Executive summary
Stress at the top of an organization is no longer a private matter, and the figures have moved decisively. In Businessolver's 2024 survey, 55 percent of chief executives reported a mental health issue, a 24 point jump in a single year, even as half described their own workplace as toxic.1 This report gathers what the published research shows about executive and leader stress, names the pattern that hides it, and sets out a course of action a decision-maker can take now rather than after a collapse.
Sustained responsibility, long hours, scarce confidants, and a culture that rewards composure combine to produce chronic stress that leaders are structurally encouraged to conceal.
Standard employee assistance programs and insurance-based care can feel exposing and slow to a leader who cannot risk a diagnosis appearing in a shared record.
Discreet, private-pay care delivered by clinicians who understand the demands of leadership, accessed early and confidentially, treats the problem while it is still small.
Leaders who get matched care before the erosion stage protect their own judgment, their health, and the performance of everyone who depends on their decisions.
The problemThe strain at the top is now measurable, and rising
The data on executive stress has stopped being anecdotal. Businessolver's 2024 State of Workplace Empathy study, which surveyed more than 3,000 employees, HR leaders, and chief executives, found that 55 percent of CEOs reported experiencing a mental health issue, a 24 point increase in a single year, and a higher rate than the 50 percent reported by employees.1 In the same study, 52 percent of CEOs described their own workplace as toxic.1 Deloitte and Workplace Intelligence, surveying 3,150 people including 1,050 C-suite leaders, found that 40 percent of executives say they always or often feel overwhelmed at work, and that more C-suite leaders reported struggling with depression, 26 percent, than the employees they lead, 23 percent.2
The usual framing treats stress as a frontline problem that flows downward from leadership. The evidence shows it runs the other way too. Loneliness compounds the load: a Harvard Business Review and RHR International survey of chief executives found that half reported feeling lonely in the role, and 61 percent of those believed it hurt their performance.3 The people best positioned to model help-seeking are the same people most exposed to its perceived cost, which is why the strain at the top so often stays invisible until it breaks.
The leader most able to set the tone for help-seeking is also the one with the most to lose by being seen to need it, so the strain at the top stays hidden until it is expensive. CEREVITY Clinical Whitepaper, Series No. 39
The evidenceWhat the research shows
The figures below are drawn from several large surveys and peer-reviewed studies rather than a single source, so they triangulate rather than echo. Read together, they describe a population under sustained load that is both more affected than the workforce it leads and less likely to say so.
55%
of chief executives report having experienced a mental health issue, a 24 point rise year over year
Businessolver, 2024
61%
of CEOs who feel lonely in the role say the isolation hinders their performance
HBR / RHR, 2012
745k
deaths in one year from heart disease and stroke linked to working 55 or more hours a week
WHO / ILO, 2021
70%
of C-suite leaders say they are seriously considering quitting for a job that better supports well-being
Deloitte, 2023
No single statistic carries the argument. Taken together they establish a consistent pattern: leaders carry a measurable and growing mental health burden, that burden is sharpened by isolation specific to the role, the hours that drive it have a documented physical cost, and a large share of leaders are already weighing exit rather than treatment. The pattern is not that leaders are fragile. It is that the conditions of the role are predictably harmful, and that the current options for relief feel riskier than silence.
| Source and year | Population studied | Headline finding | Sample |
|---|---|---|---|
| Businessolver, 2024 | US CEOs vs. employees | 55% of CEOs reported a mental health issue, up 24 points year over year | 3,000+ |
| Deloitte / Workplace Intelligence, 2023 | C-suite, managers, employees | 26% of C-suite reported depression vs. 23% of employees; 40% feel overwhelmed | 3,150 (1,050 C-suite) |
| HBR / RHR International, 2012 | Public and private company CEOs | 50% of CEOs feel lonely; 61% of those say it hinders performance | 83 CEOs |
| Gallup, 2024 | Global employees and managers | Manager engagement fell from 30% to 27%; 40% feel stress a lot of the day | Global sample |
| WHO / ILO, 2021 | Workers in 194 countries | 745,000 deaths in 2016 from long hours; 55+ hrs/wk raises stroke risk 35% | 194 countries |
| Freeman et al., 2018 | Entrepreneurs vs. comparison group | 72% of entrepreneurs affected by mental health concerns; 30% report depression | 242 entrepreneurs |
| APA Stress in America, 2023 | US adults | 77% cite money as a stressor; 33% feel consistently overwhelmed despite coping | US adults |
The frameworkA model you can name and own
A named model gives a reader something to recognize in real time, before a crisis forces the issue. The pattern below, which we call the Composure Trap, describes the specific way stress hides in leaders: the more capable a person is of holding a steady surface, the longer the underlying strain goes unaddressed, and the higher the eventual cost. Each stage names a behavior a board member, a partner, or the leader can spot.
