Background

Spirituality is a powerful force that can influence decisions, livelihoods, lifestyles, and perspectives (International Federation of Red Cross 2014). Similarly, religion often plays a vital role in people’s lives, and it is interpreted in different ways from various reference points (Meisenhelder 2002). For instance, different meanings attached to “religion” include religion as an identity, religion as a culture, religion as a practice, and religion as a power (Nabi 2001). For instance, over recent decades, many researchers have found that individuals and families often use religion to cope with different health issues, including asthma, dementia, cancer, and surgery (Belavich and Pargament 2002; Benore et al. 2008; Bowie et al. 2004; Kinney et al. 2003; Tausch et al. 2011). Religion is also related to higher self-esteem, lower suicide rates, and less substance abuse (Hackney and Sanders 2003).

Religion and Disasters

In the case of natural disasters, religious beliefs influence perceptions of nature and the methods for construing the consequences of disaster. This can help people deal with the devastating events that happen to them (Schipper et al. 2014). People taking solace in their religion is a common reaction to unexpected harmful events. However, one study finds that nonreligious people have also stated that a god exists during the occurrence of strong natural forces (Bentzen 2013).

Religious beliefs can either threaten a person’s health or help a person cope after a stressful event, especially when resources and supplies are limited (Pargament 1997; Park et al. 1990; Smith et al. 2003). For instance, religion may negatively impact people’s perceptions of risk, which can lead to death, injuries, and destruction in hazard-prone regions. In Bangladesh, those who believe that flooding is “the will of Allah” do not do anything to prepare for floods, which make 30,000 people homeless annually. Their lack of flood prevention puts them at a greater risk of death, injury, and physical infrastructures (Schumak 2000).

Religion can promote or reduce coping after disastrous events (Chan and Rhodes 2013). That is, regarding a natural disaster, affected people or communities may use either positive or negative religious coping strategies to alleviate their post-disaster challenges (Meisenhelder 2002; Nabi 2012). For instance, finding meaning for unforeseeable and uncontrollable events, perceiving an opportunity for intimacy with others, seeking spiritual support, and religious forgiveness are the positive methods for coping after disasters (García et al. 2014; Pargament et al. 2011). By contrast, new assessment of the devil (e.g., “the devil was responsible for my new condition”), spiritual discontentment, and punitive religious perceptions comprise the negative religious coping strategies applied by affected people after disaster (Chan and Rhodes 2013). Positive religious coping leads to psychological and physical well-being and interpersonal friendliness, whereas negative religiosity leads to poorer physical and mental health, worse quality of life, and greater depression (Kerley et al. 2011; Pargament 1997).

A number of studies in the literature have reported the use of different religious coping mechanisms during post-disaster phases. For instance, about 90% of surveyed Americans after the September 11 attacks reported that they coped with their distress by turning to their religion Schuster et al. 2001). Positive religious coping mechanisms applied to disaster survival helped them cope with their psychological distress and posttraumatic stress disorders (PTSD) after a number of natural disasters, such as Hurricane Katrina, the Pakistan earthquake, the Malaysia flood, and the Chile earthquake (Chan and Rhodes 2013; Feder et al. 2013; García et al. 2014; Sipon et al. 2014). Furthermore, some studies have reported the relationship between religiosity and mental health (Gartner et al. 1991; Hackney and Sanders 2003; Koenig and Larson 2001). Regardless of the inconclusive findings of the studies on religion and disaster, they have often reported that religious commitment is connected to better mental health (Hussain et al. 2011).

Gender and Disaster

Gender is an important variable when examining natural disaster consequences. For example, regarding psychological and physical symptoms due to a disaster, women are more psychologically affected than men (Sipon et al. 2014; Cerdá et al. 2013; Harville et al. 2011). Gender differences in coping with disasters and access to social support networks may influence psychological reactions during post-disaster phases (Brown et al. 2010). For instance, women tend to cope better than men when influenced by disastrous events; they try to build and mobilize large networks of social support and make more meaningful relationships (Brown et al. 2010; Phifer 1990). In addition, a number of gender and disaster studies reported gendered survival strategies after natural disasters (Bradley et al. 2005; Ensor 2003). For example, women organized temporary shelters, coordinated relief efforts in community, and activated religious groups to meet urgent needs after disasters. Men, on the other hand, followed strategies that take them away from their families and communities (e.g., seeking job, migration, and abandoning families) (Delaney and Shrader 2000; Ginige et al. 2009).

