Objectives. This study aimed to determine the contribution made to psychological distress following stoma surgery by stoma‐related cognitions and ‘non‐cognitive’ factors such as age, marital status, physical symptoms and past psychiatric history.Design. A questionnaire (Stoma Cognitions Questionnaire, SCQ) to measure negative stoma‐related beliefs was developed. The main contributors to psychological adjustment to stoma surgery were determined by interviewing patients post‐operatively.Methods. Seventy‐nine patients who had undergone stoma surgery were interviewed at home between one and three months post‐operatively. Patients were asked about belief in negative stoma‐related cognitions, psychological distress, physical symptoms and demographic and medicosurgical information.Results. The contribution of cognitions, demographic and medicosurgical information to variance in psychological outcome was examined using stepwise multiple regression. Responses to three SCQ items explained almost 60 per cent of the variability in psychological distress levels. Past psychiatric history and the presence of physical symptomatology were also significant contributors.Conclusions. The presence of a past psychiatric history and physical complications/symptomatology are significantly related to post‐operative psychological distress following stoma surgery. Cognitions about physical integrity, impact on life and control are important in understanding adjustment to stoma surgery. These could be targeted for modification using cognitive therapy to reduce psychological distress among