CEREVITY model
The Composure Trap
A four-stage description of how stress hides in leaders. Composure is rewarded, so the people most skilled at maintaining it are the slowest to be helped. Each stage names a behavior a board, a partner, or the leader can recognize before the final one forces everyone's hand.
Steady surface
Performance and presentation stay intact while the effort behind them quietly climbs. Recovery time, sleep, and patience erode first, none of it visible from the outside.
Reputation management
The leader actively manages the impression of being fine because the role appears to require it. Deloitte found that 54 percent of workers feel a greater need to cover, to hide parts of themselves, specifically when interacting with executives, which signals to leaders that exposure is unsafe.4
Isolation
Confiding becomes harder as the stakes of being seen to struggle rise. Half of CEOs already report loneliness in the role, and the isolation that protects the surface also removes the early outlet that would relieve the pressure.3
Cost comes due
A threshold is crossed. Judgment, health, or the role itself gives way, whether through a health event, an abrupt exit, or a decision made on a depleted mind. By this stage the problem is obvious to everyone and far costlier to treat than it was three stages earlier.
The value of the model is that it points to the earliest stage at which help is cheap and effective. Waiting for the cost to come due is the most expensive option available. Treating composure as a signal to check on, rather than proof of health, is the whole point.
By professionHow it presents across roles
The Composure Trap is general, but the pressures that drive it, and the disguises stress wears, differ by role. The three groups below carry distinct loads, and the published research on each points to a different leading edge of risk. What they share is a structural incentive to keep the surface steady.
C-suite executives
Among chief executives the trap is reinforced by visibility. Every signal a leader sends is read by the board, the staff, and the market, so the incentive to project stability is constant. The data shows the cost of that performance. In Businessolver's 2024 survey, 55 percent of CEOs reported a mental health issue, a 24 point increase in one year, and 52 percent called their own workplace toxic.1 Deloitte found that 40 percent of C-suite leaders always or often feel overwhelmed, and that 26 percent reported depression, slightly more than the employees they manage.2 Isolation is the distinguishing feature of the executive variant: the Harvard Business Review and RHR International survey found half of CEOs felt lonely in the role, with 61 percent of those saying it hurt their performance, and the effect was sharper among first-time CEOs.3 The result is a population that scores worse than its own workforce on several measures while being least able to say so, because the role treats disclosure as risk. At a network level rather than for any individual, the pattern we see at intake is consistent: senior leaders arrive late, after the steady surface has already cost them sleep, judgment, or a relationship, and frequently frame the conversation as a performance problem rather than a stress problem.
Senior managers
Senior and middle managers sit at the structural pinch point, accountable upward for results and downward for the people delivering them, and the most recent data shows their strain is worsening fastest. Gallup's 2024 State of the Global Workplace found that manager engagement fell from 30 percent to 27 percent in a single year, with the steepest declines among managers under 35 and among women, and that managers' well-being declined while individual contributors held steady.5 The same report found that 40 percent of employees globally feel stress a lot of the day, and that having a poor manager makes a worker nearly 60 percent more likely to feel stressed, which means a strained manager propagates strain through an entire team.5 Because Gallup attributes roughly 70 percent of the variance in team engagement to the manager, the manager layer is where leader stress does the most organizational damage.5 The Composure Trap operates here with a particular cruelty: managers are expected to absorb pressure from above and shield those below, which is precisely the behavior that drives the steady-surface and reputation-management stages. They rarely present as in crisis. They present as tired, irritable, and quietly disengaging, the early erosion that precedes a resignation, and they often leave before anyone names what was happening.