Regarding natural disasters, religion interacts with economic and social vulnerability factors (Gaillard and Texier 2010). Although gender, as a social determinant, is also starting to be more recognized in disaster literatures, there have been a few studies on gender differences in using religion as a coping method. Some researchers have reported that using religious coping strategies is more common among women (Ferraro and Koch 1994; Hood et al. 1996; Koenig 1998). For instance, the well-being of disaster-affected women who suffered from gender-based discrimination and inferior position in South Asia was improved by benefiting from positive aspects of religiosity as the important source of confidence, hope, and power after disasters (Nabi 2012; Sohrabizadeh et al. 2015). While religion and spirituality are emerging as one of the more important subjects in disaster management, identifying gender differences in using religion as a coping method has attracted very little attention. In particular, no explicit research has been undertaken to explore the effects of religiosity on adult women and men in the context of Iran as an Islamic country. On the other hand, religion is considered as a cultural factor in different local and regional settings (Ha 2015; Hood et al. 1996). Thus, the value of this study lies in its exploration of the different effects of religiosity on disaster-affected women and men after the recent quakes and floods in Iran’s setting. A field-based investigation was carried out to achieve the study’s purpose, which was to exploring the effects of religiosity on affected men and women.

Methods

Study Design

A qualitative research design was used in this study to obtain insight into personal experiences and individual perspectives as well as to observe social interactions with a gender perspective. In addition, new research questions or hypotheses are identified by a qualitative approach (Graneheim and Lundman 2004; Strauss and Corbin 1998). In accordance with the research’s purpose, the qualitative approach using content analysis was considered the most appropriate for conducting the investigation.

Setting

Iran (the Islamic Republic) ranks as a highly disaster-prone country in which floods, drought, and earthquakes have been frequent natural disasters (Fatemi 2009). In Iran, gender distribution is almost equal (49.6% women). The majority of Iranian people (99.4%) are Muslim, and the others are Christian, Jewish, and Zoroastrian. Shiah Islam is dominant in Iran instead of Sunni Islam (Sohrabizadeh et al. 2015). Iran can be an example of a highly religious country in which people are committed to following the Islamic rules in their routine lives and occupations (Hussain 2013).

This study was conducted in East Azerbaijan, Bushehr, and Mazandaran, which are provinces that were significantly affected by earthquakes and floods between 2012 and 2013. These natural disasters resulted in more than 330 deaths and about 3600 injuries concerning those who lived in the affected regions (Iranian Student News Agency 2012, 2013; Jafari 2012). Since these disasters took place more recently than others, access to those affected was possible; hence, these regions were selected for the study.

Participants

Due to the necessity of obtaining in-depth experiences and perceptions, the participants included men and women who were affected by the quakes and floods. They were chosen through a purposive sampling method with maximum diversity. Sampling continued until data saturation was achieved through 24 interviews, but one additional interview was performed to make certain that no new concepts emerged. All participants were the survivors of the disaster-stricken areas and lived in the small cities and villages of East Azerbaijan, Bushehr, and Mazandaran. The inclusion criteria consisted of experiencing at least one negative effect from the recent disasters as well as a having a willingness to participate. The gender distribution of samples was 52% for female group. In addition, all participants followed Shiah Islam. The age of the participants was between 20 and 55 years, and they had an educational level that ranged from illiteracy to academic education (Table 1).

Table 1 Participants’ demographic information based on gender, age, education, and habitation status
Full size table

Data Collection

Data were collected through unstructured in-depth interviews as well as field observations. Participants were selected through the Family Physician Program lists, which have been prepared by local health centers in Iran. The lists included the addresses and phone numbers of households. Colleagues who worked in local health centers facilitated data collections by accompanying the researcher house-to-house in the field. They were familiar with the affected regions and knew most of the disaster-affected inhabitants. Before the interviews, the researcher introduced herself and explained the aim of the study. Each interview began with this query: “Please tell me what you have experienced since the disaster happened.” Each interview lasted between 50 and 90 min. Probing was performed to encourage the respondents to explain their experiences and feelings in detail. All interviews were recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously and iteratively in a way that allowed the retrieved information to become a guide for further data gathering.

