Soc Psychiatry Psychiatr Epidemiol (2011) 46:1027–1032 Table 3 Comparing religious and non-religious respondent groups (t test) according to life satisfaction (LOL), general psychopathology (GHQ-28) and posttraumatic stress (IES-R) Religious group n = 128 Non-religious group n = 1,133 P values LOLa Mean score 7.38 (SD = 1.92) 7.28 (SD = 1.85) 0.58 GHQ-28b Mean total score 26.2 (SD = 14.3) 24.3 (SD = 13.4) 0.22 IES-Rc Mean total score 24.0 (SD = 19.2) 20.7 (SD = 18.2) 0.06 a Ladder of life b General health questionnaire c Impact of event scale-revised with ongoing threat of life [38]. There was also less change in our study population than in a mixture of US community and mental health treatment samples that had experienced various potentially traumatizing events [13]. The respondents in the present study experienced the tsunami as a distinct and time-limited stressful event. Due to repatriation to safe and stable communities in Norway, they escaped the typical burden of secondary disaster stressors. Thus, the lower prevalence of change in reli- gious belief may be due to the particular type, magnitude and duration of exposure [34]. Posttraumatic stress was the main predictor of both strengthening and weakening of religious beliefs. This is in agreement with some previous studies [13], but not with others [14]. Post-disaster stress may be a confounder for severe disaster exposure, which could be the real cause of religious changes or it may have triggered changes in religious beliefs by itself [1, 13]. It has been suggested that greater spirituality may develop as a coping mechanism in response to personal suffering [10]. Also, personal growth in general may follow trauma and subsequent struggle with adversity [5, 28]. Respondents with pre-tsunami mental health problems were more likely to report strengthening of religious beliefs. It is possible that previous mental health problems evoked spiritual or existential interests at an earlier stage of life [2, 3]. When coping with the tsunami, a strengthening of religious belief may have been more likely among those who had previously used religion as part of a coping strategy [32]. No differences were found in life satisfaction or general psychological distress between the religious and non-reli- gious survivors. This does not support the general idea that religiosity prevents long-term mental stress [18, 24, 37] or leads to higher life satisfaction [18, 20, 27]. 1031 Limitations The cross-sectional study design did not allow us to draw conclusions about cause–effect relationships. Use of single item measures limits an in-depth understanding of the ﬁndings given the complex construct of religiosity [24]. Also, caution should be exercised in generalizing our ﬁndings, which may be limited to populations who expe- rience traumatic events with a sudden impact and relatively brief exposure. The representativeness of the population in terms of religion may be questioned as participants had chosen to celebrate their Christmas holiday abroad in a non-Christian country. However, more than 90% of the Norwegian tsu- nami survivors were in Thailand, where Christmas is cel- ebrated in tourist resorts and also by the Norwegian Church Abroad. Further, the participants were similar to the age- and gender-adjusted Norwegian population with regard to employment and marital status [21]. Conclusion We found a bidirectional change in religious beliefs among a minority of the tourists who experienced the 2004 tsu- nami; changes in religious beliefs were more common among respondents who had the greatest disaster exposure. Our ﬁndings did not support the hypothesis that religious beliefs prevent long-term posttraumatic stress, and religi- osity was not associated with higher levels of life satis- faction. Future studies should focus on repeated measures of religiosity, posttraumatic stress and life quality to examine religious stability, changes in religious beliefs and cause–effect relationships. Acknowledgments The study was funded by the Research Council of Norway. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Ai AL, Park CL (2005) Possibilities of the positive following violence and trauma: informing the coming decade of research. J Interpers Violence 20:242–250 2. Baetz M, Grifﬁn R, Bowen R, Koenig HG, Marcoux E (2004) The association between spiritual and religious involvement and depressive symptoms in a Canadian population. J Nerv Ment Dis 192:818–822 3. Blazer DG (2007) Section introduction: spirituality, depression and suicide. South Med J 100:733–734 123