Eco-anxietyREFLECTNCT07251218
Assessing the Effects of Cool Roofs on Mental Health in Ahmedabad, India
A study testing Cool roof in people with Eco-anxiety and PTSD - Post Traumatic Stress Disorder, run by Aditi Bunker at 1 site in India.
Trial summary
Ambient air temperatures in India have broken record highs. Solutions are needed to build heat resilience in communities and adapt to increasing heat from climate change. Sunlight-reflecting cool roof coatings may passively reduce indoor temperatures and energy use to protect home occupants from extreme heat. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Eco-anxiety, PTSD - Post Traumatic Stress Disorder, Resilience
- What is being tested?
- Cool roof
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 800 participants
- Where
- 1 siteIndia
- Study dates
- 1 Dec 2024to 1 Mar 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Permanent household resident.
Who cannot join
- Roof damage, inaccessible or instability of roof adversely affecting cool roof coating application.
- Participant unable to provide written/verbal informed consent.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: A Cluster Randomised Controlled Trial (cRCT) Evaluating the Effects of Cool Roofs on Mental Health Outcomes in Ahmedabad, India
Ambient air temperatures in India have broken record highs. Solutions are needed to build heat resilience in communities and adapt to increasing heat from climate change. Sunlight-reflecting cool roof coatings may passively reduce indoor temperatures and energy use to protect home occupants from extreme heat. Occupants living in poor housing conditions are susceptible to increased heat exposure.
Heat exposure can instigate and worsen mental health. The worst adverse health effects are experienced in communities that are least able to adapt to heat exposure. By reducing indoor temperatures, cool roof use can promote mental wellbeing in household occupants.
The long-term research goal of the investigators is to identify viable passive housing adaptation technologies with proven health benefits to reduce the burden of heat stress in communities affected by heat. To meet this goal, the investigators will conduct a cluster-randomized controlled trial to establish the effects of cool roof use on mental health in Ahmedabad, India.
Read the detailed description
Increasing heat exposure from climate change is causing and exacerbating heat-related illnesses in millions worldwide - particularly in low resource settings. June 2024 was the 13th consecutive hottest month on record globally - shattering previous records. Heat exposure can instigate and worsen mental health conditions, including depression, anxiety and aggression. Adaptation is essential for protecting people from increasing heat exposure. The built environment, especially homes, are ideal for deploying interventions to reduce heat exposure and accelerate adaptation efforts. However, there currently is a lack of evidence on a global scale - generated through empirical studies - guiding the uptake of interventions to reduce heat stress in low resource settings.
Sunlight-reflecting cool roof coatings passively reduce indoor temperatures and lower energy use, offering protection to home occupants from extreme heat. The investigators therefore aim to conduct a cluster-randomized controlled trial investigating the effects of cool-roof use on mental health outcomes in Ahmedabad.
The trial will quantify whether cool roofs are an effective passive home cooling intervention with beneficial health effects for vulnerable populations in Ahmedabad. Findings will inform regional policy responses on scaling cool roof implementation to protect people from increasing heat exposure driven by climate change.
- Being tested
- Cool roof
- Keywords
- Cool roof, Mental health, Heat stress, Housing, Hot temperature, Humidity
- Medical subject headings
- Combat Disorders, Anxiety Disorders, Psychological Well-Being, Heat Stress Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Cool roofOther
Cool roofs are a heat-reflecting material that can be applied to existing household roofing in the form of a liquid-applied membrane. Cool roofs work by increasing solar reflectance (the ability to reflect the visible wavelengths of sunlight, reducing heat transfer to the surface) and thermal emittance (the ability to radiate absorbed solar energy) thereby reducing the amount of heat transferred into the home.
| Study group | Role | What they receive |
|---|---|---|
| Cool roof | Experimental | Households will receive sunlight reflecting 'cool roof' coating on their roofs. Receives: Other: Cool roof |
| No cool roof | No intervention | No cool roof application. Households will keep their original roofing for the duration of the trial. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Depression
Self-reported presence and frequency of symptoms of depression assessed using aggregate score of the Patient Health Questionnaire 9 (PHQ-9). Minimum score of 0 and a maximum score of 27 with a higher score meaning a worse outcome.
Measured: Eight measurements will be taken: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.
