The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African-American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia.