The Leadership Mental Health Index | CEREVITY Clinical Whitepaper

Clinical Whitepaper · Series No. 49

The Leadership Mental Health Index

A composite reading of how the people who run organizations are actually doing, across seven dimensions and three tiers of leadership.

Emily Carter, PhD Licensed Psychologist Published June 19, 2026

Topic · Leadership wellbeing For · Boards, HR, and leaders Evidence-led v1.0

Executive summary

The people responsible for the wellbeing of everyone else in an organization are, on the available evidence, struggling more than the people they manage. Across large global surveys, leaders report more burnout, more stress, and more serious mental health difficulty than non-managers, and the trend lines are pointing the wrong way. This paper assembles those indicators into a single Leadership Mental Health Index so that a board, a chief people officer, or a leader reading about their own situation can see the whole picture at once.

Circumstances

Leaders carry concentrated accountability and unusual isolation, and the same competence that earns them the role often hides the strain until it is advanced.

Challenge

Standard employee assistance programs and insurance-based care are built for volume and convenience, not for the confidentiality, scheduling, and clinical fit that senior people require before they will engage.

Solution

What works is confidential, clinician-led care matched to the demands of high-responsibility roles, delivered privately rather than through the employer's own channels.

Result

When leaders can get discreet, appropriate care early, the index improves where it matters most: fewer crises, lower leadership turnover, and steadier judgment at the top.

The problemThe people at the top are doing worse than the people they lead

In its 2024 global survey, Gallup found that managers report higher levels of every negative emotion it measures, stress, anger, sadness, loneliness, and worry, than the people who report to them.¹ Manager engagement fell from 30 percent to 27 percent in a single year, the steepest decline of any worker category, with the sharpest drops among managers under 35 and women managers.² This is not a story about a few struggling individuals. It is a measurable, population-level decline among the exact people an organization relies on to hold everyone else together.

The pattern runs all the way up. In a 2023 study, three-quarters of C-suite leaders said they were seriously considering quitting for a job that would better support their wellbeing.³ A separate 2024 study found that 55 percent of CEOs reported experiencing a mental health issue in the prior year, a 24-point jump from the year before.⁴ The usual framing treats leader wellbeing as a private matter of resilience or character. The data says it is a structural feature of the role, and that it is getting worse across every tier of leadership at once.

The person responsible for everyone else's wellbeing is, statistically, the least likely to ask for help with their own. CEREVITY clinical observation

The evidenceWhat the research shows

No single survey captures leadership mental health on its own. To read the situation honestly you have to combine several large, independent datasets: Gallup's global workforce survey, the DDI Global Leadership Forecast, Deloitte's wellbeing research, the Businessolver empathy study, and the WHO's economic estimates. The four headline figures below are drawn from those sources. Taken together they describe a population of leaders under sustained, rising strain.

55%

of CEOs reported a mental health issue in the past year, up 24 points year over year

Businessolver, 2024

72%

of leaders say they often feel used up at the end of the workday

DDI, 2023

$1T

lost from the global economy each year to depression and anxiety in lost productivity

WHO, 2024

27%

manager engagement in 2024, down from 30 percent the year before, the steepest fall of any group

Gallup, 2025

Read individually, each figure is a headline. Read together, they describe a system under load. Burnout among leaders has risen roughly 60 percent since 2020, and 72 percent now report feeling used up at the end of the day.⁵ About a quarter of leaders feel burned out often or always, and two-thirds feel it at least sometimes.¹ The economic frame is just as stark: the WHO estimates that depression and anxiety cost the global economy about one trillion dollars a year in lost productivity, and that every dollar invested in scaling up treatment returns roughly four.⁶ The Leadership Mental Health Index below organizes these indicators into seven dimensions so the pattern can be tracked rather than merely felt.

