Trajectories Of Distress Research Articles

A prospective study of the impact of child maltreatment and friend support on psychological distress trajectory: From adolescence to emerging adulthood

BackgroundTransition into adulthood is a critical developmental period that may be influenced by adverse life events as well as by protective factors. This study aimed at investigating the effect of different forms of child maltreatment experienced prior to age 14 (i.e., sexual abuse, physical abuse and exposure to intimate partner violence), and of friend support at age 14 on the psychological distress trajectory from age 14 to 24. MethodsParticipants were 605 adolescents from the general population involved in a 10-year longitudinal study. Psychological distress was evaluated at ages 14, 16, 18 and 24. Child maltreatment prior to 14 years was retrospectively assessed at 14 and 24 years while perception of support from friends was evaluated at age 14. ResultsMultilevel growth modeling indicated that psychological distress followed a significant decreasing curvilinear trajectory, with participants reporting fewer distressing psychological symptoms after 18 years. All three forms of child maltreatment, as well as their cumulative effect, predicted more psychological distress over 10 years above and beyond the protective effect of support from friends. Higher support from friends at age 14 was related to lower distress at baseline andover 10 years, beyond the effect of child maltreatment. LimitationsSelf-report nature of all measures, attrition, and measures of child maltreatment forms. ConclusionsPsychological distress decreased during the transition from adolescence to emerging adulthood. Results also revealed the detrimental impact of child maltreatment and the promotive role of friend support, which underscore the importance of early intervention.

Predictors of Prolonged Grief, Resilience, and Recovery Among Bereaved Spouses.

Most reactions to loss can be characterized by three prototypical trajectories of resilience, gradual recovery, and chronic distress (Bonanno, ). However, research on the factors that uniquely predict these trajectories of response has been limited. We examined theoretically relevant predictors of each of the trajectory patterns. We assessed 115 bereaved spouses at 1.5 to 3 years postloss and 74 married controls. To identify grief trajectory, we provided bereaved participants with a graphical depiction of the trajectories and asked them to select the one that best described their experience. Group comparisons revealed substantial differences between resilient and prolonged grievers, and almost no differences between resilient and married controls. Multivariate analyses indicated that prolonged grief, when compared to resilience, was uniquely associated with maladaptive dependency traits, difficulty accessing positive memories of the deceased, and higher recalled marital adjustment. The present results extend our understanding of factors associated with distinct trajectories of adjustment after loss.

Six years after the wave. Trajectories of posttraumatic stress following a natural disaster

BackgroundThe characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure. MethodsPostal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group. ResultsLong-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors. ConclusionsThese findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.

Can People Benefit From Acute Stress? Social Support, Psychological Improvement, and Resilience After the Virginia Tech Campus Shootings

People’s responses to acute stress are largely thought to comprise four prototypical patterns of resilience, gradual recovery, chronic distress, and delayed distress. Here we present evidence of an additional response pattern: psychological improvement. Female survivors of the Virginia Tech shootings ( N = 368) completed assessments before the shootings and at 2, 6, and 12 months post-shooting. Latent growth mixture modeling revealed distinct trajectories of resilience, chronic distress, delayed distress, continuous distress, and improvement. Although resilience was the most common pattern (56%–59%), a trajectory of substantial improvement in anxiety and depression symptoms also emerged among 13.2% and 7.4% of the sample, respectively. In support of this pattern, improvement was distinctively associated with marked increases in perceived social support and gains in interpersonal resources. Findings suggest a more complex understanding of the impact of mass trauma and a key role for dynamic changes in social support following acute stress.

Exploring trajectories of diabetes distress in adults with type 2 diabetes; a latent class growth modeling approach

BackgroundModerate to severe diabetes distress (DD) is a common comorbidity among adults with type 2 diabetes. Cross-sectional studies find DD is strongly correlated with poor diabetes management, however little is known about the pattern of change of DD symptoms over long periods of time. We sought to identify and describe a set of distinct longitudinal trajectories of DD over 4 years of follow-up time. MethodsWe used data derived from the Evaluation of Diabetes Treatment study (2011–2014), a longitudinal community-based survey of Canadian adults (40–75 years) with type 2 diabetes (n=1135). To determine the number and shape of trajectories, we used a latent class growth modeling approach. ResultsFive distinct trajectories of DD were identified. Trajectories 1 and 2 comprised participants with persistently low (61%) or persistently low, but at risk (22%) levels of distress. Trajectory 3 (7.5%) included participants with decreasing moderate levels of distress. Trajectory 4 (6.5%) consisted of participants with increasing moderate levels of distress. Trajectory 5 (2.4%) included participants with persistently severe levels of distress. LimitationsDifferent populations may produce different DD trajectories and thus the generalizability of the strata identified in this report remains to be investigated. Future research is needed to determine the extent to which time-varying covariates might alter the path of DD trajectories. ConclusionsFor most individuals, DD is a fairly stable condition over 4 years of follow-up time. However, for a subset of individuals, DD symptoms worsened over time. Medical health professionals might consider repeated screenings for DD in adults with type 2 diabetes.

