Executive summary
Founders are told to be transparent with their investors. On the subject of their own mental health, most are not. In a clinical review of 318 founders and venture-backed operators seen at CEREVITY between January 2025 and July 2026, 64 percent reported actively concealing mental health strain from investors or boards, and the most common reason given was fear of professional or funding consequences. This is the Disclosure Gap: information withheld specifically from the people holding the most structural power over the founder's company and often their livelihood. It completes a series that began with the 2026 Performance Paradox Index and continued with the Cognitive Cost Index; where those examined what strain does to output and to judgment, this one examines who is told.
Venture-backed founders operate under investors who can influence future funding, valuation and sometimes control, and who receive their information through a channel built to project confidence.
Non-disclosure is not avoidance, it is a risk calculation, and in the absence of a safe channel it is usually the correct one. Advising founders to be more open does not change the arithmetic they are doing.
Give the strain somewhere to go that is structurally separate from the cap table, and treat the disclosure decision itself as clinical material rather than a communications problem.
The gap closes from the founder's side without requiring a disclosure to the board, and the board gains a leader whose judgment is not being spent on concealment.
The problemNon-disclosure is a calculation, not a character flaw§
Investor relationships run on confidence, and founders learn early that uncertainty is priced. The external data on where founder strain actually goes is unambiguous. Asked who they turn to for support, founders name a spouse or family member 76 percent of the time and a co-founder 49 percent of the time. Investors are named by 10 percent.02 The same body of research finds 81 percent of founders describing themselves as not really open about their stress, fears and challenges, and 77 percent not getting professional help at all.02 Coverage of that finding in the venture press put the mechanism plainly: founders do not raise it with investors because they fear that showing vulnerability could jeopardise funding.03
It is tempting to read this as founders being insufficiently brave. The occupational research says otherwise. Studies of how employees decide whether to disclose a mental health condition at work find a default position of non-disclosure driven by fear of stigma, and a decision process that functions as an explicit risk and benefit analysis of the specific context the person is in. People do not disclose by default; they require a reason to.04 Applied to a venture-backed founder, the analysis is short. Three features widen the gap. Information and power are asymmetric, because investors influence the next round, the valuation and sometimes the founder's continued tenure. Identity is fused with the company, so personal instability reads as company instability rather than as a health matter. And almost no board or firm offers a confidential, non-evaluative channel, which means every available route for disclosure is also a route to being assessed. The founder is not failing to be brave. They are correctly reading a room that has no safe seat in it.
Founders name a spouse 76 percent of the time and an investor 10 percent. Startup Snapshot, The Untold Toll, 400 plus founders
The evidenceWhat the research shows§
Two bodies of evidence are used here and kept apart. The first is a clinical review of 318 consecutive founders and venture-backed operators seen at CEREVITY between January 2025 and July 2026, a help-seeking sample rather than a population survey, with n and date range attached to every internal figure. The second is published survey and occupational research on founder support networks and on how people decide whether to disclose a mental health condition at work. The second matters more than usual here, because it is what separates a claim about behaviour from a claim about character.
64%
actively concealed mental health strain from investors or boards
CEREVITY clinical review, n=318, 2025 to 2026
58%
gave fear of professional or funding consequences as the primary reason
CEREVITY clinical review, n=318, 2025 to 2026
47%
concealed the strain for longer than six months
CEREVITY clinical review, n=318, 2025 to 2026
21 mo
median delay from first recognising strain to a first clinical session
CEREVITY clinical review, n=318, 2025 to 2026
The internal and external figures describe the same behaviour from two directions. Our sample reports concealment at 64 percent and names funding consequences as the reason in 58 percent of cases; the external survey finds only 10 percent of founders willing to take stress to an investor at all.02 Surrounding prevalence is high: 54 percent of founders reported burnout in the prior 12 months and 75 percent anxiety,06 and 49 percent of entrepreneurs in a matched comparison reported a lifetime mental health condition against 23.1 percent of US adults.07, 15 Our own earlier review of tech founders documented the same concealment behaviour in a separate cohort, summarised in what founders told us about hidden strain in 2025.