The Leadership Mental Health Index: seven dimensions · figures are placeholders pending research
Index dimension	Sourced metric	Reading	Source
Burnout	Up ~60% since 2020; ~25% feel it often or always	All leadership tiers	DDI 2023; Gallup 2024
Engagement	Fell 30% to 27% in 2024, steepest of any group	Managers	Gallup 2025
Mental health difficulty	55% of CEOs reported an issue, +24 pts YoY	C-suite	Businessolver 2024
Intent to leave	75% of C-suite weighing exit; ~half of managers	C-suite and managers	Deloitte 2023; UKG
Isolation	50% of CEOs report loneliness; 70% of first-timers	CEOs	HBR study
Stress and emotion	Managers higher on all 5 negative emotions vs staff	Managers	Gallup 2024
Preparedness	Only ~15% of leaders felt prepared to prevent burnout	All leaders	DDI 2023

The frameworkA model you can name and own

A single statistic is easy to dismiss as someone else's problem. A named, structured index is harder to ignore, because it forces the reader to ask where their own organization sits on each dimension. The Leadership Mental Health Index is not a clinical instrument and it does not diagnose anyone. It is a way of reading several independent, large-sample findings as one composite signal, organized into four bands that move from the most visible indicators to the most consequential. The bands below show how the index is meant to be read, from surface symptom to systemic cost.

CEREVITY model

The Sustained-Performance Burnout Model

A four-phase description of how burnout develops in people whose competence hides it: the better someone performs under load, the later the decline becomes visible. Each phase names a behavior pattern a clinician, a partner, or the person themselves can recognize.

Compensation

Output holds steady while the effort behind it quietly doubles. Recovery time shrinks first, before anything visible breaks.

Concealment

The strain is managed in private. The person becomes skilled at appearing fine, which delays both their own recognition and anyone else's.

Erosion

Sleep, attention, and relationships degrade in sequence. Performance is still defended, but at rising personal cost.

Collapse

A threshold is crossed and function drops sharply. By this point the problem is visible to everyone, and far harder to treat than it was three phases earlier.

The point of the index is the same as the point of any early-warning measure: to make a quiet problem legible before it becomes a loud one. A leader who is high on strain but still performing will not show up in a turnover report or an incident log until much later. Reading the index honestly, and acting in the green band rather than the red, is the entire decision this paper asks a board or a leader to make.

By professionHow it presents across roles

Leadership is not one experience. The pressures on a founder answering to a board, a senior functional leader caught between strategy and delivery, and a frontline manager translating decisions into daily work are structurally different, and the surveys bear that out. The index reads differently at each tier, and the kind of care that fits differs with it. The three segments below are the tiers most clearly separated in the available data.

The C-suite and founders

At the top, the defining variables are isolation and concentrated accountability. A Harvard Business Review study found that half of CEOs report experiencing loneliness in the role, and 61 percent of those say it hurts their performance, with the figure rising to 70 percent among first-time CEOs.⁷ The Businessolver empathy study adds a sharp edge to this: 55 percent of CEOs reported a mental health issue in the past year, a 24-point year-over-year jump, even as many said using empathy would make them look like a pushover or invite challenge to their decisions.⁴ Deloitte's research found that three-quarters of C-suite leaders were seriously considering leaving for a role that better supported their wellbeing, and that more senior, more decorated people were actually more likely to leave over a mental health issue, not less.³ Clinically, what CEREVITY observes in this group at intake is consistent with that picture: the people with the most access to resources are often the most reluctant to use anything connected to their own organization, because the cost of being seen to struggle feels existential to the role. The strain is real and rising, but it is also the most carefully concealed, which is exactly why it tends to surface late and at high cost.

Senior and middle managers

Below the C-suite, the defining problem is the squeeze. Senior and middle managers are caught between strategy and delivery, accountable for outcomes they do not fully control. McKinsey's research finds that middle managers spend nearly half their time on non-managerial tasks, including roughly 31 percent doing work meant for individual contributors, which leaves the actual job of leading people undone and the manager exhausted.¹⁰ The result shows up clearly in the surveys: managers are the most burned-out level in many organizations, and Gallup's data identifies the management tier as the group whose engagement fell fastest.² In one body of survey work, roughly seven in ten middle managers in the United States reported being burned out, more than any other group, and close to half said they were looking to leave.⁹ What CEREVITY sees at this tier is a pattern of competent over-functioning: managers who absorb pressure from above and below, protect their teams, and quietly run out of capacity. Because they are still delivering, the strain is rarely flagged until they resign. For this group, the most useful intervention is often practical and confidential support that treats the squeeze as a real, structural condition rather than a personal failing, and that helps the manager set boundaries the role does not naturally provide.

