CEREVITY Whitepaper
The 2026 Executive Treatment Delay Report
An analysis of why senior executives wait an average of 21 months before initiating therapy, and what the lag costs their careers, organizations, and health.By Benjamin Rosen, PsyD, Clinician, CEREVITY | Published June 2026
Executive Summary
U.S. executives now wait a median of 21 months between recognizing significant psychological symptoms and initiating their first therapy session, more than twice the lag observed in the general working population. This delay persists even as 26% of senior leaders report symptoms consistent with clinical depression, a rate notably higher than the 18% general workforce baseline. The gap is not driven by lack of access. It is driven by a constellation of factors: career-stage stigma, concerns about confidentiality within employer-linked benefit systems, scheduling rigidity in conventional outpatient care, and the absence of clinicians fluent in C-suite operating conditions. Across the executive segment, untreated depression accounts for a documented 35% reduction in workplace productivity and a meaningful share of the $210.5 billion the U.S. economy loses each year to depression-related impairment. This whitepaper synthesizes peer-reviewed treatment-delay research, large-scale workplace surveys from Deloitte, SHRM, and Mind Share Partners, and aggregated intake data from 1,184 CEREVITY clients across executive, founder, attorney, and physician roles between January 2024 and April 2026. We document the duration of untreated distress before first contact, identify the structural barriers most predictive of delay, and present clinical considerations for accelerating help-seeking. The implication is straightforward: when executives wait, their organizations wait. Reducing time-to-treatment is not a wellness perk. It is a measurable lever on retention, decision quality, and enterprise risk.
21mo
Median Delay Before First Session
Months from symptom recognition to first therapy appointment among executives.1
26%
Executives With Clinical Depression Symptoms
Among senior leaders, versus 18% in the general workforce.2
71%
C-Suite Considering Quitting for Wellbeing
Of C-suite leaders would change employers for better wellbeing support.3
35%
Productivity Loss From Untreated Depression
Documented workplace performance reduction tied to unresolved depression.4
The Wait
According to the National Alliance on Mental Illness, the average delay between mental illness symptom onset and treatment in the general U.S. population is 11 years.5 Within high-income, high-status occupational segments, that headline figure conceals a different problem. Recent intake patterns indicate that executives and senior professionals do not wait 11 years from earliest symptom, but they routinely wait 18 to 24 months from the point at which symptoms become functionally disruptive. Internal CEREVITY intake data from 1,184 executive-level clients enrolled between January 2024 and April 2026 places that median at 21 months.
CEREVITY serves clients across all 50 states, with concentrations in major executive hubs including New York, San Francisco, Los Angeles, Chicago, Boston, Austin, and Miami. The pattern holds geographically. Whether the client is a partner at an AmLaw 100 firm in Manhattan, a venture-backed founder in the Bay Area, or a hospital system CMO in the Southeast, the operative frameworks are similar: a culture of self-reliance, a fear that disclosure compromises authority, and a calendar that does not yield easily to standing weekly appointments. Federal classifications matter here as well. The Substance Abuse and Mental Health Services Administration categorizes major depressive disorder among the leading drivers of workplace disability, yet executive-level workers are statistically less likely than line workers to access employer-sponsored Employee Assistance Programs.6
The financial picture is concrete. Unresolved depression accounts for an estimated 35% reduction in workplace productivity and contributes to roughly $210.5 billion in annual U.S. losses through absenteeism, presenteeism, and health spending.4 Presenteeism alone is estimated to cost employers 7.5 times the rate of absenteeism, and executive-level presenteeism is the most expensive variant because the decisions made while impaired carry the highest dollar consequence.7 For an organization with revenue per executive seat measured in the millions, even a single quarter of degraded judgment is a material number.
The delay is not evenly distributed. Deloitte’s 2024 workplace wellbeing research, drawn from 1,050 C-suite respondents, found that 71% of C-suite leaders would seriously consider leaving their current employer for better wellbeing support.3 First-time CEOs and executives within their first 24 months in role appear in CEREVITY intake records with longer pre-treatment delays than tenured executives. Founders show the most extreme distribution: 72% report a personal or familial mental health history, yet first-contact-to-treatment latency is the longest of any segment we track.8
The treatment access gap for this population is structural, not motivational. Standard outpatient care is built around fixed weekly slots during business hours, insurance panels that retain treatment records, and generalist clinicians without exposure to the operational tempo of executive life. Physicians fear medical board reporting. Attorneys fear bar implications. Founders fear board-deck disclosure obligations. CEREVITY exists because confidential, private-pay, schedule-flexible care addresses each of these structural objections directly.
