Changes in macroinvertebrate communities exposed to pulp and paper mill effluent (PPME) have been seen in mesocosm and short-term field studies. However, long-term patterns of macroinvertebrates in PPME receiving streams have not been examined. We conducted a study of 4 PPME receiving streams (Codorus Creek, PA; the Leaf River, MS; and the McKenzie and Willamette rivers, OR) over 9 y to assess temporal patterns in macroinvertebrate community structure and metrics related to PPME discharge. Study streams represented different ecoregions, warm-/cold-water systems, gradients of PPME concentration (<1%–33%), and mill process types. Bray–Curtis similarity and nonmetric multidimensional scaling showed significant community differences across sites in Codorus Creek, but differences were related to stream temperature patterns and not PPME. In the other study streams, seasonal community differences across years were greater than differences across sites. General linear models were used to examine spatial and temporal variation in macroinvertebrate metric response (% dominant taxa, density, richness, Hilsenhoff Biotic Index [HBI], Simpson's Index, and ash-free dry mass). Mean HBI scores indicated that the macroinvertebrate community reflected fair to very good water quality conditions, with water quality typically classified as “good” at most sites. Significant site differences in macroinvertebrate metric response were uncommon in the Leaf, McKenzie, and Willamette rivers but were seen in all metrics in Codorus Creek, where metric response was spatially variable. In the McKenzie River, there was an increase in mean HBI scores at sites downstream of the mill relative to 1 of the 2 upstream sites. However, significant differences were seen only between 1 upstream and downstream site, and HBI scores at all downstream sites consistently reflected “good” water quality. Significant annual differences in metric response were typical in all rivers. Water quality (pH, conductivity, total nitrogen) and habitat (velocity, depth, substrate composition) variables explained community structure patterns in the Leaf and McKenzie rivers, but macroinvertebrate–environment relationships were weak in the other 2 streams. The results of this study indicate that macroinvertebrate community structure is temporally variable and reiterate the importance of long-term studies for accurate determination of the effects of point sources such as PPME on receiving systems.