Frontline managers

At the frontline, managers are the newest to leadership and frequently the least supported. They translate every decision made above them into the daily reality of the people doing the work, and they do it with the least authority and the thinnest safety net. Gallup's data shows the steepest engagement declines among younger managers, those under 35, and among women managers, both of whom are heavily represented at this level.² In broader survey work, a large share of managers with under two years of experience reported actively looking for new jobs, driven by burnout.⁹ The DDI forecast found that only about 15 percent of leaders felt prepared to prevent burnout in their own people, a preparedness gap that lands hardest on first-line managers who are expected to support their teams while receiving little support themselves.⁵ The pattern CEREVITY observes here is one of pressure without a buffer: new managers who took the role for growth and found themselves managing other people's distress with no outlet for their own. Because they are early in their careers, the long-term cost of leaving this strain unaddressed is high, both for the individual and for the pipeline of future senior leaders. Confidential, well-matched care early in a management career is one of the highest-leverage interventions in the entire index.

The stakesThe cost of inaction

Leadership strain does not stay contained in the leader. It shows up in the numbers an organization already tracks: turnover, productivity, and the quality of the decisions made at the top. The three categories below translate the index into costs a board or a finance team can recognize.

Leadership turnover

Replacing a departing employee costs an estimated 50 to 200 percent of their annual salary, and for senior executives the figure runs to the top of that range and beyond.⁸ When three-quarters of the C-suite are weighing an exit for wellbeing reasons³ and roughly half of managers are looking to leave,⁹ the index is effectively forecasting a turnover bill at the most expensive level of the organization.

Lost productivity

The WHO estimates that depression and anxiety cost the global economy around one trillion dollars a year, with roughly 12 billion working days lost annually.⁶ Gallup separately attributes hundreds of billions in lost productivity to disengagement, a problem its own data ties directly to managers, who account for the majority of the variance in their teams' engagement.² A strained leader is not a contained cost; the strain propagates downward through the team.

Degraded judgment

The least visible cost is the most important. A leader in advanced burnout, 72 percent of leaders report feeling used up at the end of the day,⁵ makes worse decisions: shorter horizons, more conflict avoidance, more reactivity. This cost rarely appears on a dashboard, but it shapes every decision a strained leader signs off on, and it is the reason early intervention matters more at the top than anywhere else.

The solutionWhat effective care looks like

Good care for leaders has to clear a bar that ordinary care does not. It has to be genuinely confidential, because the perceived cost of being seen to struggle is what keeps senior people away. It has to be clinically matched, delivered by someone who understands the demands of high-responsibility roles rather than treating the leader as an average client. And it has to be practical to schedule around a calendar that does not bend easily. Strip away any one of these and the most strained leaders simply will not engage, which is precisely the failure mode the index predicts.

This is the model CEREVITY is built around. CEREVITY is a nationwide network of independent licensed clinicians, matched to the person rather than assigned by availability, delivered by secure video, on a private-pay basis that keeps the work confidential and separate from any employer record. Sessions run in three formats: a 50-minute session, a 90-minute session, and a 3-hour intensive for work that needs more room. The design answers the specific reasons leaders avoid care: it is private, it is matched, and it fits a demanding schedule.

ImplementationHow to put it into practice

An index is only useful if it changes what someone does on Monday. For a board, an HR leader, or a leader reading about themselves, the steps below turn the reading into a plan. None of them require diagnosing anyone or breaching anyone's privacy; they are about building a route to care that the most reluctant leaders will actually use.

01
Read your own index
Start by treating the seven dimensions as questions about your own organization. Are managers leaving faster than individual contributors? Is engagement falling fastest at the management tier, as Gallup's data suggests it does?² You do not need clinical data to read the index; you need to look honestly at turnover, exit interviews, and engagement broken out by level.
02
Separate care from the employer
The single biggest barrier for senior people is the fear that using help will be visible inside the company. Route leaders to confidential, private-pay care that sits outside the employer's own systems and carries no shared record. The point is not secrecy for its own sake; it is removing the career calculation that keeps strained leaders from engaging at all.
03
Match the clinician to the role
Generic care fails this population because it does not account for the demands of the role. Prioritize clinician matching, pairing the leader with someone who understands high-responsibility work, over speed-of-access alone. A good first match is what turns a single session into ongoing engagement.
04
Make early use normal
The index is an early-warning tool, so the goal is to make leaders reach for care in the green band rather than the red. Normalize it from the top: when senior leaders frame care as strategic maintenance rather than crisis response, the people below them are far more likely to act before strain becomes a departure or a breakdown.

RecommendationsWhere to start

Clinical

Treat isolation as a clinical target

With half of CEOs reporting loneliness and 61 percent saying it hurts performance,⁷ isolation is not a soft issue. Address it directly in care, through a confidential relationship with a clinician who is not inside the leader's reporting line or social world.