Data Analysis

Qualitative content analysis using the Graneheim approach was applied for data analysis (Graneheim and Lundman 2004). The process of data analysis was conducted through several steps. First, the interviews were read a couple of times to obtain a sense of the whole and to become familiar with the data. Second, to form the unit of analysis, the entire material was elicited and brought together into a single text. Third, the text was extracted into meaningful units. Fourth, the condensed meaningful units were labeled with a code. At the same time, peer check was used to control the quality of codes. Hence, some interview transcripts were coded by an independent researcher who was not directly involved in the project. Discrepancies were reconciled through discussions of the codes. Finally, the emergent codes were compared based on differences and similarities and grouped into four categories and two themes. Word processing software was used for typing the transcribed interviews. Quotations are taken from the transcripts and used in the Results section to highlight the participants’ opinions and experiences.

Trustworthiness

The strategies of credibility, dependency, confirmability, and transferability were used for data trustworthiness. The triangulation strategy was applied to achieve credibility; this included a triangulation of data, samples, and the research field. Participant and expert checks were also used to achieve credibility and dependency. In the member-check strategy, unclear words or misunderstandings were presented to the participants during the interviews. Confirmability and transferability of data were provided by the personal interest of the author and by offering a detailed explanation of the research process.

Ethical Considerations

The Ethics Committee of the Shahid Beheshti University of Medical Sciences approved this study. According to the written consent form accepted by the ethics committee, all participants were informed about the confidentiality of their names and other personal information in the related reports and field notes. The written consent form was read aloud for the participants who were illiterate or unable to write. In total, informed consent was obtained from all individual participants included in the study. In addition, the possibility of leaving or declining the interview session was provided to the participants.

Results

Two themes, negative and positive effects of religiosity, and five categories were extracted from the data. Positive effects of religiosity refer to positive consequences of religious beliefs which can lead to improving the well-being of disaster-affected people. This theme includes three categories of mental health, social and livelihood supports which were promoted and increased through religious coping of people in the studied fields. Negative effects of religiosity, on the other hand, include the destructive consequences of religiosity in the disaster-stricken regions. Act of God belief refers to people who considered disasters as acts of God and ignored their key roles in disaster prevention. Sorrowful climate refers to the religious environment in which sadness and depressive environment was encouraged by religious centers after destructive events.

Positive Effects of Religiosity

All participants believed that God played an important role in bringing them quakes or floods. They asked God for help and full assistance in order to overcome the stressful circumstance (fear and distress) that resulted from the recent disasters. Religion provided mental support for both women and men in the aftermath of the disasters. However, all the women highlighted the advantages of relying on religion more than some men.

Mental Health

Survivors benefited from their religious beliefs as a source of hope and patience. Some women believed that God enabled them to cope with the difficult post-disaster situation. That is, some disaster-affected women endured the losses and destruction imposed by the disasters because they perceived that God gave them strength and capability. Some disaster-affected women stated that their power and capability for organizing family affairs and for making money for their post-disaster livelihood were the gifts of God. Most of the women carried out their religious tasks, such as praying or reading the Quran, regularly to stay calm and hopeful. A woman explained her mental coping:

I’m not strong, God makes me empowered, and the prophet (Mohammad) keeps me alive for taking care of my children. I read the Quran every night and repeat the name of God and his prophet Mohammad to restore to my normal life. (P1)

Religious beliefs motivated women to tolerate the loss of loved ones and to continue their increased duties in the aftermath of the disasters. The supportive effects of religion helped women reinforce their coping capacities and restore their normal lives.

Although some men benefited from their religious beliefs to deal with the new situation after disasters, they did not explain it as much as women did. Most men who survived usually worked all day to compensate post-disaster destruction and provide for their families’ livelihoods. An adult man said,

I believe that I should work and try to make my current life better than pre-disaster. We cannot rely on God’s assistance for post-disaster recovery. I have to work hard and rebuild the destruction as soon as possible. (P3)

At the time of remembering post-disaster experiences, a common male reaction was to fall silent. In other words, men shared less information about their health status after the disasters than women.

