This study used contextual stress measurement to look at the occupational sequelae of stress. One hundred and five civil aviation pilots were interviewed. Events and difficulties were dated and rated for contextual threat; dating information was also obtained for distress symptoms and air traffic incidents. There were significant relationships between stress and air incidents, between stress and distress, and between distress and incidents. Some symptoms (sleep disturbances, loss of energy and tiredness) were more likely to be associated with reported incidents than others. The results are in line with previous suggestions that the effect of stress on job performance is via distress. Distress-related sleep disturbances may be particularly crucial. Further work using contextual stress measurement is needed to clarify the causal pathways involved. Copyright © 2000 John Wiley & Sons, Ltd.