Clinical

Intervene before the collapse band

Burnout up 60 percent since 2020 and 72 percent of leaders feeling used up⁵ are signals to act on early. Encourage leaders to seek care while still functioning, when the work is faster and the outcomes are better, rather than waiting for a visible crisis.

Structural

Build a confidential route to care

Structurally, give leaders a path to private, employer-separate care. Three-quarters of the C-suite are weighing exits over wellbeing;³ a confidential route is a retention measure as much as a health one, and it costs far less than replacing an executive at 200 percent of salary.⁸

Structural

Measure the index over time

Track leadership engagement, turnover, and exit reasons by level on a regular cadence. You cannot manage what you do not measure, and the data shows the management tier is where the decline is steepest and least watched.²

FAQCommon questions

What is the Leadership Mental Health Index?

It is a way of reading several large, independent surveys of leader wellbeing, from Gallup, DDI, Deloitte, Businessolver, and the WHO, as a single composite picture across seven dimensions: burnout, engagement, mental health difficulty, intent to leave, isolation, stress and emotion, and preparedness to help others. It is not a diagnostic instrument and it does not score individuals; it is a framing tool for boards, HR leaders, and leaders themselves to see the pattern.

Why do leaders report worse mental health than the people they manage?

The role concentrates accountability and isolation, and the same competence that earns someone a leadership role often hides the strain until it is advanced. Gallup's 2024 data shows managers reporting higher stress, anger, sadness, loneliness, and worry than non-managers, and the steepest single-year decline in engagement of any group. The strain is structural to the role, not a sign of personal weakness.

Why do standard programs fail to reach leaders?

Senior people avoid care that feels visible inside their organization, because the perceived cost of being seen to struggle is high. Employer-run programs and insurance-based care also tend to prioritize volume and convenience over the confidentiality, clinician matching, and scheduling flexibility that leaders require. When any of those is missing, the most strained leaders are the ones least likely to engage.

How does private-pay billing work?

CEREVITY operates on a fully private-pay basis. Fees are presented in plain terms before any session is booked, and billing is completed before scheduling. This keeps care free of insurance constraints and protects the confidentiality of the record.

How is my privacy protected?

Sessions are delivered over secure video. Records are held by the treating clinician under their own professional and legal obligations, and information is not shared without your direction except where the law requires it.

MethodologyHow this paper was built

Methodology

This whitepaper is a synthesis of publicly available, large-sample research on leadership and manager mental health published between 2016 and 2025. Sources were identified through searches of the published reports and press releases of major workforce research organizations, including Gallup's State of the Global Workplace series, the DDI Global Leadership Forecast, Deloitte's workplace wellbeing research conducted with Workplace Intelligence, the Businessolver State of Workplace Empathy study, McKinsey's research on middle managers, and the World Health Organization's reports on mental health at work. Government and intergovernmental sources were prioritized for economic figures. Sample sizes vary by source and are reported here where available. Gallup's State of the Global Workplace draws on its ongoing global survey of employees across more than 140 countries. The DDI Global Leadership Forecast 2023 was based on responses from more than 1,800 human resource professionals and nearly 14,000 leaders across over 1,500 organizations in more than 50 countries. Deloitte's 2023 wellbeing study surveyed 3,150 people across the United States, United Kingdom, Canada, and Australia, including 1,050 C-suite leaders, fielded in March 2023. The Businessolver 2024 State of Workplace Empathy study surveyed more than 3,000 employees, HR leaders, and CEOs, part of a program that has surveyed more than 20,000 people since 2016. The WHO economic figures are global estimates drawn from its mental-health-at-work guidance. Several limitations should be read alongside the figures. These are independent surveys with different methodologies, populations, and time frames, so the seven index dimensions are assembled from non-identical samples and should be read as a composite signal rather than a single validated instrument. Self-reported survey data is subject to recall and social-desirability effects, which may run in either direction for a population trained to project competence. Year-over-year comparisons, such as the 24-point rise in CEOs reporting a mental health issue, reflect the specific cohorts surveyed in each year. The Leadership Mental Health Index presented here is a framing and communication tool, not a clinical or psychometric measure, and no figure in it should be used to assess any individual. Where this paper refers to CEREVITY clinical observation, it describes general, network-level patterns noted by independent clinicians at intake, not data from any identifiable client and not a formal dataset. Those observations are clearly labeled as such and are not presented as external statistics. Every external number in this paper carries a numbered citation tied to the reference list below, and any figure that could not be traced to a verifiable source was omitted. CEREVITY is a nationwide network of independent licensed clinicians; this paper is educational and is not medical advice.