The most consequential finding is about what happens after a disclosure rather than before it. In a study of 322 employees who disclosed a mental health condition to a supervisor, outcomes diverged sharply on the supervisor's reaction: 85.7 percent intended to stay with their employer after a positive reaction against 36.7 percent after a negative one, and 75.0 percent felt comfortable discussing mental health afterwards against 36.7 percent. Roughly three quarters of disclosures met a positive reaction.05 Two things follow. The feared outcome is not the most likely one, and the cost when it does occur is severe enough that the caution is rational. This is also why the concealment itself is not free: background preoccupation with a withheld secret, rather than the acts of hiding, is what predicts reduced wellbeing,08 and suppression draws on the same attention the work requires.09, 10
| Indicator | CEREVITY sample (n=318) | External evidence | Source |
|---|---|---|---|
| Concealed mental health strain from investors or boards | 64% | Only 10% of founders name an investor as someone they turn to for support | CEREVITY01; Startup Snapshot02 |
| Fear of professional or funding consequences as the reason | 58% | Founders avoid raising it with investors for fear vulnerability could jeopardise funding | CEREVITY01; PitchBook03 |
| Concealment lasted longer than six months | 47% | 81% of founders describe themselves as not really open about stress, fears and challenges | CEREVITY01; Startup Snapshot02 |
| Concealment itself increased internal strain | 53% | Preoccupation with a withheld secret, not the acts of concealment, predicts lower wellbeing | CEREVITY01; Slepian et al.08 |
| Median delay, recognising strain to first session | 21 months | 6 to 8 years from onset to first treatment contact for mood disorders, general population | CEREVITY01; Wang et al.11 |
| Why non-disclosure is the default | Not separately scored | Employees hold a default non-disclosure position from fear of stigma and require a reason to disclose | Toth and Dewa04 |
| What determines the outcome of disclosing | Not separately scored | Intent to stay ran 85.7% after a positive supervisor reaction against 36.7% after a negative one (n=322) | Volkov et al.05 |
01, 02 CEREVITY clinical review, n=318, January 2025 to July 2026. Clinical, help-seeking sample; concealment is self-reported.
Startup Snapshot (2023). The Untold Toll, 400 plus founders.
05 Volkov, I. et al. (2025). Workplace outcomes after mental health disclosure. Journal of Occupational Rehabilitation, n=322 employees who disclosed to a supervisor.
Measured in employment settings, not founder and investor relationships, which differ in the direction of dependency.
The frameworkA model you can name and own§
Four phases recur in the clinical sample. The model is descriptive rather than diagnostic, and it is built around a trap: the perceived cost of disclosing rises at roughly the same rate as the need to disclose, so waiting makes the decision harder rather than easier.
CEREVITY model
The Disclosure Gap Cycle
A four-phase description of how strain becomes information that is deliberately not shared. Each phase is a decision rather than a symptom, which is what makes the cycle interruptible without anyone being told.
Recognition under pressure
The founder notices rising strain while still delivering. Nothing is concealed yet, because nothing has been named. The company is usually performing.
Calculated non-disclosure
A deliberate decision not to surface the strain to investors or the board, almost always framed as protecting the company or the round rather than protecting the self.
Extended concealment
The gap holds and the load compounds. The longer the position is maintained, the more a later disclosure would have to explain, which raises its perceived cost precisely as the need for it grows.
Forced or chosen disclosure
A crisis, a near miss, external feedback, or a private decision to seek care outside the company breaks the pattern. In this sample the median lag from recognition to a first session was 21 months.
The clinical objective is to interrupt during phase one or two, and the useful insight is that interruption does not require disclosure to the board at all. It requires one channel that is not connected to the cap table. That is the specific absence a confidential room outside the org chart is built to fill for people whose every existing relationship carries an evaluative function.
SCHEMATIC Schematic, not measured data.
Descriptive model derived from patterns observed in the CEREVITY clinical review, n=318, January 2025 to July 2026. The curves are illustrative and carry no units.
By professionHow it presents across roles§
The gap is one behaviour, but who the founder is hiding from, and what they believe disclosure would cost, changes with the stage and the seat. The three groups below are the ones represented in the CEREVITY sample.
Early and growth-stage founders
This group shows the highest concealment rates in the sample, and the reason is specific rather than general: the disclosure risk is tied directly to a live or approaching raise. Founders describe timing their worst months around board meetings and diligence windows, and the phrase that recurs is a fear of looking unstable at the exact moment the company is being valued. The external picture supports the caution as a reading of the room even where it does not support it as a strategy: only 10 percent of founders name an investor as someone they turn to, against 76 percent naming a spouse and 49 percent a co-founder.02 Strain in the group is not rare. Fifty-four percent reported burnout in the prior year and 75 percent anxiety.06 What makes this segment distinct clinically is that the concealment has an audience and a calendar. It is not a diffuse reluctance to be vulnerable; it is a scheduled performance with known observers, repeated every six to eight weeks, and it produces a recognisable pattern of compressed sleep and narrowed decision-making in the fortnight before each one. Treating it means treating the calendar as clinical material, not only the mood. The founders in this group who moved earliest were almost always the ones who had found a channel with no line back to the company, rather than the ones who had been persuaded that disclosure was safe.