Founders and entrepreneurs
Founders carry a documented elevation in mental health risk. In Michael Freeman's comparison study, 72 percent of entrepreneurs reported being affected by mental health concerns, with 30 percent reporting depression and 32 percent reporting two or more conditions, rates higher than the comparison group.8 The founder variant of the Composure Trap is amplified by identity: when the person and the company are fused, admitting strain can feel like admitting the venture is failing, which makes concealment almost reflexive. Founders also face the most acute version of the loneliness that affects CEOs generally, often without a board, a peer group, or a salary to fall back on, and with investors whose confidence they feel they must protect. The financial pressure is constant and personal, and broader survey work underscores how heavily money weighs: the APA found 77 percent of US adults cite money as a significant source of stress and 33 percent feel consistently overwhelmed despite their efforts to cope.9 At a network level, the pattern at intake is that founders tend to arrive either very late, after a health event or a near-collapse of the company, or under cover of a performance question, reframing what is a stress and isolation problem as a productivity or focus problem. Reaching them earlier means making care feel like a strategic act of stewardship over the company, rather than an admission that the founder, and therefore the venture, is in trouble.
The stakesThe cost of inaction
The cost of leaving leader stress untreated is not abstract. It lands in three places an organization and an individual already measure: the body, the quality of decisions, and the continuity of leadership itself.
Physical health and mortality
The hours that drive leader stress carry a documented physical toll. The WHO and ILO estimated that long working hours led to 745,000 deaths from stroke and heart disease in 2016, and that working 55 or more hours a week raises the risk of stroke by 35 percent and of dying from heart disease by 17 percent compared with a 35 to 40 hour week.6 For a leader, the schedule that looks like dedication is also a measurable cardiovascular risk.
Decision quality
Stress and depletion degrade exactly the capacity a leader is paid for: judgment. The well-known study of judicial rulings by Danziger and colleagues found that the share of favorable parole decisions fell from about 65 percent at the start of a session toward zero by its end, recovering after a break, evidence that even trained experts default to the easy option when depleted.7 A leader making consequential calls on a chronically taxed mind is exposed to the same drift, at far higher stakes.
Leadership continuity
Untreated strain shows up as exit. Deloitte found that roughly 70 percent of C-suite leaders are seriously considering quitting for a job that better supports their well-being.2 Gallup's finding that the manager drives most of the variance in team engagement means each leader lost to burnout takes a measure of organizational performance with them.5 Replacing a senior leader is slow and expensive; preventing the departure is neither.
The solutionWhat effective care looks like
Good care for leaders has to clear three bars the standard options often miss. It has to be discreet enough that seeking it does not itself feel like a professional risk. It has to be delivered by clinicians who understand the specific pressures of sustained responsibility, so the leader is not spending the first month explaining the role. And it has to be accessible early, on the leader's schedule, so it can do its work at the steady-surface stage rather than after the cost comes due. Confidentiality, fit, and speed are not luxuries here; they are what make care usable for this population at all.
This is the structure CEREVITY is built on. CEREVITY is a nationwide network of independent licensed clinicians, matched to the person rather than assigned, delivered by secure video, on a private-pay basis that keeps the work confidential and free of insurance constraints. Because there is no insurance claim, there is no diagnosis code in a shared record. Sessions run in three formats: 50-minute, 90-minute, and 3-hour intensive, so the depth of a session can match the moment rather than a billing increment.
ImplementationHow to put it into practice
The point of a whitepaper is to be actionable. Below is a sequence a leader, a chief of staff, or a board can run without committing to anything irreversible, ordered so the lowest-risk steps come first.
- 01
Treat composure as a signal, not proof
Adopt the Composure Trap as a shared language. Agree, privately, that a steady surface under heavy load is something to check on rather than admire, and name the early markers, shrinking recovery time, eroding sleep, withdrawal, as worth acting on.
