Factors associated with distress in relatives of people experiencing recent-onset psychosis are unclear, but subjective appraisals of the illness seem to be implicated. We aimed to identify the contribution of illness perceptions to predicting distress in relatives of people experiencing recent-onset psychosis. The relatives were assessed on measures including distress and illness perceptions, and these were repeated 6 months later. Almost half of the relatives had significant distress that persisted at 6 months. Where symptoms of the service users were more severe, and for the older relatives, distress showed less improvement. Perceptions of greater perceived future negative consequences and a more chronic timeline predicted greater distress at 6 months, whereas increased perceived coping efficacy of the relatives predicted a reduction in distress. Distress in relatives is evident early on in psychosis, but assessment of appraisals of relatives may help identify those at risk for enduring problems and offers opportunity for clinical intervention. Copyright © 2014 by Lippincott Williams & Wilkins.