Individual therapy for founders
Organizational founder mental health handled at fund level
Operators and non-founder executives in venture-backed companies
Operators carry the founder's disclosure problem plus one more layer. They are managing what the board sees and also what the founder sees, and the founder is simultaneously their colleague, their manager and the person whose composure they are helping to maintain. In practice this produces a narrower disclosure set than the founder has: a founder can at least talk to a co-founder, while an operator often concludes that any internal route reaches the founder eventually. The occupational research is directly relevant here, because it is about employees rather than principals: the default is non-disclosure driven by fear of stigma, and people need a reason before they move off it.04 The reason rarely arrives in a company where the leadership is itself concealing. Clinically this group presents later than founders do and with more somatic complaint, and they are the most likely of the three to describe their own strain as not serious enough to warrant attention, which is a comparison to the founder rather than to any clinical threshold. Two practical features distinguish them. Their equity is usually smaller and their optionality larger, so the exit they consider is leaving rather than disclosing, and departures in this group are frequently recorded as ordinary attrition when the precipitant was untreated strain nobody was told about. And because they hold operational detail the founder does not, their concealment removes a second and independent read on how the company is actually running, which is a governance cost as much as a clinical one.
Individual clinical care for technical leaders
Organizational startup mental health partnership
Repeat and post-exit founders
Concealment rates are lower in this group but remain substantial, which is the finding worth sitting with: having done it before does not create a safe channel, it only makes the person better at the concealment. Several factors are specific. Reputation is now an asset with a longer horizon than any single company, so the perceived cost of a disclosure extends past the current cap table to future fundraising and board seats. Wealth introduces its own barrier, the sense that distress is illegitimate given the outcome, which delays help-seeking further. And the structures around a post-exit founder, a family office, advisors, a foundation, are staffed by people who are financially dependent on them, which removes the last relationships that were not evaluative. The clinical presentation often centres on isolation and on identity after the exit rather than on acute performance pressure, and the delay to care in this group is the longest in the sample despite the fewest external constraints on getting it. The reframe that lands with this group is rarely about wellbeing. It is that the concealment habit was built for a context that no longer exists, and is now being maintained at cost against an audience that has changed. Where a first-time founder is hiding from investors who hold power over the company, a post-exit founder is often hiding from people who hold no power at all, which makes the pattern easier to name and, in the sample, substantially easier to interrupt once named.
Individual confidential therapy for principals and inheritors
Organizational family office succession and principal therapy
The stakesThe cost of inaction§
The first cost is borne by the founder, in the form of strain that goes untreated for a median of 21 months from the point they recognised it.01 The second is borne by the company, and it is the one investors consistently discover late: material personal risk to the key person stays invisible until it is advanced. In this sample 53 percent reported that the concealment itself increased their internal load, which is consistent with the finding that preoccupation with a withheld secret, more than the acts of hiding, is what tracks with reduced wellbeing.08
The concealment is its own load
Holding the position consumes attention the company is paying for. Expressive suppression measurably impairs memory for information encountered while suppressing,09 and stress shifts choice toward habit and away from exploration,12 with working memory and cognitive flexibility both impaired under acute stress.13 The founder is running the company on a reduced allocation and is the only one who knows.
Discovery at the worst moment
Because nothing surfaces early, the disclosure that eventually happens is usually the involuntary kind: during diligence, a crisis, or a health event. That is the least controllable moment for the founder and the most expensive one for the board, which learns about a key-person risk at the same time it has to act on it.
A treatable delay
Twenty-one months is fast against the general population's lag to first treatment contact, where the delay for mood disorders runs 6 to 8 years,11 and slow against the lifespan of a funding round. It is also the single variable in this cycle that an individual, a board or an investor can actually shorten.
01, 11 CEREVITY clinical review, n=318, January 2025 to July 2026.
Wang, P. S. et al. (2005). National Comorbidity Survey Replication, n=9,282. The context bar measures a different population and interval and is shown for scale.
The solutionWhat effective care looks like§
Care for this population has to be built around the disclosure problem rather than around the symptom, because the disclosure problem is what produced the delay. That means a structure with no line back to the company or the cap table, clinicians who understand venture dynamics well enough that a founder does not spend the first session explaining what a down round or a board observer is, formats with enough depth to reach material held for a year or more, and explicit attention to the disclosure decision itself. Treating the anxiety while leaving the concealment unexamined addresses the symptom and leaves the mechanism running.
