1028 religion as predictor of health resulting in few studies where religiosity is used as an outcome measure [24]. In many European countries, religion plays a secondary role in daily life activities [19]. According to an interna- tional Gallup survey [15], the Norwegians are among the least religious people in Europe. Although the majority of Norwegians are members of the state church, religiosity does not impact on the daily lives of most individuals. Yet, attendance to religious ceremonies and participation in memorial services were striking among Norwegians in the aftermath of the 2004 tsunami. Such collective ritual response has also been described in the acute phase after major accidents in Norway [9]. However, it is unclear what role religion plays in the lives of Norwegian trauma victims in the long run and whether major disasters can induce enduring changes in religious beliefs. In the present study, we explored the association of characteristics of survivors of a natural disaster and their religious beliefs. We speciﬁcally address four questions. First, what is the prevalence of changes in the strength of religious faith following the 2004 tsunami in Norwegian tourists? Second, what factors predict these changes? Third, does religion play an important role in the lives of the tsunami survivors 2 years after the disaster? And ﬁnally, are there any differences regarding posttraumatic stress, general psychopathology and life satisfaction between those who report that religion is a source of strength and those who do not? Methods Study sample and design The 2004 southeast Asia tsunami was one of the largest tragedies in recent history with a death toll of 226,408 (Centre for Research on the Epidemiology of Disasters, de Louvain, Belgium, e-mail of 25 June 2008). In the days following the disaster, all Norwegian tourists were repatriated from disaster-affected countries and registered by the police upon their arrival in Norway. To investigate the long-term mental health aspects, 2 years after the tsunami a questionnaire was mailed to all registered individuals over the age of 18 years at the time of the disaster (N = 2,468). The questionnaire was returned by 1,180 survivors (49.3% response rate, 76 persons not located). The average current age of respondents was 45.0 years (SD = 12.9); 49.2% were men, 58.2% had C13 years of education, 68.5% were currently married or cohabitating and 73% were employed. The reported life- time prevalence of contact with a general practitioner, psychologist or psychiatrist for mental health concerns was 23.3% prior to the tsunami. 123 Soc Psychiatry Psychiatr Epidemiol (2011) 46:1027–1032 Most respondents had been exposed to the tsunami as threat to their lives and/or horriﬁc witness experiences [22]. We investigated lack of participation with follow-up telephone interviews in a random sample of non-partici- pants (n = 171) [25]. Non-participants did not differ sig- niﬁcantly from participants in terms of age and gender, but they reported lower levels of disaster exposure and lower levels of posttraumatic stress symptoms. The most fre- quently reported reasons for not participating in the study were lack of interest or time (39.2%) and not being directly affected by the disaster (32.2%). The study was approved by the regional committee for medical research ethics and by the Norwegian Social Science Data Services. Measures Religiosity Changes in religious beliefs were measured by a question from the ‘Religious Outcome Scale’ [33]: do you feel that you have become more religious after the tsunami? Sub- jects were asked to answer this question using a ﬁve-point scale: 1 = much more religious; 2 = somewhat more religious; 3 = no change; 4 = somewhat less religious; 5 = much less religious. Responses 1 and 2 were consid- ered as strengthening of religious beliefs, while responses 4 and 5 were considered as weakening of religious beliefs. Religiosity at the time of the study (‘‘current religios- ity’’) was measured by a question from Zuckerman’s three- item Index of Religiousness [41]: how much is religion a source of strength and comfort to you? Responses were coded on a four-point scale ranging from 1 (= ‘‘none’’) to 4 (= ‘‘a great deal’’). Responses 1 and 2 were considered to indicate that the respondent was less religious (labeled non- religious), while responses 3 and 4 were considered to indicate that the respondent was positively religious (labeled religious). Both questions concerning religion addressed personal feelings of religiosity rather than attachment to a religious community or participation in religious activities. Thus, the questions were applicable to all the respondents regardless of their speciﬁc belief system. Disaster exposure Respondents were asked about the degree to which they perceived that their life had been threatened by the tsunami, whether a close relative or friend died in the tsunami, and whether they sustained physical injuries from the tsunami. In a previous study of Norwegian tsunami survivors, the life threat intensity was the best predictor of health complaints [23].