Social Support

Social support, which was provided by different religious ceremonies in the affected regions, facilitated the restoration of normal life after the disasters. Women were eager to come together in religious places. They talked about their family or social challenges at the end of religious rituals and received sympathy or a solution. Sometimes, a number of religious women established a female network for holding regular religious ceremonies. They read the Quran and shared similar disaster experiences of the famous Islamic leaders, including the Prophet Mohammad, his family, and their innocent followers. Social assistance and leadership stories about the Prophet Mohammad and his grandchildren at the time of crisis were explained and repeated in the religious rituals. Islamic advice given during religious lectures encouraged family and community members to be respectful and offer assistance, alliance, and collaboration with others. A participant said,

Helping community members is the Prophet Mohammad’s advice, which must be followed. Religious ceremonies have provided us the opportunity of helping and social assistance. (P10)

Men financed and supplied different religious ceremonies. They worked as a team to hold religious ceremonies. Affected men often focused on rituals and benefited from the opportunity of social support less than women. An adult man stated,

We have held religious ceremonies in mosques and other religious sites after the quake. We worked together and often talked about our important tasks. (P12)

Livelihood Support

Obtaining economic aid for damaged households was conducted as an important religion-based initiative. For instance, most women played an important role in providing livelihood support through religious ceremonies. Poor people, more especially widows and orphans, were considered for different economic help post-disaster. Funding was provided by different groups including local people, Islamic NGOs and organizations, Islamic leaders, and independent religious centers. A widow said,

My neighbors who participated in religious sessions economically helped me and sympathized with me. I could talk about my grandchild who lost her family in the flood and ask them for economic assistance. (P8)

Men did not tend to talk about their experiences and methods for coping as much as the women did. Instead, they preferred to talk about post-disaster livelihood challenges, including poverty and joblessness. Actually, mental and physical health issues were not important for most men, who placed them second or third in their priorities. Thus, the perceptions of some men regarding religious associations or networks were significant as long as they could resolve their livelihood problems. A man stated:

Now, I have lost my job after the flood and poverty has made me disappointed. I am ashamed when cannot buy anything for my wife and children. Can such religious ceremonies help us economically? (P20)

Negative Effects of Religiosity

In addition to the positive effects of religion on communities, religiosity negatively influenced affected people, especially the female population. The acts of God belief and sorrowful climate were the categories of the negative effects of religiosity, as described below:

“Acts of God” Belief

Considering natural disasters as God’s torments was common among affected people. They believed that disasters are inevitable acts of God that may hit all sinful communities. In their mindset, the actions of humans are reflected by natural disasters sent from God. Accordingly, any destruction means that God’s principles have not been followed by religious people. In total, natural disaster events were assumed as a method by which victims and survivors are punished by God. Removing sins from the community was considered as one reason for holding post-disaster religious ceremonies. One participant stated,

We said that everything can happen for us according to our fate determined by God. God’s torture is equal for all and there is no difference between us and people affected by the Bam earthquake [the most destructive earthquake in Iran which killed about 26,500 people who lived in the Bam region in 2003]. (P18)

There were some differences between men and women in regard to the acts of God belief. Disaster-affected women emphasized disasters as acts of God much more than men. They dreaded reoccurring disasters and asked God to forgive their sins. Women usually tried to review their pre-disaster lives to find their sins as the causes of the disasters so as to not repeat them in the future. A widow who lost her husband in the earthquake said,

God! Tell me what did I do? I had done nothing bad before the quake … I did not say any blasphemy and always lived in poverty and misery with my husband. (P6)

Some men considered natural disasters as a punishment from God for survivors rather than victims. A young man who lost his mother in the earthquake stated:

I believed that God punished survivors through earthquakes. My mother was an angel and the wife of that widower was innocent. Both of them died in the quake and they were moved to heaven. Now, look at us! We are depressed and upset. (P22)

Some women and young girls believed that disaster prevention measures cannot work because the occurrence of natural disasters as the acts of God is inevitable. Hence, they prepared for death, injuries, and unhealthy conditions resulting from disaster. A young girl said,

