predicting lower levels of depression at the follow-up were preoperative use of prayer for coping, optimism, and hope. Predicting lower levels of anxiety at the follow-up were subjective religiousness, marital status, and hope. Predicting poorer adjustment were reverence in religious contexts, preoperative mental health symptoms, and medical comorbidity. Including optimism and hope in the model did not eliminate effects of religious factors. Several other religious factors had no long-term influences. MPLICATIONS: the influence of religious factors on the long-term postoperative adjustment is independent and complex, with mediating factors yet to be determined. Future research should investigate mechanisms underlying religion-health relations.

Much research related to individual coping following human-made and natural disasters suggests religious and spiritual coping is associated with positive outcomes (Aten et al., 2019). The presentation of this positive relationship may erroneously infer that nonreligious individuals' outcomes are negatively impacted by the absence of religious coping. Rather, studies of psychological well-being suggest a curvilinear relationship between (non)religiosity and well-being, such that low, as compared to high, levels of identification with a religious or nonreligious identity are associated with lower well-being (Galen & Kloet, 2011). Studies of the relationship between religiosity and mental health, including in the context of disaster, often exclude participation of nonreligious individuals through omission (Hwang et al., 2011) or utilize measures of religiousness that fail to capture nonreligious people (e.g., atheists, agnostics, religious nones; Cragun et al., 2015). Thus, studies of coping with natural disasters that are inclusive of a wide range of (non)religious orientations and examine differences, if any, among people of varying levels of reli-giousness and spirituality, are needed, a problem the current investigation sought to address. Of note, the terms (non)religious and (non)spiritual are used throughout the manuscript to refer to the full spectrum of systems of belief and nonbelief, ranging from atheism to high religiosity, whereas nonreligious/nonspiritual are used to refer to people without a religious and/or spiritual orientation. Natural Disasters and Trauma Natural disasters are sudden, potentially traumatic, often weather-related events (e.g. tornados, hurricanes) that generally occur locally but require national or international assistance due to the far-reaching impact of the resulting destruction (Kilmer et al., 2019). Much scholarship has focused on the psychological impact of natural disasters and the established link between exposure to disasters and the development of mental health problems, especially post-traumatic stress disorder (PTSD; Goldmann & Galea, 2014). However, a wide range in the prevalence of PTSD rates (i.e., 3% to 60%) after a natural disaster suggests that factors other than mere exposure to the traumatic aspects of a disaster determine whether mental health problems develop (Neria et al., 2008). Many such factors have been identified, including peri-traumatic distress, disruption distress, social support, and coping strategies (Baral & Bhagawati, 2019; McGuire et al., 2018).