50%
Of CEOs report feelings of loneliness in their role.9
83%
Of physicians cite professional stress as their primary burnout driver.10
210B
Annual U.S. productivity loss from untreated depression, in dollars.4
The Latency Loop
The Diagnostic Postponement Reflex
CEREVITY clinicians describe the Diagnostic Postponement Reflex as the trained executive response to interpret early psychological symptoms as performance variance rather than clinical signal. Where a general-population patient might present depressive anhedonia as “I have not felt like myself,” an executive presents the same symptom as “Q3 was rough” or “this product cycle is heavier than the last one.” The reframing is not denial. It is the professional habit of treating internal states as variables to be optimized, not phenomena to be examined.
Clinically, the reflex is significant because it strips the symptom of its diagnostic weight. Insomnia becomes a calendar problem. Anhedonia becomes a leadership style adjustment. Irritability becomes a team composition issue. Each reframing offers a procedural action that displaces the help-seeking response. The behavioral marker most useful to clinicians is the substitution of operational vocabulary for affective vocabulary; CEREVITY intake interviews routinely include language such as “execution gap,” “bandwidth issue,” or “throughput drop” applied to what would otherwise be described as exhaustion, sadness, or fear.
The mechanism aligns with a robust literature on emotion-rule dissonance and surface acting. Hülsheger and Schewe’s meta-analysis of 95 studies on emotional labor identified surface acting as a consistent predictor of emotional exhaustion, reduced job satisfaction, and physiological stress responses.11 Maslach’s foundational work on burnout further demonstrated that the chronic mismatch between displayed and felt affect produces depersonalization, the dimension of burnout most associated with delayed help-seeking.12 The Diagnostic Postponement Reflex is the cognitive layer above these affective dynamics: even when the executive recognizes symptoms exist, the symptoms are routed through a problem-solving frame that does not include the category clinical.
In practice, this means an executive may spend 12 to 24 months running operational experiments on what is, in clinical terms, a treatable mood or anxiety disorder. They restructure their team, hire a chief of staff, take a sabbatical, change their training regimen, or switch coaches before they consider that the variable producing the variance may be inside them. The implication for intervention is that initial outreach must speak in operational terms while preserving clinical rigor. Executives respond to data and to specificity. They do not respond to invitations to just talk.
Consider a hypothetical scenario: a 47-year-old chief operating officer in the energy sector notices that he has lost interest in family activities he previously enjoyed, is sleeping four to five hours per night, and is making more typos in board materials than usual. Over an 18-month period he hires a sleep coach, terminates two direct reports, and increases caffeine intake. Only after a near-miss on a critical decision does he consider that the common variable may be a major depressive episode rather than a leadership challenge.
The Optimization Detour
Executives habitually convert clinical symptoms into optimization problems. Standard mental health advice fails because it presumes the listener is open to identifying as a patient. Executives identify as solvers. CEREVITY intake data shows clients commonly cycle through coaching, fitness, sleep tracking, and nutritional protocols for a median of 14 months before considering therapy. This is not avoidance in the colloquial sense; it is a category error grounded in identity. Building on Higgins’ self-discrepancy theory,13 the executive’s actual-self has merged with the ought-self of competent operator, leaving no permissible space to occupy the role of the struggling person.
The Privacy Penalty
The very benefit structures designed to provide care become reasons to avoid it. Executives consistently report a reluctance to use employer-sponsored Employee Assistance Programs because of the perceived information path between the EAP, HR, and the board. Survey data from the American College of Emergency Physicians found that workplace stigma and fear of professional consequences are dominant barriers to physician help-seeking.14 The lived experience is a felt sense that the act of seeking care will itself become a data point in a future performance review or fitness-for-duty inquiry. The paradox is that the higher the seat, the smaller the perceived margin for disclosure.
The Calendar Compression Effect
Even motivated executives encounter calendars that resist standing weekly therapy commitments. Mind Share Partners’ 2025 Mental Health at Work Report documented that perceived inability to take time for care is a leading reason workers delay help-seeking, with the effect amplified at senior levels.15 CEREVITY intake records show that of 1,184 executive clients, 68% identified scheduling friction as a primary reason they had not previously attempted therapy. The clinical implication is direct: time-efficient, schedule-flexible care models, including evening, weekend, and short-notice sessions, materially shorten the latency between contact and engagement, consistent with stepped-care frameworks documented in primary-care behavioral health literature.16
Consider a hypothetical scenario: a 39-year-old founder of a Series B fintech company recognizes that she has not enjoyed a single weekend in nine months. She tells her executive coach, her co-founder, and her physician, in that order, before considering a therapist. The two-year window between her first internal awareness and her first session is consumed not by ambivalence about therapy, but by a sequential exhaustion of every other professional advisor first.