CEREVITY is a nationwide network of independent licensed clinicians, matched to the person and delivered by secure video on a fully private-pay basis, with no diagnosis code travelling through an insurer and no record inside the company's systems. That structure is the point rather than a feature: it is what makes the channel usable by someone whose objection to care was never the care. Sessions run in three formats and no others. The 50-minute format carries continuity week to week, and 90-minute extended work gives room to material that a single hour tends to leave half-opened.
Where what needs saying has been held for a year or more, therapy intensives running 3 hours reach it in one sitting rather than across a quarter of weekly appointments, which matters when the delay to care has already been measured in months. The approach behind this model sets out how clinicians are matched to the pressures of a role rather than to a diagnosis alone.
ImplementationHow to put it into practice§
Four steps. The first two are for the founder or operator, the second two for the investor or board that would rather not learn about this during diligence.
- 01
Name the gap as a gap, not as a symptom
Ask directly whether mental health information is being systematically withheld from investors or the board, and for how long. It is a more answerable question than any question about mood, because the founder has already made the decision consciously and can usually date it. The company performing normally is not evidence against the strain: people with occupational burnout have been shown to match controls on cognitive task performance while showing altered underlying neural processing, meaning the same output at a higher internal cost.14
- 02
Open one channel that is not connected to the company
The channel has to be structurally separate from the cap table and the employment record, not merely promised to be confidential. Given that the default position is non-disclosure until a reason to disclose exists,04 the practical intervention is to create a route where the risk calculation comes out differently rather than to argue with the calculation.
- 03
For investors: audit whether your culture makes disclosure survivable
The determinant of a disclosure's outcome is the reaction it meets. Intent to stay ran 85.7 percent after a positive reaction and 36.7 percent after a negative one.05 A firm that has never considered how it would respond has already answered the founder's question, and the founder has already priced it. This is also worth reading alongside how investors experience decision fatigue themselves.
- 04
Intervene during early concealment, not after rupture
Waiting for a visible break means waiting for phase four, and the 21-month median in this sample is long enough to contain an entire funding cycle.01 Early concealment is also the point at which the founder is least likely to raise it unprompted, which is why the prompt has to come from somewhere structural rather than from goodwill.
RecommendationsWhere to start§
Clinical
Read prolonged concealment as both a clinical and a governance signal
Sustained withholding from the people with the most structural power is a marker worth acting on in its own right. It sits alongside the pattern described in the 2026 Performance Paradox Index, where output held while internal strain rose.
Clinical
Screen for the low mood underneath, not only the stress
Concealment is usually described in the language of pressure, but what is being concealed is frequently anxiety or persistent low mood that has never been assessed, which is what clinical care for anxiety and low mood in senior roles is structured to address.
Structural
Measure the lag and treat it as an operational number
Track the interval between recognising strain and reaching care. It was a median of 21 months here, it is knowable, and unlike stigma it can be moved directly.
Structural
Separate the channel from the relationship
A founder should not have to choose between saying nothing and saying it to someone who votes on their future. Boards and firms benefit when founders have a private place to think that does not automatically become a board-level disclosure, and the evidence on disclosure outcomes suggests the alternative is not neutral.05
FAQCommon questions§
Where does the 64% figure come from?
Is this only about diagnosed mental illness?
Does concealment protect the company?
How does private-pay billing work?
How is my privacy protected?
MethodologyHow this paper was built§
Methodology
This Index is the third in a series. The 2026 Performance Paradox Index established that peak output frequently coincides with peak internal strain, the Cognitive Cost Index quantified what concealment does to decision quality, and this paper examines the disclosure decision itself: who is told, who is not, and why. The three samples overlap in population but are separately drawn and their figures are not interchangeable. The clinical component is a review of consecutive founder and venture-backed clients seen through CEREVITY between 1 January 2025 and 31 July 2026. After inclusion criteria were applied, senior decision-making responsibility in a venture-backed company and sufficient clinical contact for the relevant variables to be assessed, 318 clients remained. Variables were recorded from structured intake and clinician-documented review: whether mental health strain was deliberately withheld from investors or a board, the stated primary reason, the duration of the withholding, self-rated change in internal load attributed to the concealment itself, and the interval between first recognising strain and a first clinical session. The external component draws on survey and peer-reviewed research identified through PubMed, PsycINFO and Google Scholar and through direct retrieval from publishing organisations, covering 2000 to 2026. Sample sizes are stated wherever a source is used: Startup Snapshot (400 plus founders), Volkov and colleagues (n=322 employees who disclosed to a supervisor), Toth and Dewa (13 in-depth interviews, grounded theory), Sifted (n=138, February 2025), Freeman and colleagues (n=242 entrepreneurs against 93 comparison participants), Slepian and colleagues (ten studies, more than 13,000 secrets) and Wang and colleagues (n=9,282). Limitations are material. The CEREVITY sample is clinical and help-seeking and cannot support a prevalence claim about founders generally; people who reach a clinician may conceal more, or less, than those who do not. Concealment is self-reported and reported retrospectively, and the reason given for it is the founder's own attribution rather than an observed cause. No investor-side data were collected, so the paper describes what founders believe about investor reactions and not what investors would actually do. The disclosure research cited is drawn from employment settings rather than founder-investor relationships, which differ in the direction of dependency, and Toth and Dewa in particular is a small qualitative study whose value is the mechanism it describes rather than any rate it establishes. The Index should be read as clinical observation placed against occupational evidence, not as a causal account.