There is no need to prevent from earthquake damage. I believed that everybody will pass away sometime based on God’s decision. I do not focus on individuals’ death or live. This is kind of fate. (P25)

Although men believed that disasters are acts of God, they mentioned the necessity of prevention measures. Some men declared that unsafe and nonstandard buildings could have played an important role such destruction. An affected man said,

This quake occurred based on God’s will; however, if our houses had been safe, we never would have faced such damage. It may be our fault somehow. (P4)

Sorrowful Climate

Although regular religious ceremonies were considered as suitable places for socioeconomic supports, they could not play the role of making people happy. Instead, these rituals had the effect on strengthening people’s sadness and mourning through describing the distressing life stories of Islamic leaders. For instance, the tragedies of Islamic pioneers’ lives as well as their afflictions and painful experiences were frequently explained in rituals. The melancholy and despondent environment that existed in some damaged regions prevented survivors from starting a normal and happy life. In some destructive regions, “the more dolefulness, the more religious” was a common attitude of inhabitants. Negative effects of disasters provided a chance to continue their misery in the form of longtime grief and mourning. This can be labeled as the culture of unhappiness, which was highly observed among the participants, especially among the disaster-affected women. Both women and men were affected by the culture of unhappiness that was exacerbated by religiosity. A young girl said:

We have been raised with religious ritual. My mother and other neighbors who survived participate in the religious ceremonies every day. Such ceremonies are considered as a common part of the lives of women who survived and led to some misery and cheerlessness. (P13)

Based on the author’s observations, some women made a deal with God in the form of a vow, which is rooted in religious beliefs. They prepared foods and drinks to feed their relatives and neighbors or local communities. Accordingly, God should give them rich and happy lives as the consequence of feeding others. However, a number of women who prepared vows were poor and required financial aid. They spent their relief aid on fulfilling their vows and paying for memorial ceremonies for their loved ones who had passed away in the disasters.

Discussion

This is the first empirical study carried out in the context of Iran (as a highly Islamic country) to explore the effects of religiosity on disaster-affected men and women. Mental rehabilitation, social supports, and livelihood supports were extracted as positive effects of religiosity on people affected by disasters. On the other hand, the acts of God belief and a sorrowful climate were the negative aspects of religiosity in the affected regions. Religiosity was important for both sexes, and they considered their religious beliefs helped them to cope with their health and social issues. However, the extent of such focus on the religiosity as a coping method differed. For example, women preferred using both negative and positive religiosity for coping more than men. Women’s reliance on religion can be justified by the gender structure of Iran, with the gender gap rate of 0.58 (0.00 = gender inequality and 1.00 = gender equality) and the gender gap rank of 137 out of 142 countries (World Economic Forum 2013). According to this index, men have greater access to economic, political, education and health resources in Iran. This gender inequality may lead to the kind of insecurity felt by women in the society of Iran and motivate them to stick to their religion as a supportive and helpful resource. That is, women may prefer to consider religiosity as a safe and assured method for modifying their insecure lives after disasters more than men.

Based on the results, one of the positive effects of religiosity on disaster-affected people’s status was in relation to mental health. A number of researchers have suggested that people with higher levels of religiosity may show greater problem-solving and stress management skills than less religious or nonreligious people (García et al. 2014). An increase in religiosity (Christianity, Islam, and Buddhism) has been reported as a coping method in the aftermath of natural disasters. For instance, one study of 800 regions of the world showed that people are more religious when living in regions that are more repeatedly demolished by natural disasters (Bentzen 2013). In addition, Penick’s study (1981) showed that membership in the Methodist Church increased by 50% in Midwestern and southern states, where quakes were frequently felt in 1811 and early 1812 in Missouri, USA, compared to an only 1% increase in the rest of the USA in 1811 and 1812. By contrast, religiosity did not prevent post-tsunami long-term mental distress among Norwegian survivors and was not connected to higher levels of life satisfaction (Hussain et al. 2011).

All 13 women in the sample believed that God made them strong and capable of dealing with any post-disaster issue and returning to normal status. That is, they used their religious beliefs as a distress relief mechanism. This finding is in line with some researchers who report that religious coping had been more common among affected women than men (Ferraro and Koch 1994; Hood et al. 1996; Koenig 1998), and women tended to cope better than men when influenced by disastrous events (Brown et al. 2010; Phifer 1990). For instance, the well-being of the affected women in South Asia was improved by applying positive aspects of religiosity such as patience and hope (Nabi 2012).

