Australian researchers have launched a major new study tracking mental health and wellbeing across generations, aiming to identify the factors driving psychological distress and opportunities for earlier intervention.
The Sax Institute’s 18 and Up study will recruit more than 100,000 Australians aged 18 and over, following participants over many years to investigate how mental and physical health are shaped by family history, individual experiences and social conditions.
Backed by $4.5 million in National Health and Medical Research Council funding, the national longitudinal study will build on the institute’s landmark 45 and Up Study, which has followed more than 267,000 Australians since 2005 – and is the largest population-based cohort study in the Southern Hemisphere.
The new research will invite existing 45 and Up participants and their adult children, grandchildren, and other family members to participate, allowing researchers to examine health outcomes across multiple generations within the same families.
Sax Institute CEO and chief investigator Dr Martin McNamara said the study would provide evidence to guide future healthcare policy and practice.
“45 and Up has played a critical role in advancing health research outcomes nationwide over the past two decades, informing policies that have improved the lives of Australians,” he said.
“This new study will build on this legacy, providing unprecedented insights into how our lives and health are shaped by our family history, shared environments and a range of social and lifestyle factors.
“By following participants over this length of time, we will be able to build a comprehensive picture of how health has evolved across generations, showcasing the long-term evidence needed to inform our future health and care systems and policy.”
The study comes amid growing concerns about deteriorating mental health among younger Australians, particularly those aged 18 to 35 years, who remain underrepresented in long-term population health research.
Almost two in five Australians aged 16 to 24 years experienced a mental disorder in the previous 12 months, according to figures highlighted by the Sax Institute.
However, researchers say there is insufficient longitudinal evidence to explain why mental health problems are increasing or identify the protective factors that could inform prevention strategies.
Adjunct Professor Justine Gatt, 18 and Up’s scientific director, said the study would examine not only mental illness but also the factors associated with positive mental health and resilience.
“Importantly, we won’t just be tracking symptoms of mental illness. We’ll also be measuring wellbeing: how people are coping, connecting and thriving. Mental health is more than the absence of illness, and understanding what helps people stay well is just as important as understanding what makes them unwell,” Professor Gatt said.
“What we know already is clear. Almost two in five young Australians aged 16 to 24 experienced a mental disorder in the past year, and that number has been rising. Yet we still lack the long-term evidence needed to understand why.”
Participants will complete surveys covering mental health, physical health, employment, housing, finances, social connections, and family circumstances.
Researchers will combine survey responses with securely linked health records to investigate how these factors interact over time and whether experiences in one generation influence health outcomes in the next.
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Professor Gatt said this approach would provide a more comprehensive understanding of the complex influences on mental health.
“By bringing together what participants tell us through the 18 and Up survey with their linked health records over time, we will be able to see how different experiences and circumstances shape health outcomes and use that evidence to improve care for future generations,” she said.
The study will also explore how social and economic circumstances influence health throughout adulthood, potentially identifying periods when preventive interventions could have the greatest impact.
Unlike studies that capture health outcomes at a single point in time, the longitudinal design will allow researchers to investigate changes across the adult lifespan and examine associations between earlier experiences and later health outcomes.
The research builds on two decades of findings from the 45 and Up Study, which has contributed to more than 600 peer-reviewed publications and informed Australian health policy, prevention programs, and healthcare planning.
Previous research using the cohort has demonstrated associations between childhood experiences and psychological distress decades later, while highlighting the protective role of strong social connections.
Other findings have identified gaps in mental healthcare access, including research showing that more than a quarter of participants aged 45 and over who died by suicide had not accessed federally funded mental health services in the preceding year.
Research from the cohort has also demonstrated links between psychological distress and cardiovascular disease, as well as increased rates of depression and anxiety following diagnoses of cancer, heart disease and diabetes.
Beyond mental health, the 45 and Up Study has contributed to research informing tobacco control, lung cancer screening and dementia prevention.
The new study brings together researchers from institutions including Deakin University, the University of Melbourne, the University of Sydney, the University of Newcastle, UNSW, Monash University, and the Black Dog Institute, alongside Lived Experience Australia.
Its multidisciplinary team includes expertise in epidemiology, psychology, psychiatry, health economics, suicide prevention, and lived-experience research.
Participant information will be deidentified and used only for approved research under established ethical and data governance arrangements, the institute said.
Dr McNamara said the long-term investment in population health research would help Australia anticipate emerging healthcare challenges.
“18 and Up will be a national resource that will allow us to tackle the health challenges that are right around the corner,” he said.
“This asset, along with 45 and Up, will prepare us for the future and help ensure that health policy and services evolve in response to the needs of our population.”
Recruitment opens in November 2026, with the institute aiming to enrol more than 100,000 participants by mid-2027.
For more information see here.
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