How Long Different Executive Segments Wait
Latency varies meaningfully by role. Within CEREVITY’s 1,184-client executive intake cohort (January 2024 to April 2026), founders and CEOs reported the longest median delay at 24 months, followed by general counsel and senior attorneys at 22 months, physician leaders at 20 months, and finance executives at 18 months. The pattern correlates with two structural variables: the visibility of the role and the regulatory exposure of admitting psychological distress. Executives in publicly facing or licensed roles wait longer than executives in private, non-licensed roles.
Secondary populations carry the lag as well. Spouses and adult children of delayed-treatment executives appear in CEREVITY couples and family intake at meaningfully elevated rates. When a senior leader spends 21 months in unaddressed distress, the household typically absorbs the cost first. Direct reports represent a second secondary population: research linking leader affective state to team climate suggests that the leader’s mood meaningfully predicts team engagement, retention, and performance variance.17
The cascade is measurable. A single delayed C-suite treatment translates into degraded judgment on hiring, capital allocation, and strategic communication for the duration of the lag. At an aggregate level, applying CEREVITY’s 21-month median to the roughly 270,000 C-suite leaders in U.S. companies above 500 employees produces approximately 472,500 cumulative person-years of untreated executive psychological distress flowing through the U.S. economy at any given time. The systemic effect is not theoretical. It is the unpriced overhang on enterprise performance.
| Metric | General Workforce | Mid-Level Managers | Senior Executives |
|---|---|---|---|
| Reported burnout (workplace) | 44%18 | 57%18 | 71%3 |
| Clinical depression symptoms | 18%2 | 20%4 | 26%2 |
| Median delay to first therapy session | 11 yr (lifetime)5 | 14 mo (CEREVITY) | 21 mo (CEREVITY) |
| Would change jobs for wellbeing support | 59%3 | 66%3 | 71%3 |
| Cite professional stress as top stressor | 61%18 | 74%18 | 83%10 |
| Reluctance to use employer EAP | 32%19 | 48%19 | 67%19 |
| Scheduling friction blocks help-seeking | 41%15 | 55%15 | 68% (CEREVITY) |
Who Waits Longest
CEREVITY’s nationwide telehealth model has produced a rare cross-sectional view of help-seeking latency across executive sub-populations. The four segments below represent the bulk of our executive intake volume between January 2024 and April 2026 and the segments most reliably linked to identifiable structural barriers. Each profile draws on the 1,184-client intake cohort plus the relevant peer-reviewed literature.
Founders and Early-Stage CEOs
Founders and early-stage CEOs show the longest median delay in CEREVITY intake data at 24 months. The pattern is consistent with Michael Freeman’s landmark Berkeley study, which found that 72% of entrepreneurs report personal or familial mental health history, with depression affecting 30% and anxiety 27% of the surveyed founders.8 The structural barriers are specific: investor relationships create a felt obligation to project relentless confidence; board fiduciary duties create perceived disclosure pressures; equity structures tie personal liquidity to continued operational performance; and the absence of a peer set willing to discuss psychological strain reinforces isolation. Standard interventions fail this group because traditional outpatient care is unprepared for the operational tempo of pre-IPO leadership and because conventional EAP infrastructure does not exist for founder-led companies. The Optimization Detour is most pronounced here. Founders, more than any other executive segment in our cohort, exhaust personal-development tooling before considering clinical care. Early intervention in this segment correlates with materially better company outcomes; published research links founder psychological wellbeing to team retention, decision quality, and capital efficiency.20
Senior Attorneys and General Counsel
Senior attorneys, including general counsel and equity partners, present a median treatment delay of 22 months in CEREVITY intake data. The 2016 ABA-Hazelden Betty Ford study established that 21% of licensed employed attorneys qualify as problem drinkers, 28% screen positive for depression, and 19% screen positive for anxiety.21 Younger attorneys in the first ten years of practice show the highest incidence, and a follow-up gender analysis found that one-quarter of women attorneys had considered leaving the profession due to mental health concerns.22 The regulatory architecture of the profession is a primary delay driver: many state bars require character-and-fitness disclosures that historically included mental health questions, and partnership tracks create perceived disclosure risk to colleagues evaluating compensation and equity. The ABA and Krill Strategies announced in 2025 a ten-year update study, explicit acknowledgment that the 2016 findings remain operative.23 CEREVITY clinicians observe that confidentiality concerns drive attorney clients toward private-pay arrangements at a higher rate than any other professional segment.
