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NCT Number: NCT07251218

Assessing the Effects of Cool Roofs on Mental Health 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.

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Key information

Conditions

Eco-anxiety Anxiety Anxiety Disorders Behavior Combat Disorders Heat Stress Disorders Mental Disorders PTSD - Post Traumatic Stress Disorder Personal Satisfaction Psychological Well-Being Resilience Stress Disorders, Traumatic Trauma and Stressor Related Disorders Wounds and Injuries

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

IndianI Institute of Public Health Gandhinagar

Ahmedabad, India

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Permanent household resident.

Exclusion criteria

  • Roof damage, inaccessible or instability of roof adversely affecting cool roof coating application.
  • Participant unable to provide written/verbal informed consent.

Treatment and study plan

Cool roof

Other

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.

Primary outcomes

  1. 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.

Secondary outcomes

  1. Aggression

    Time frame: Eight measurements: one at baseline and seven over 12 months, covering three consecutive hottest months and four alternate months.

    Self-reported personal aggresion assessed using the Buss-Perry Aggression Questionnaire-Ultra Short Form (BPAQ-ML).

  2. Mental Well-being

    Time frame: One measurement at the end of follow-up at 12 months post-intervention

    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.

  3. Resilience

    Time frame: One measurement at the end of follow-up at 12 months post-intervention.

    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.

  4. Eco-anxiety

    Time frame: One measurement taken at the end of follow-up at 12 months post-intervention.

    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.

  5. Post-Traumatic Stress Disorder

    Time frame: One measurement taken at the end of follow-up at 12 months post-intervention.

    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.

  6. Anxiety

    Time frame: One measurement at the end of follow-up at 12 months post-intervention.

    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.

Sponsors and collaborators

Lead sponsor

Aditi Bunker

Other

Collaborators

  • Boston University
  • Heidelberg University
  • Indian Institute of Public Health, India
  • Rutgers University
  • Sika
  • University of Auckland, New Zealand

Registry information

Official study title

A Cluster Randomised Controlled Trial (cRCT) Evaluating the Effects of Cool Roofs on Mental Health Outcomes in Ahmedabad, India

Acronym: REFLECT

Important dates

Study start
2024
Primary completion
2026
Study completion
2026
First posted
Nov 26, 2025
Registry last updated
Feb 27, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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