- 02
Lower the cost of the first conversation
Make discreet, private-pay care available so that seeking it carries no diagnosis code, no insurance claim, and no shared record. Removing the perceived professional risk is the single change most likely to move a leader from silence to a first session.
- 03
Match to clinicians who know the role
Insist on fit. A leader should be matched to a clinician who works with people in their position, so the work starts with the actual pressures of leadership rather than with orientation. Matching, not assignment, is what makes the first few sessions count.
- 04
Build the off-ramp before the crisis
Put the access path in place while everyone is functioning. A leader who already knows where to turn, and that turning there is safe, can act at the steady-surface stage. Standing up the route during a crisis is the most expensive time to build it.
RecommendationsWhere to start
Clinical
Screen for the early stages, not just crisis
Watch for shrinking recovery time, sleep erosion, and withdrawal, the steady-surface and isolation stages, rather than waiting for an obvious breakdown. The earlier the stage, the cheaper and more effective the care.
Clinical
Address isolation directly
Because half of CEOs report loneliness and 61 percent of those say it hurts performance, treat a confidential, role-aware therapeutic relationship as a direct intervention on a documented performance risk, not a perk.3
Structural
Make help-seeking private by design
Offer a private-pay route with no insurance claim and no shared diagnosis record. The structure of the option, not an encouragement campaign, is what determines whether a leader uses it.
Structural
Set sustainable hours as a health control
Given the WHO and ILO finding that 55 or more hours a week measurably raises stroke and heart disease risk, treat chronic overwork as a quantified health and continuity exposure at the leadership level, not a badge.6
FAQCommon questions
Is executive stress really different from ordinary work stress?
Why would a leader use private-pay care instead of an employer program?
What can a board or chief of staff do without overstepping?
How does private-pay billing work?
How is my privacy protected?
MethodologyHow this paper was built
Methodology
This report synthesizes publicly available research on executive and leader stress. Between May and June 2026 we searched the published outputs of major workforce and health bodies, including the American Psychological Association, Gallup, Deloitte, Businessolver, the World Health Organization and the International Labour Organization, together with peer-reviewed work indexed in PubMed and the Proceedings of the National Academy of Sciences, and reporting from Harvard Business Review. We prioritized large surveys and peer-reviewed studies over commentary, and we recorded the source, year, population, and sample size for every figure cited. Where a finding appears in the text it carries a numbered superscript tied to the references list below. The studies vary in design and population, and several limitations should be read alongside the figures. Survey-based prevalence estimates, including the Businessolver and Deloitte findings on CEO and C-suite mental health, rely on self-report and on the samples each firm recruited, so they describe the surveyed populations rather than all leaders. The Harvard Business Review and RHR International loneliness figures come from a survey of 83 chief executives, a modest sample that is suggestive rather than definitive. The Gallup figures are drawn from its global workforce sample and describe employees and managers broadly rather than senior executives specifically. The WHO and ILO mortality estimates are modeled associations between long working hours and cardiovascular outcomes across 194 countries, not a direct count of executives, and association is not proof of causation for any individual. The decision-fatigue evidence comes from a study of judicial rulings, not of executives, and is cited as an illustration of how depletion affects expert judgment rather than as a measurement of leaders. The entrepreneur figures come from a comparison study of 242 entrepreneurs and a smaller comparison group. No statistic in this report is a CEREVITY internal figure. The two references in the segments section to what CEREVITY observes at intake are described qualitatively as network-level patterns, not as quantified findings, and should be read as clinical observation rather than data. This document is educational. It is not medical advice, not a diagnostic tool, and not a substitute for care from a licensed clinician. Figures are current as of June 2026 and reflect the most recent editions of each source that were available at the time of writing.
