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 daily stress, more burnout, and more serious mental health difficulty than the people who report to them, and the trend lines are pointing the wrong way. This paper assembles that leadership mental health data 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.
Leaders carry concentrated accountability and unusual isolation, and the same competence that earns them the role often hides the strain until it is advanced.
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.
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.
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 Gallup's 2025 global data, leaders who manage other managers reported more stress, anger, sadness, and loneliness the previous day than individual contributors, by margins of 7 to 12 percentage points.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, up from 69 percent the year before.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, 12 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. Signs of burnout among leaders have increased 60 percent since 2020, and 72 percent now report often feeling used up at the end of the day.5, 13 The decline is steepest in the management layer, the subject of the middle management burnout crisis. 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 about four in better health and ability to work.6, 20 The Leadership Mental Health Index below organizes these indicators into seven dimensions so the pattern can be tracked rather than merely felt.
02, 03, 04, 07, 13 Deloitte and Workplace Intelligence 2023 (3,150 respondents).
DDI Global Leadership Forecast 2023 (13,695 leaders).
Businessolver 2024; RHR International via Harvard Business Review 2012; Gallup 2025.
| Index dimension | Sourced metric | Reading | Source |
|---|---|---|---|
| Burnout | Signs of burnout up 60% since 2020; 72% often feel used up | All leadership tiers | DDI 2023 |
| 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 and 64% of managers weighing a move for wellbeing | C-suite and managers | Deloitte 2023 |
| Isolation | 50% of CEOs report loneliness; 61% of them say it hurts performance | CEOs | HBR / RHR 2012 |
| Stress and emotion | Leaders above individual contributors on daily stress, anger, sadness, loneliness | Managers of managers | Gallup 2026 |
| Preparedness | Only 15% of leaders feel prepared to prevent employee burnout | All leaders | DDI 2023 |
02, 19 Gallup State of the Global Workplace 2025 (engagement, 2024).
Gallup State of the Global Workplace global data (daily emotions, 2025).
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 Leadership Mental Health Index
Seven sourced dimensions read as four bands, ordered from the earliest signal of strain to the costliest. It is a framing tool, not a clinical measure, and it scores no individual. Each band names something a board, an HR leader, or the leader can check.
Strain
Stress and emotion, and burnout. Daily stress, irritability and depletion rise while performance holds. This band is visible to the leader first and rarely to anyone else.
Withdrawal
Engagement and isolation. Energy for the work and the people drains away, and the leader stops confiding in anyone. Engagement data catches this band before performance data does.
Impairment
Mental health difficulty and preparedness. Strain becomes a reportable mental health issue, and the leader loses the capacity to protect their own people from burnout.
Exit
Intent to leave. The strain converts into a departure, a resignation or a quiet search, and only now appears on the reports an organization already reads. It is the costliest band to act in.
SCHEMATIC Schematic, not measured data.
CEREVITY conceptual model; illustrative only.
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 first band rather than the last, is the entire decision this paper asks a board or a leader to make; at that stage burnout treatment built for senior leaders is shorter and far less disruptive than it becomes later.
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. RHR International's CEO survey, reported in Harvard Business Review, found that half of CEOs report experiencing loneliness in the role, and 61 percent of those say it hurts their performance, a share that rises to nearly 70 percent among lonely 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 69 percent said being empathetic would make them a pushover and 72 percent expected to be challenged on their decisions if they used empathy.4 Founders carry a sharper version of the same bind: when the person and the company are fused, admitting strain can read to a board or an investor as doubt about the venture itself, which is why founder mental health support has to treat discretion as part of the clinical frame. Deloitte's 2023 research found that three-quarters of C-suite leaders were seriously considering leaving for a role that better supported their wellbeing.3, 11 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.
Individual therapy built for chief executives
Organizational founder burnout support for portfolios
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 work, including roughly 31 percent on 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. The Workforce Institute at UKG, surveying 3,400 people in 10 countries, found managers more often stressed than either their teams or senior leadership, 42 percent against 40 and 35 percent, with a quarter often or always burned out.9 Gallup's data identifies the management tier as the group whose engagement fell fastest.2 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.
Individual therapy for people whose ambition is not the problem
Organizational an executive mental health benefit built for companies
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 Capterra's 2024 middle manager research found that more than 40 percent of managers with under two years of management experience were looking for new jobs, driven by burnout.18 The DDI forecast found that only 15 percent of leaders felt prepared to prevent burnout in their own people, and DDI's companion analysis of 529 CEOs found that while most CEOs claim to be well equipped to prevent burnout, only 27 percent of leaders say their organization is committed to employee wellbeing.13, 14 That preparedness gap lands hardest on first-line managers who are expected to support their teams while receiving little support themselves. 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. Confidential, well-matched care early in a management career is one of the highest-leverage interventions in the entire index.