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.

Trajectories of distress, anxiety, and depression among women with breast cancer: Looking beyond the mean

Objective. Little is known about the development of psychological wellbeing over time among women who have been treated for breast cancer. The aim of this study was to identify distinct patterns of distress, anxiety, and depression in such women.Methods. We invited 426 consecutive women with newly diagnosed primary breast cancer to participate in this study, and 323 (76%) provided information on distress (‘distress thermometer’) and on symptoms of anxiety and depression (‘hospital anxiety and depression scale’). Semiparametric group-based mixture modeling was used to identify distinct trajectories of distress, anxiety, and depressive symptoms assessed the week before surgery and four and eight months later. Logistic regression analysis was used to evaluate the characteristics of women in the distinct groups.Results. Although no sub-group of women with chronic severe anxiety or depressive symptoms was found, we did identify a sub-group of 8% of the women who experienced continuously severe distress. Young age, having a partner, shorter education, and receiving chemotherapy but not radiotherapy might characterize women whose psychological symptoms remain strong eight months after diagnosis.Conclusion. By looking beyond the mean, we found that 8% of the women experienced chronic severe distress; no sub-groups with chronic severe anxiety or depression were identified. Several socio-demographic and treatment factors characterized the women whose distress level remained severe eight months after diagnosis. The results suggest that support could be focused on relatively small groups of patients most in need.

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.

Health behaviors in family members of patients completing cancer treatment.

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change. Descriptive, cross-sectional, correlational. A National Cancer Institute-designated comprehensive cancer center in the midwestern United States. 39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment. Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone. Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness. Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors. Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition. Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

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.

A brief retrospective method for identifying longitudinal trajectories of adjustment following acute stress.

Research increasingly indicates that prototypical trajectories of resilience, recovery, delayed, and chronic distress characterize reactions to acute adversity. However, trajectory research has been limited by the practical and methodological difficulties of obtaining pre-event and longitudinal data. In two studies, we employed a novel method in which trained interviewers provided a graphical depiction of prototypical stress trajectories to participants and asked them to select the one that best described their experience. In Study 1, self-identified trajectories from 21 high-exposure survivors of the September 11th World Trade Center attacks distinguished variation in posttraumatic stress disorder and depression symptoms at 7 and 18 months, and were consistent with trajectories based on longitudinal outcomes and friend/relative ratings. In Study 2, we examined self-identified trajectories from 115 bereaved spouses at 1.5 to 3 years. Persons who identified a resilient trajectory, compared with recovery and chronic distress trajectories, had fewer interviewer-rated symptoms of grief, depression, and posttraumatic stress disorder were rated as functioning more effectively by friends, reported higher life satisfaction, and had fewer somatic complaints. The present results provide initial evidence for the construct validity of a cross-sectional and less demanding method for identifying acute stress trajectories.

The Effectiveness of Collaborative/Therapeutic Assessment for Psychotherapy Consultation: A Pragmatic Replicated Single-Case Study

This pragmatic study evaluated the effectiveness of a collaborative assessment intervention as an approach to midtherapy consultation, which has yet to be empirically tested. Ten adult participants in ongoing psychotherapy with a variety of presenting concerns, primarily consisting of general mood and adjustment issues, received a brief assessment-based intervention based on Finn's (2007) Therapeutic Assessment model. Following the collection of assessment questions and the administration of a multimethod assessment battery, clients and therapists participated in a joint feedback session with the assessor. Clients were then followed as their psychotherapy continued. The results of idiographic and aggregate analytic approaches revealed significant reductions in client-reported symptomatic distress, as evidenced by a medium effect size (d = –.50) and a significant change in the trajectory of distress. Client reports of the process of psychotherapy revealed a significant increase in the clients’ ratings of the working alliance. The findings suggest that a midtherapy consultation using collaborative/therapeutic assessment methods is beneficial but that further rigorous investigation is needed.

Evidence from Two Longitudinal Studies concerning Internal Distress, External Stress, and Dissociative Trajectories

Dissociation is an alteration in consciousness that is viewed as an avoidant or repressive coping style in response to distress. Previous literature suggests that stressful life events (an external source of stress) bring about dissociation, and that dissociation is correlated with psychopathological symptoms (an internal source of distress). We examined the main and interactive effects of external stress and internal distress on dissociation using two longitudinal studies ( Ns = 214 and 155), in which undergraduates were assessed for dissociation, stressful life events, and psychopathological symptoms. In both studies, internal distress predicted an elevation in dissociation when external stress was low but not when it was high. The effect of external stress on dissociation was moderated by baseline internal distress, albeit in an inconsistent manner. The findings suggest that the effects of internal and external pressures on dissociation are competing, and that elevated external stress derails the attempt to cope with internal distress using dissociative processes.