Secondary outcomes (6)
Aggression
Self-reported personal aggresion assessed using the Buss-Perry Aggression Questionnaire-Ultra Short Form (BPAQ-ML).
Measured: Eight measurements: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.
Mental Well-being
Self-reported mental wellbeing over the last two weeks using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) with a minimum score of 14 and a maximum score of 70. A higher score indicates a higher level of mental well-being.
Measured: One measurement at the end of follow-up at 12 months post-intervention
Resilience
Self-reported resilience rating over the last month using the Connor-Davidson Resilience Scale (CD-RISC-10) with a minimum score of 0 and a maximum score of 40. Higher total scores indicate a greater ability to cope with adversity and higher resilience.
Measured: One measurement at the end of follow-up at 12 months post-intervention.
Eco-anxiety
Self-reported eco-anxiety over the last two weeks measured using the Hogg Eco-Anxiery Scale with a total score range from a minimum of 0 to a maximum of 52. Higher scores on the scale and its sub-dimensions indicate higher levels of eco-anxiety.
Measured: One measurement taken at the end of follow-up at 12 months post-intervention.
Post-Traumatic Stress Disorder
Self-reported symptoms of post-traumatic stress disorder using the Short PTSD Rating Interview (SPRINT) questionnaire with a potential score range from a minimum of 0 to a maximum of 32. A higher score indicates greater PTSD symptoms.
Measured: One measurement taken at the end of follow-up at 12 months post-intervention.
Anxiety
Self-reported anxiety over the last two weeks using the GAD-7 Anxiety Severity Scale with a minimum score of 0 and a maximum score of 21. Higher scores indicate greater anxiety severity.
Measured: One measurement at the end of follow-up at 12 months post-intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Nov 2025
- Study start1 Dec 2024
- Primary completion1 Mar 2026 (estimated)
- Study completion1 Mar 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Eco-anxietyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 800 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Aditi Bunker
- Sponsor type
- University, hospital or other
- Collaborators
- Heidelberg University, Rutgers University, Boston University, Indian Institute of Public Health, India, Sika, University of Auckland, New Zealand
- Responsible party
- Sponsor-investigator, Aditi Bunker, University of Auckland, New Zealand
- Investigators
- Collin Tukuitonga, Principal investigator, University of Auckland, New Zealand
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07251218
- Sponsor's protocol ID
- 3728166
- Other IDs
- 226745/Z/22/Z
- Acronym
- REFLECT
- Status last verified
- Feb 2026
- First submitted
- 13 Nov 2025
- Last updated
- 27 Feb 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Data that can be shared unconditionally underpinning the published research articles will be made available to other researchers at the time of publication, and data will be linked via the article DOI. Data that cannot be unconditionally shared upon publication owing to confidentiality or data protection requirements will be identified as such and a contact email will be provided in relevant publications for data access enquiries by other researchers. Individual names of study participants and identifying factors will be removed prior to data sharing. It is expected that demographic data of people at the study sites (family size and composition, basic socioeconomic indicators) may contain personally identifiable information and location data. All such data will be removed prior to storage on online data repositories and therefore will be available to be publicly shared at the time of publication of manuscripts.
Study at a glance
From the registry record, last updated by the sponsor on 27 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Cluster Randomised Controlled Trial (cRCT) Evaluating the Effects of Cool Roofs on Mental Health Outcomes in Ahmedabad, India
- ClinicalTrials.gov ID
- NCT07251218
- Acronym / sponsor ID
- REFLECT / 3728166
- Keywords
- Cool roof, Mental health, Heat stress, Housing, Hot temperature, Humidity
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 800 participants (estimated)
- Lead sponsor
- Aditi BunkerUniversity, hospital or other
- Collaborators
- Heidelberg University, Rutgers University, Boston University, Indian Institute of Public Health, India, Sika, University of Auckland, New Zealand
- Study start
- 1 Dec 2024 (actual)
- Primary completion
- 1 Mar 2026 (estimated)
- Study completion
- 1 Mar 2026 (estimated)
- First posted
- 26 Nov 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Ambient air temperatures in India have broken record highs. Solutions are needed to build heat resilience in communities and adapt to increasing heat from climate change. Sunlight-reflecting cool roof coatings may passively reduce indoor temperatures and energy use to protect home occupants from extreme heat. Occupants living in poor housing conditions are susceptible to increased heat exposure.
