavioural development in preterm infants prior to term equivalent age, and how it relates to perinatal factors, cerebral structure, and later developmental outcomes. In addition, maternal psychological wellbeing has been associated with child development. Given the high rate of psychological distress reported by parents of preterm children, it is vital we understand maternal and paternal wellbeing in the early weeks and months after preterm birth and how this influences the parent–child relationship and children’s outcomes. Therefore this study aims to examine how 1) early neurobehaviour and 2) parental mental health relate to developmental outcomes for infants born preterm compared with infants born at term.Methods/DesignThis prospective cohort study will describe the neurobehaviour of 150 infants born at <30 weeks’ gestational age from birth to term equivalent age, and explore how early neurobehavioural deficits relate to brain growth or injury determined by magnetic resonance imaging, perinatal factors, parental mental health and later developmental outcomes measured using standardised assessment tools at term, one and two years’ corrected age. A control group of 150 healthy term-born infants will also be recruited for comparison of outcomes. To examine the effects of parental mental health on developmental outcomes, both parents of preterm and term-born infants will complete standardised questionnaires related to symptoms of anxiety, depression and post-traumatic stress at regular intervals from the first week of their child’s birth until their child’s second birthday. The parent–child relationship will be assessed at one and two years’ corrected age.DiscussionDetailing the trajectory of infant neurobehaviour and parental psychological distress following very preterm birth is important not only to identify infants most at risk, further understand the parental experience and highlight potential times for intervention for the infant and/or parent, but also to gain insight into the effect this has on parent–child interaction and child development.

Factors associated with trajectories of psychological distress for Australian fathers across the early parenting period

Little is known about the course of fathers' psychological distress and associated risk factors beyond the postnatal period. Therefore, the current study aimed to: (a) assess the course of distress over 7 years postnatally; (b) identify classes of fathers defined by their symptom trajectories; and (c) identify early postnatal factors associated with persistent symptoms. Data from 2,470 fathers in the Longitudinal Study of Australian Children were analysed using latent growth modelling. Fathers' psychological distress was assessed using the Kessler-6 (Kessler et al. in Arch Psychiatry 60:184-189, 2003) when their children were aged 0-1, 2-3, 4-5 and 6-7 years. Overall, distress was highest in the first postnatal year and then decreased over time. Two distinct trajectories were identified. The majority of fathers (92%) were identified as having minimal distress in the first postnatal year which decreased over time, whilst 8% had moderate distress which increased over time. Low parental self-efficacy, poor relationship and job quality were associated with 'persistent and increasing distress'. Early postnatal factors associated with fathers' persistent distress were identified, providing opportunities for early identification and targeted early intervention.