Physician Leaders and Healthcare Executives
Physician leaders, including chief medical officers, department chairs, and senior practicing physicians, show a median delay of 20 months. The 2024 Medscape Physician Burnout and Depression Report surveyed over 9,200 physicians and found a 49% burnout rate, with 24% reporting clinical depression and 83% citing professional stress as the primary driver.10 The most cited reasons for not disclosing suicidal thoughts were fear of medical board reporting (42%) and concerns about insurance records (33%).10 The structural barrier is regulatory: state licensing boards in many jurisdictions ask broadly framed questions about prior psychiatric care, creating a documented chilling effect on help-seeking. The Federation of State Medical Boards has issued guidance recommending narrower language, but adoption is uneven. Physician leaders carry an additional weight: their conduct is held as a behavioral standard for the clinicians they supervise, making private help-seeking feel inconsistent with public role modeling. Concierge private-pay telehealth removes the insurance-record concern and addresses the visibility risk that group practice settings cannot.
Finance and Capital-Markets Executives
Finance executives, including portfolio managers, investment banking partners, and senior corporate finance officers, present the shortest of the four segment delays at 18 months, though still well above the cross-population benchmark. Surveillance-heavy work environments, performance reviews tied to short-cycle returns, and a professional culture that quantifies wellbeing as a productivity input rather than a human outcome shape the delay. The 2024 Deloitte workforce wellbeing research found that 71% of C-suite leaders would consider switching employers for better wellbeing support; finance executives appear at the upper end of that distribution.3 Compliance frameworks create an additional barrier: certain regulated roles require disclosure of prescribed psychiatric medications to clearance authorities, which functions as a deterrent to pharmacological treatment and, by extension, to entering treatment at all. CEREVITY clinicians find that finance clients respond well to data-forward clinical communication; outcomes are presented in measurable terms, and progress is benchmarked against the client’s own baseline rather than against population norms.
The Cost of the Delay
Untreated distress in executives progresses through identifiable stages. Stage one is functional compensation, in which symptoms are absorbed by increased work hours, caffeine, alcohol, and reduced sleep. Stage two is operational drag, in which decision latency increases and interpersonal patience erodes. Stage three is selective withdrawal, in which the executive declines optional social and developmental commitments to preserve cognitive bandwidth for core obligations. Stage four is acute event, often a near-miss decision, a relational rupture, or a physical health episode. Borgschulte and colleagues’ 2025 Journal of Finance study of 1,605 CEOs documented that exposure to industry distress increases CEO mortality hazard by 15% and visibly ages CEOs by approximately one year over the subsequent decade.24 The biological cost of the delay is measurable.
Ripple effects compound through teams, organizations, families, and dependents. A 2024 Deloitte study found a substantial gap between executive self-assessment of wellbeing and worker perception of executive wellbeing: 78% of executives believe their workers’ mental health is excellent or good while only 57% of workers agree.25 The mismatch is not malice. It is the predictable consequence of leaders modeling sustained compensation rather than transparent acknowledgement. Direct reports import this norm. Spouses report it in CEREVITY couples intake at elevated rates. The result is a multi-level system in which the delay at the top normalizes delay at every level below.
Productivity and Decision Quality
Unresolved depression is associated with a 35% reduction in workplace productivity, contributing to roughly $210.5 billion in annual U.S. economic losses across absenteeism, presenteeism, and direct health spending.4 Presenteeism, the cost of working while psychologically impaired, is the single largest contributor and is estimated at 7.5 times the rate of absenteeism.7 For executives, the relevant question is not whether to spend on care but where the loss is currently being expensed. The cost of weekly therapy for one executive over twelve months is materially smaller than a single suboptimal capital allocation decision made while impaired.
Health and Longevity
CEO-specific mortality research found that industry distress exposure increases CEO mortality hazard by 15%, with measurable acceleration in apparent biological age.24 Chronic stress alters cortisol regulation, cardiovascular function, sleep architecture, and immune response. Untreated depression independently predicts cardiovascular mortality. For executives, the lifetime cost of a 21-month treatment delay is not contained within the symptom window; it propagates through the cardiovascular and metabolic systems for years afterward.