References
- 01CEREVITY. (2026). Disclosure Gap Index: clinical review of 318 consecutive founders and venture-backed operators, January 2025 to July 2026. Internal clinical data, not publicly posted.
- 02Startup Snapshot. (2023). The Untold Toll: the impact of stress on the well-being of startup founders and CEOs. 400 plus founders surveyed. startupsnapshot.com
- 03PitchBook. (2023). Prioritizing founders' mental health could pay off for VCs. pitchbook.com
- 04Toth, K. E., and Dewa, C. S. (2014). Employee decision-making about disclosure of a mental disorder at work. Journal of Occupational Rehabilitation, 24(4), 732 to 746. Thirteen in-depth interviews, grounded theory. link.springer.com
- 05Volkov, I., Sheppard, D. M., Kirk-Brown, A., and Van Dijk, P. (2025). Workplace outcomes after mental health disclosure: the critical influence of supervisor reactions. Journal of Occupational Rehabilitation. n=322. link.springer.com
- 06Sifted. (2025, February 26). More than half of founders experienced burnout last year. Founder mental health survey, n=138. sifted.eu
- 07Freeman, M. A., Staudenmaier, P. J., Zisser, M. R., and Andresen, L. A. (2019). The prevalence and co-occurrence of psychiatric conditions among entrepreneurs and their families. Small Business Economics, 53(2). n=242 entrepreneurs, 93 comparison participants. link.springer.com
- 08Slepian, M. L., Chun, J. S., and Mason, M. F. (2017). The experience of secrecy. Journal of Personality and Social Psychology, 113(1), 1 to 33. Ten studies, more than 13,000 secrets. columbia.edu
- 09Richards, J. M., and Gross, J. J. (2000). Emotion regulation and memory: the cognitive costs of keeping one's cool. Journal of Personality and Social Psychology, 79(3), 410 to 424. pubmed.ncbi.nlm.nih.gov
- 10Pachankis, J. E. (2007). The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychological Bulletin, 133(2), 328 to 345. pubmed.ncbi.nlm.nih.gov
- 11Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., and Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 603 to 613. n=9,282. pubmed.ncbi.nlm.nih.gov
- 12Starcke, K., and Brand, M. (2012). Decision making under stress: a selective review. Neuroscience and Biobehavioral Reviews, 36(4), 1228 to 1248. pubmed.ncbi.nlm.nih.gov
- 13Shields, G. S., Sazma, M. A., and Yonelinas, A. P. (2016). The effects of acute stress on core executive functions: a meta-analysis and comparison with cortisol. Neuroscience and Biobehavioral Reviews, 68, 651 to 668. escholarship.org
- 14Pihlaja, M., Perakyla, J., Erkkila, E.-H., Tapio, E., Vertanen, M., and Hartikainen, K. M. (2023). Altered neural processes underlying executive function in occupational burnout: basis for a novel EEG biomarker. Frontiers in Human Neuroscience, 17. n=54. frontiersin.org
- 15National Institute of Mental Health. (2022 data). Mental illness: any mental illness among US adults, 23.1 percent. nimh.nih.gov
Licensed Clinical Social Worker
Martha Fernandez, LCSW is Co-Founder of CEREVITY and a Licensed Clinical Social Worker licensed in California, seeing clients by telehealth nationwide through CEREVITY's network of independent licensed clinicians. USC-trained and bilingual in English and Spanish, she works with founders, executives, attorneys and pilots on burnout, anxiety and depression in high performers, on trauma, grief and high-stakes transitions, and on couples and relationship strain under pressure. Her clinical work draws on cognitive behavioral therapy, acceptance and commitment therapy, behavioral activation, and narrative and solution-focused approaches. She is the author of Wired to Burn.
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