Psychological distress in patients and caregivers over the course of radiotherapy for head and neck Cancer

Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress. This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy. Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physical symptoms had a significant (p<.05) time-varying effect on both patient and caregiver distress. Increases in one dyad member's distress levels were also significantly associated with decreases in the other's distress levels over time. Findings highlight the adverse impact of patient physical symptoms during radiotherapy on both patient and caregiver distress. They also support a dyadic coping model whereby patients and caregivers manage their distress together as a unit. Overall, dyadic supportive care interventions that focus on controlling patient physical symptoms and that address both patient and caregiver distress are sorely needed in head and neck cancer.

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.

Cortisol response to an experimental stress paradigm prospectively predicts long-term distress and resilience trajectories in response to active police service

Heterogeneity in glucocorticoid response to experimental stress conditions has shown to differentiate individuals with healthy from maladaptive real-life stress responses in a number of distinct domains. However, it is not known if this heterogeneity influences the risk for developing stress related disorders or if it is a biological consequence of the stress response itself. Determining if glucocorticoid response to stress induction prospectively predicts psychological vulnerability to significant real life stressors can adjudicate this issue. To test this relationship, salivary cortisol as well as catecholamine responses to a laboratory stressor during academy training were examined as predictors of empirically identified distress trajectories through the subsequent 4 years of active duty among urban police officers routinely exposed to potentially traumatic events and routine life stressors (N = 234). During training, officers were exposed to a video vignette of police officers exposed to real-life trauma. Changes in salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) and cortisol in response to this video challenge were examined as predictors of trajectory membership while controlling for age, gender, and baseline neuroendocrine levels. Officers who followed trajectories of resilience and recovery over 4 years mounted significant increases in cortisol in response to the experimental stressor, while those following a trajectory of chronic increasing distress had no significant cortisol change in response to the challenge. MHPG responses were not associated with distress trajectories. Cortisol response prospectively differentiated trajectories of distress response suggesting that a blunted cortisol response to a laboratory stressor is a risk factor for later vulnerability to distress following significant life stressors.

Prevalence and patterns of depression and anxiety in hemodialysis patients: a 12-month prospective study on incident and prevalent populations.

Depression is common in dialysis patients and has been shown to be associated with higher morbidity and mortality, but little is known about the course of symptoms over time. The current study set up to explore group and individual patterns of change in symptoms of anxiety and depression within the hemodialysis population and to identify socio-demographic, clinical, and psychological factors that may be associated with different trajectories of emotional distress. A total of 159 hemodialysis patients (n = 42 incident and n = 117 prevalent) completed the Hospital Anxiety and Depression Scale and social support and symptoms subscales from the Kidney Disease Quality of Life (Short Form) on two occasions 12 months apart. Clinical cut-offs were used to identify individual patterns of change in anxiety and depression symptoms across time, and analysis of variance (ANOVA) procedures were employed to establish potential correlates of these trajectories. Mean levels of anxiety and depression symptoms remained unchanged over 1 year with 44.7-54.1% of patients above cut-off at both baseline and follow-up. Individual-level analyses showed that the course of symptoms does not follow a single trajectory. While most patients had either persistent symptoms of distress (39.6% and 31.8% for depression and anxiety, respectively) or no/low symptoms of distress (32.1% and 36.9% for depression and anxiety, respectively), a total of 12.7-18.5% patients either had new-onset symptoms of depression/anxiety or symptoms diminishing over time. Patients with persisting or new-onset symptoms of depression or anxiety reported reduced perceived social support and quality of social interaction compared to the subgroups with low depressive/anxious symptoms. Different patterns of symptoms reflect heterogeneity in patients' emotional reactions and adjustment. More research is needed to identify patients at risk for emotional distress and to explore social support in the context of dialysis. Statement of contribution What is already known on this subject? Depression and poor mental health are common in hemodialysis patients and are associated with higher risk of hospitalization and death. Course of depression in incident hemodialysis patients is variable, but evidence on prevalent patients and course of symptoms of anxiety is largely lacking. What does this study add? Anxiety and depression remain undifferentiated over time with most patients reporting persistently high or no symptoms of anxiety or depression. New-onset symptoms of anxiety or depression or recovery are less frequent. The lack of consistent associations between socio-demographic or clinical parameters with patterns of emotional distress makes early identification difficult. Regular screening as part of clinical care is hence essential. Persistently high or new-onset symptoms of anxiety and/or depression are associated with reduced perceived social support. More research is needed to explore the role of social resources in the context of dialysis.

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.