Heat exposure can instigate and worsen mental health. The worst adverse health effects are experienced in communities that are least able to adapt to heat exposure. By reducing indoor temperatures, cool roof use can promote mental wellbeing in household occupants.
The long-term research goal of the investigators is to identify viable passive housing adaptation technologies with proven health benefits to reduce the burden of heat stress in communities affected by heat. To meet this goal, the investigators will conduct a cluster-randomized controlled trial to establish the effects of cool roof use on mental health in Ahmedabad, India.
Detailed description
Increasing heat exposure from climate change is causing and exacerbating heat-related illnesses in millions worldwide - particularly in low resource settings. June 2024 was the 13th consecutive hottest month on record globally - shattering previous records. Heat exposure can instigate and worsen mental health conditions, including depression, anxiety and aggression. Adaptation is essential for protecting people from increasing heat exposure. The built environment, especially homes, are ideal for deploying interventions to reduce heat exposure and accelerate adaptation efforts. However, there currently is a lack of evidence on a global scale - generated through empirical studies - guiding the uptake of interventions to reduce heat stress in low resource settings.
Sunlight-reflecting cool roof coatings passively reduce indoor temperatures and lower energy use, offering protection to home occupants from extreme heat. The investigators therefore aim to conduct a cluster-randomized controlled trial investigating the effects of cool-roof use on mental health outcomes in Ahmedabad.
The trial will quantify whether cool roofs are an effective passive home cooling intervention with beneficial health effects for vulnerable populations in Ahmedabad. Findings will inform regional policy responses on scaling cool roof implementation to protect people from increasing heat exposure driven by climate change.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cool roof | Experimental | Other: Cool roofHouseholds will receive sunlight reflecting 'cool roof' coating on their roofs. |
| No cool roof | No intervention | –No cool roof application. Households will keep their original roofing for the duration of the trial. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Permanent household resident.
Key exclusion criteria (2 listed)
- Roof damage, inaccessible or instability of roof adversely affecting cool roof coating application.
- Participant unable to provide written/verbal informed consent.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Cool roofCool roofs are a heat-reflecting material that can be applied to existing household roofing in the form of a liquid-applied membrane. Cool roofs work by increasing solar reflectance (the ability to reflect the visible wavelengths of sunlight, reducing heat transfer to the surface) and thermal emittance (the ability to radiate absorbed solar energy) thereby reducing the amount of heat transferred into the home. | Other | Cool roof |
Primary outcome
Depression
Time frame: Eight measurements will be taken: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.
Self-reported presence and frequency of symptoms of depression assessed using aggregate score of the Patient Health Questionnaire 9 (PHQ-9). Minimum score of 0 and a maximum score of 27 with a higher score meaning a worse outcome.
6 secondary outcomes
Aggression
Time frame: Eight measurements: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.
Mental Well-being
Time frame: One measurement at the end of follow-up at 12 months post-intervention
Resilience
Time frame: One measurement at the end of follow-up at 12 months post-intervention.
Eco-anxiety
Time frame: One measurement taken at the end of follow-up at 12 months post-intervention.
Post-Traumatic Stress Disorder
Time frame: One measurement taken at the end of follow-up at 12 months post-intervention.
Anxiety
Time frame: One measurement at the end of follow-up at 12 months post-intervention.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Feb 2026.
- Individual participant dataSharing planned: Yes. Data that can be shared unconditionally underpinning the published research articles will be made available to other researchers at the time of publication, and data will be linked via the article DOI. Data that cannot be unconditionally shared upon publication owing to confidentiality or data protection requirements will be identified as such and a contact email will be provided in relevant publications for data access enquiries by other researchers. Individual names of study participants and identifying factors will be removed prior to data sharing. It is expected that demographic data of people at the study sites (family size and composition, basic socioeconomic indicators) may contain personally identifiable information and location data. All such data will be removed prior to storage on online data repositories and therefore will be available to be publicly shared at the time of publication of manuscripts.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Collin Tukuitonga principal investigator
University of Auckland, New Zealand
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Cool roof in people with Eco-anxiety and PTSD - Post Traumatic Stress Disorder, run by Aditi Bunker at 1 site in India.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 27 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Depression (time frame: Eight measurements will be taken: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Feb 2026.