References
- 01Businessolver. (2024). 2024 State of Workplace Empathy Study: 55% of CEOs Say They've Experienced a Mental Health Issue, Up 24 Points. Businessolver. https://businessolver.com/news/businessolver-2024-empathy-study-55-of-ceos-say-theyve-experienced-a-mental-health-issue-up-24-points/
- 02Deloitte and Workplace Intelligence. (2023). As Workforce Well-being Dips, Leaders Ask: What Will It Take to Move the Needle? Deloitte Insights. https://www.deloitte.com/us/en/insights/topics/talent/workplace-well-being-research.html
- 03Saporito, T. J. (2012). It's Time to Acknowledge CEO Loneliness. Harvard Business Review. https://hbr.org/2012/02/its-time-to-acknowledge-ceo-lo
- 04Deloitte. (2024). Covering and Workplace Well-being. Deloitte Insights. https://www.deloitte.com/us/en/insights/topics/talent/identity-covering-could-be-undermining-workplace-well-being-efforts.html
- 05Gallup. (2024). State of the Global Workplace: 2024 Report. Gallup. https://www.gallup.com/workplace/349484/state-of-the-global-workplace.aspx
- 06World Health Organization and International Labour Organization. (2021). Long Working Hours Increasing Deaths from Heart Disease and Stroke. WHO. https://www.who.int/news/item/17-05-2021-long-working-hours-increasing-deaths-from-heart-disease-and-stroke-who-ilo
- 07Danziger, S., Levav, J., and Avnaim-Pesso, L. (2011). Extraneous Factors in Judicial Decisions. Proceedings of the National Academy of Sciences, 108(17), 6889-6892. https://www.pnas.org/doi/10.1073/pnas.1018033108
- 08Freeman, M. A., Staudenmaier, P. J., Zisser, M. R., and Andresen, L. A. (2018). The Prevalence and Co-occurrence of Psychiatric Conditions Among Entrepreneurs and Their Families. Small Business Economics. https://link.springer.com/article/10.1007/s11187-018-0059-8
- 09American Psychological Association. (2023). Stress in America 2023: A Nation Recovering from Collective Trauma. APA. https://www.apa.org/news/press/releases/stress/2023/collective-trauma-recovery
- 10Pfeffer, J. (2018). The Overlooked Essentials of Employee Well-being. McKinsey Quarterly. https://www.mckinsey.com/capabilities/people-and-organizational-performance/our-insights/the-overlooked-essentials-of-employee-well-being
- 11World Health Organization. (2022). World Mental Health Report: Transforming Mental Health for All. WHO. https://www.who.int/publications/i/item/9789240049338
- 12Pieterse, A. (2021). Pega, F., et al. Global, Regional, and National Burdens of Ischemic Heart Disease and Stroke Attributable to Long Working Hours, 2000-2016. Environment International, 154. https://www.sciencedirect.com/science/article/pii/S0160412021002208
- 13CNBC. (2021). Long Working Hours Kill 745,000 People a Year, WHO/ILO Study Finds. CNBC. https://www.cnbc.com/2021/05/17/long-working-hours-kill-745000-people-a-year-who-ilo-study-finds.html
- 14Businessolver. (2024). 2024 Empathy Study Reveals High Demand for Workplace Empathy Despite Low Rates of Implementation. Businessolver. https://businessolver.com/news/businessolvers-2024-empathy-study-reveals-high-demand-for-workplace-empathy-despite-low-execution/
- 15Fortune. (2025). Stressed Business Leaders Are Considering Leaving, a Threat to the Management Pipeline. Fortune. https://fortune.com/2025/01/23/stressed-business-leaders-considering-leaving-management-pipeline-threat/
- 16Tierney, J. (2011). Do You Suffer from Decision Fatigue? The New York Times Magazine. https://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html
ROSEN
PsyD
Benjamin Rosen, PsyD
PsyD, Licensed Psychologist · Licensed Psychologist
Dr. Rosen is a Licensed Psychologist working with high-achieving professionals across executive, entrepreneurial, legal, and medical fields. His work integrates evidence-based cognitive and psychodynamic approaches with a deep understanding of the pressures that come with sustained responsibility. He sees clients via CEREVITY's nationwide telehealth network.
Talk to someone who gets it.
If this paper describes something you recognize, a confidential conversation is the next step. CEREVITY matches you to an independent licensed clinician who works with people in your position.
Schedule consultationPrivate-pay, telehealth, nationwide. Questions: (562) 295-6650