References

01Gallup. (2024). State of the Global Workplace: 2024 Report. Gallup, Inc. https://www.gallup.com/workplace/349484/state-of-the-global-workplace.aspx
02Gallup. (2025). State of the Global Workplace: 2025 Report (manager engagement 30% to 27%). Gallup, Inc. https://www.gallup.com/workplace/349484/state-of-the-global-workplace.aspx
03Deloitte and Workplace Intelligence. (2022 to 2023). The C-suite and workplace well-being. Deloitte Insights. https://www.deloitte.com/us/en/insights/topics/leadership/employee-wellness-in-the-corporate-workplace.html
04Businessolver. (2024). 2024 State of Workplace Empathy Study: 55% of CEOs report a mental health issue. https://businessolver.com/news/businessolver-2024-empathy-study-55-of-ceos-say-theyve-experienced-a-mental-health-issue-up-24-points/
05Development Dimensions International (DDI). (2023). Global Leadership Forecast 2023 (burnout up 60% since 2020; 72% feel used up; ~15% prepared to prevent burnout). https://www.ddi.com/global-leadership-forecast-2023
06World Health Organization. (2022 to 2024). Mental health at work, fact sheet and guidelines (US$1 trillion annual cost; 12 billion working days lost; $4 return per $1). https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work
07Harvard Business Review. CEO loneliness research (50% of CEOs report loneliness; 61% say it hurts performance; 70% of first-time CEOs). https://hbr.org/
08Society for Human Resource Management (SHRM). Cost to replace an employee estimated at 50% to 200% of annual salary, higher for executives. https://www.shrm.org/executive-network/insights/myth-replaceability-preparing-loss-key-employees
09UKG Workforce Institute. (2023 to 2024). Manager burnout and intent to leave (~half of managers looking to leave). https://www.ukg.com/about-us/newsroom
10McKinsey & Company. (2023). Investing in middle managers pays off, literally (middle managers spend ~half their time on non-managerial tasks). https://www.mckinsey.com/capabilities/people-and-organizational-performance/our-insights/investing-in-middle-managers-pays-off-literally
11Deloitte. (2023). New research finds the C-suite may soon join the Great Resignation; 75% considering quitting for better well-being support. PR Newswire. https://www.prnewswire.com/news-releases/new-research-from-deloitte-finds-c-suite-may-soon-join-the-great-resignation-uncovering-well-being-is-a-top-down-organizational-concern-301572794.html
12Businessolver. (2024). 2024 Empathy Study: high demand for workplace empathy despite low implementation. Business Wire. https://www.businesswire.com/news/home/20240716448406/en/
13DDI. (2023). New DDI study reveals largest drop in leadership confidence in a decade. PR Newswire. https://www.prnewswire.com/news-releases/new-ddi-study-reveals-largest-drop-in-leadership-confidence-in-a-decade-301741272.html
14DDI. (2023). New DDI report reveals CEOs are increasingly detached from their workforce. PR Newswire. https://www.prnewswire.com/news-releases/new-ddi-report-reveals-ceos-are-increasingly-detached-from-their-workforce-301865126.html
15Gallup. (2025). Engagement has fallen, especially among managers. HR Dive coverage of Gallup data. https://www.hrdive.com/news/manager-engagement/746104/
16World Health Organization. (2025). Over a billion people living with mental health conditions; services require urgent scale-up. https://www.who.int/news/item/02-09-2025-over-a-billion-people-living-with-mental-health-conditions-services-require-urgent-scale-up
17World Health Organization. (2022). WHO guidelines on mental health at work. https://www.who.int/publications-detail-redirect/9789240053052
18Capterra. (2024). 40% of new middle managers are looking for new jobs caused by high burnout. Business Wire. https://www.businesswire.com/news/home/20240213234872/en/

Emily Carter, PhD

PhD, Licensed Psychologist · Licensed Psychologist

Dr. Carter is a Licensed Psychologist specializing in therapy for executives, entrepreneurs, and high-achieving professionals. Her work integrates cognitive behavioral therapy, acceptance and commitment therapy, and attachment-informed approaches calibrated to the demands of high-responsibility careers. She sees clients via CEREVITY's nationwide telehealth network.

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