Individual leadership burnout therapy for managers
Organizational the clinical gap in leadership development programs
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, depending on their level, with senior roles toward the top of that range.8 When three-quarters of the C-suite and nearly two-thirds of managers are weighing a move for wellbeing reasons,3 the index is effectively forecasting a turnover bill at the most expensive levels 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, 16, 17 Gallup put the cost of 2024's two-point fall in global engagement at 438 billion dollars in lost productivity, a decline it traced chiefly to managers,2 and it estimates that managers account for at least 70 percent of the variance in engagement across business units.15 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. When 72 percent of leaders report often feeling used up at the end of the day,5 the decisions they sign off on are made on depleted reserves, and depletion tends to shorten horizons and favor the easy option. This cost rarely appears on a dashboard, but it shapes every call a strained leader makes, which is why care for cognitive load in decision-heavy roles belongs in the conversation about leadership risk.
20 World Health Organization, 2016, return-on-investment study of scaled-up treatment, 2016 to 2030.
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, and the reason behind CEREVITY's approach to treatment.
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 weekly 50-minute session, a 90-minute session, and a 3-hour intensive session 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, and the extended 90-minute format gives a first meeting room to cover the role as well as the person.
- 04
Make early use normal
The index is an early-warning tool, so the goal is to make leaders reach for care in the first band rather than the last. 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 of them saying it hurts performance,7 isolation is not a soft issue. Address it directly in care, through a confidential room outside the org chart with a clinician who is not inside the leader's reporting line or social world.
Clinical
Intervene before the exit band
Signs of burnout up 60 percent since 2020 and 72 percent of leaders feeling used up13 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 a senior leader at up to 200 percent of salary,8 the case made in the real ROI of executive mental health.
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?
Why do leaders report worse mental health than the people they manage?
Why do standard programs fail to reach leaders?
How does private-pay billing work?
How is my privacy protected?
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 2012 and 2026. Sources were identified through searches of the published reports, articles 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, the Workforce Institute at UKG, Capterra, 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. Every reference was re-opened and checked against the claim it supports in October 2026, and figures that could not be traced to their cited source were corrected or removed. Sample sizes vary by source and are reported here where available. Gallup's leader analysis draws on 9,880 employees in its 2025 World Poll, and its engagement figures on its ongoing global survey of employees. The DDI Global Leadership Forecast 2023 was based on 13,695 leaders and 1,827 human resource professionals from 1,556 organizations in more than 50 countries, and its CEO analysis on 529 CEOs. Deloitte's 2023 wellbeing study surveyed 3,150 people across the United States, United Kingdom, Canada, and Australia, including 1,050 C-suite leaders. The Businessolver 2024 study surveyed more than 3,000 employees, HR leaders, and CEOs. UKG surveyed 3,400 people in 10 countries; the Capterra release does not state its sample size. The WHO economic figures are global estimates. 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. Gallup reports that in the United States, unlike the global pattern, leaders report fewer negative daily emotions than the people they manage. 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 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. This paper is educational and is not medical advice.
References
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- 03Deloitte and Workplace Intelligence. (2023). As Workforce Well-being Dips, Leaders Ask: What Will It Take to Move the Needle? Deloitte Insights. deloitte.com
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- 11Deloitte. (2022). New Research From Deloitte Finds C-suite May Soon Join the Great Resignation. PR Newswire. prnewswire.com
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- 13DDI. (2023). New DDI Study Reveals Largest Drop in Leadership Confidence in a Decade. PR Newswire. prnewswire.com
- 14DDI. (2023). New DDI Report Reveals CEOs Are Increasingly Detached From Their Workforce. PR Newswire. prnewswire.com
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- 16World Health Organization. (2025). Over a Billion People Living with Mental Health Conditions; Services Require Urgent Scale-up. WHO. who.int
- 17World Health Organization. (2022). WHO Guidelines on Mental Health at Work. WHO. who.int
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- 20World Health Organization. (2016). Investing in Treatment for Depression and Anxiety Leads to Fourfold Return. WHO. who.int
PhD, Licensed Psychologist
Emily Carter, PhD is a clinical psychologist licensed in California, New York and Massachusetts, seeing clients by telehealth through CEREVITY's nationwide network of independent licensed clinicians. She works with executives, attorneys, physicians and entrepreneurs on burnout, perfectionism and imposter syndrome in high-achieving professionals, on anxiety in high-stakes roles, and on relationship strain. Her clinical work draws on cognitive behavioral therapy, psychodynamic work, emotionally focused therapy and mindfulness-based interventions.
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