In 2004, one of the largest earthquakes ever recorded led to a tsunami devastating two-thirds of the Sri Lankan coastline. We examined whether certain causal beliefs (attributional style and karma, a Buddhist concept used to explain bad events) are associated with tsunami survivors experiencing PTSD and poor health about six months later. Previous studies of causal beliefs associated with illness following the same traumatic event have focused on Western countries and none have considered the role of karma. We interviewed 264 Sri Lankan tsunami survivors. As predicted, we found that belief in karma and a pessimistic explanatory style are independently associated with poor health and a pessimistic explanatory style is associated with PTSD, after adjusting for relevant factors. Thus, both universal and more culturally specific beliefs may contribute to coping following a natural disaster.