Soc Psychiatry Psychiatr Epidemiol (2011) 46:1027–1032 Posttraumatic stressors and symptoms Results 1029 The ‘‘List of Threatening Experiences, questionnaire ver- sion (LTE-Q)’’ [4] was used to assess additional stress experienced after the tsunami. This instrument measures 12 adverse life events during the previous year that carry signiﬁcant long-term threat. Current posttraumatic stress symptoms were measured using the Impact of Event Scale-Revised (IES-R) [39]. The IES-R is a 22-item self-report measure of subjective dis- tress following exposure to traumatic events. Symptom severity was measured according to the original IES-R by ﬁve response anchors (0 = not at all, 1 = a little bit, 2 = moderately, 3 = quite a bit and 4 = extremely), as experienced in the previous 7 days. The General Health Questionnaire (GHQ-28) [17], scored on a four-point Likert scale (0,1,2,3), was used as a measure of general psychopathology. Life satisfaction was measured with Cantril’s Ladder of Life (LOL) [6] which consists of ten steps. The top rung of the ladder (10) represents the best possible life imag- inable and the bottom rung (1) represents the worst pos- sible life. Respondents were instructed to write the number of the step on which they felt they currently stood. Statistics Bivariate logistic regression analyses were used to determine associations between demographic and back- ground variables, disaster exposure, current posttraumatic stress symptoms and dependent variables such as strengthening of religious beliefs (versus not) or weak- ening of religious beliefs (versus not). Odds ratio was used as measure of the strength of an association. Multi- variate logistic regression analysis was used to deter- mine the adjusted effects of predictors of changes in religious beliefs, controlled for age and gender. All variables that were signiﬁcant in bivariate analyses were entered in the multivariate regression model. Bivariate analyses were performed using t tests (continuous vari- ables) and Chi-square tests (categorical variables) to compare the religious and the non-religious respondent groups according to demographic and exposure variables. Multiple linear regression analyses were performed to assess the relationship between religiosity and measures of posttraumatic stress (IES-R), general psychopathology (GHQ-28) and life satisfaction (LOL), while adjusting for other signiﬁcant variables. All analyses were conducted using the software Statis- tical Package for the Social Sciences (SPSS, version 16.0). P values \0.05 were considered to be signiﬁcant. The majority of responding Norwegian tourists, 86.5% (n = 1,005) reported no change in their religious beliefs following the tsunami, 97 (8.3%) reported strengthening of religious beliefs and 60 (5.2%) reported weakening. Strengthening of religious beliefs was bivariately associated with pre-tsunami mental health problems, life threat inten- sity as experienced during the tsunami, loss of a family member or close friend, inﬂicted injuries, posttraumatic stress and post-tsunami adverse life events (Table 1). A multivariate logistic regression model revealed that strengthening of religious beliefs remained signiﬁcantly associated with pre-tsunami mental health problems (OR: 1.82, 95% CI: 1.12–2.95, P = 0.015) and with posttrau- matic stress (OR: 1.62, 95% CI: 1.22–2.16, P = 0.001). Weakening of religious beliefs was bivariately associ- ated with younger age, life threat intensity, posttraumatic stress and post-tsunami adverse life events (Table 2). A multivariate logistic regression model showed that weakening of religious beliefs remained signiﬁcantly associated with younger age (OR: 0.98, 95% CI: 0.96–1.00, P = 0.047) and posttraumatic stress (OR: 1.72, 95% CI: 1.23–2.41, P = 0.002). A minority of the study population (10.8%) reported that religion was an important source of personal strength and comfort (positively religious). Religiosity was associated with female sex, older age, unemployment, and pre- tsunami mental health problems, but not with exposure (analyses not shown). There were no signiﬁcant differences between the religious and the non-religious groups regarding posttraumatic stress, general psychopathology and life satisfaction (Table 3). Also when controlling for potential confounders such as gender, age, unemployment, and pre-tsunami mental health problems, no signiﬁcant association between religiosity and posttraumatic stress, general psychopathology or life satisfaction were found. Discussion Our results showed bidirectional changes in religious beliefs in Norwegian disaster survivors 2 years after the 2004 southeast Asian tsunami. To the authors’ knowl- edge, no other study has examined changes in religious beliefs after a natural disaster. However, similar changes have been reported in studies after other types of traumas [11, 13, 14, 38]. In the present study, there was less change in religious beliefs compared to populations of potentially traumatized individuals with prolonged expo- sure, such as US war veterans [11, 14] and cancer patients 123