The livelihood challenge was the most important issue for the men in this study and was linked to their health status. The findings suggest that mental and physical health rehabilitation mechanisms should be developed based on both men’s and women’s preferences. For instance, women may prefer to take a psychological or religious consultant and men’s health may relate to being given livelihood aid from religious organizations.

According to the results, social and livelihood supports which resulted from religious rituals or networks were other positive effects of religion on disaster-affected people’s lives. In other words, religious participation (networks or rituals) was considered as a post-disaster social support, which is important for social integration and people’s health rehabilitation after disasters (García et al. 2014). Similarly, a number of studies have reported that religious activity can be considered as a source of social support after stressful events such as disasters (García et al. 2014; Pargament et al. 2011).

All women in the sample tried to build a religious association or network and join it more than men. Religious meetings of the affected women provided them the opportunity of networking, sharing their stories, and supporting one another. Accordingly, some reports showed that women developed networks of social support and tended to make more meaningful relationships more than men (Brown et al. 2010; Phifer 1990). Most men emphasized their livelihood challenges and mentioned religious associations as a source of providing economical aids. It seems that religious participation can benefit from the financial support of some religion-based organizations, which are rich, powerful, and trustable institutions in Iran. Similarly, a number of religion and disaster studies show that such organizations can play an important role in people’s well-being, effective disaster response, and humanitarian aid at the time of crisis (DeCordier 2009; Gaillard and Texier 2010).

The acts of God belief and sorrowful climate were extracted as the negative effects of religiosity, which can lead to mental distress (e.g., hopelessness, fear, stress) and, importantly, to neglecting disaster prevention measures in the affected regions. Similarly, the act of God belief’s effect was reported in Bangladesh where people consider disasters as “the will of Allah” and do not prepare their community against destructive floods, making plenty of people homeless annually (Schumak 2000). This viewpoint can lead to a low perception of risk and thus increase the risk of health-related consequences (death, injuries, and mental disorders) through recurring similar disasters in such hazard-prone regions (Gaillard and Texier 2010; Mitchell 2000).

In addition, the culture of unhappiness, rooted in firm religious beliefs, may increase the mental disorders of the affected people, especially women. It can bring a serious challenge for psychologists and social workers who provide mental health care in disaster contexts. Post-disaster psychological interventions can be performed through a community-based approach in the affected regions.

Limitations

The main limitation of the study was the cultural sensitivity of the research subject, religion and gender, which meant that the participants were not comfortable enough to explain their stories in detail. Additionally, the results may not be generalizable due to the small samples, which may not include the perceptions and experiences of all Iranians who were affected by the natural disasters. A lack of facilities and transportation systems in the regions with damaged infrastructure made the data collection process difficult.

Conclusion

In conclusion, the positive effects of religiosity such as increasing social and livelihood supports as well as improving mental health can accelerate post-disaster recovery for both women and men (e.g., physical, mental, and livelihood aspects of recovery). On the other hand, the negative effects of religiosity such as acts of God beliefs and making a sorrowful climate can make both women and men more vulnerable to future natural disasters and prevent them from achieving well-being in disaster-stricken communities.

Islamic leaders who have a lot of followers all over the country can play an important role in reducing the negative effects of religiosity. However, some religious leaders encourage their followers to consider disasters as the act of God in order to punish sinful communities. A close collaboration and cooperation between psychologists and religious centers or leaders who advocate for screening and treating post-disaster psychological disorders are strongly suggested. In particular, women may be influenced by religion more than men, and thus, they can participate in strengthening the positive effects of religiosity in the affected regions. In addition, the culture of happiness and a better quality of life can be achieved by the collaboration of religious institutions in disaster-stricken regions. Developing disaster prevention mechanisms as well as well-being interventions in accordance with the preferred religious coping of people are suggested. Further research is needed to determine the coping strategies used by the religious minorities (e.g., Christian, Jewish, and Zoroastrian) living in hazard-prone regions of Iran.