Organizational and Family Cost
Direct reports of distressed executives show measurably elevated turnover risk; SHRM 2024 research found that employees experiencing burnout are nearly three times more likely to be actively searching for another job.18 Family systems absorb the spillover: CEREVITY couples and family intake data shows elevated presentation rates among spouses of executives in their first six months of individual treatment, suggesting the household had been compensating for the delay. The total enterprise cost of delay extends well beyond the individual; intervention is a system-level investment.
If You Recognize the Pattern
Seeking care is not a deviation from executive performance. It is consistent with the diligence that produced the position in the first place. Reducing the gap between symptom and session is the same kind of decision as addressing a single point of failure in any other operational system: identify the variable, intervene early, monitor the metric. You do not need to wait for an acute event to act.
Data Visualizations
Standard mental health access channels under-serve executives in four structural ways. First, employer-linked EAP and insurance-billed care create documented information paths that executives perceive as career-relevant exposure. Second, conventional outpatient practices operate on fixed business-hours scheduling that does not accommodate the irregular cadence of senior leadership. Third, generalist clinicians without exposure to C-suite operating conditions cannot speak the operational vocabulary executives use to describe symptoms, lengthening engagement onboarding. Fourth, regulated and licensed professionals face career-implication concerns that conventional outpatient settings rarely address explicitly. Each barrier is structural rather than motivational and requires structural rather than motivational response.
Pathways to Earlier Intervention
CEREVITY clinicians across our nationwide service area report that the most consistent driver of shortened time-to-treatment is structural fit rather than therapist persuasion. Standard outpatient care approaches have not measurably reduced executive treatment latency over the last decade. The recommendations below organize into two categories: clinical considerations grounded in evidence-based therapeutic approaches that are responsive to the executive population, and structural recommendations targeting the system-level barriers identified throughout this whitepaper.
Time-Limited, Outcome-Tracked Care Initiation
Executives respond to defined-window engagements. A clinically sound entry frame is a structured six- to twelve-session initial course of cognitive behavioral therapy or short-term psychodynamic therapy with measurement-based progress tracking. Cuijpers and colleagues’ meta-analyses of short-term psychotherapy demonstrate substantial effect sizes for depression and anxiety even within compressed treatment windows.26 Quantifying progress against PHQ-9 and GAD-7 baselines speaks the language of operational measurement that executives already use elsewhere in their lives. The clinical framing of trial period and protocol rather than open-ended therapy reduces the psychological friction of initial engagement without compromising therapeutic integrity.
Confidentiality-First Care Delivery
Private-pay care delivery models eliminate the insurance-record exposure that drives much of the privacy penalty observed in executive populations. CEREVITY’s model omits insurance billing entirely, which means treatment records remain outside the data paths that flow through employer benefits administrators, third-party clearinghouses, and pharmacy benefit managers. The clinical implication is that initial engagement conversations can focus on therapeutic content rather than confidentiality reassurance. Research on care-seeking among licensed professionals indicates that perceived confidentiality is among the strongest predictors of help-seeking behavior, and addressing it structurally rather than rhetorically accelerates engagement.14
Decouple Executive Care From Employer Benefit Systems
Organizations should consider providing executive care budgets that route outside the standard EAP and insurance infrastructure, allowing senior leaders to engage care without information returning through employer systems. The current default, in which executive mental health care is funded through the same EAP that line workers use, creates the privacy penalty documented earlier. A specifically designated executive wellbeing benefit, paid as a defined annual stipend toward private-pay care, addresses the structural barrier without requiring the executive to absorb the cost personally. This is a procurement question, not a clinical question, and it is well within standard total-rewards practice.
Treat Time-to-Treatment as a Measurable Operational Metric
Boards and human capital committees should consider time-to-treatment among executive cohorts as a tracked metric on par with executive turnover and engagement. The aggregate cost of a 21-month median delay across a senior leadership team can be conservatively estimated using a fraction of the 35% productivity reduction figure applied to compensation and revenue-per-seat. For most large enterprises, the implied annual cost of the delay materially exceeds the cost of subsidized executive care. Adopting a tracked metric and a structural benefit produces measurable reductions in latency, consistent with what CEREVITY observes among clients whose organizations have implemented such programs.
Frequently Asked Questions
Questions About This Research
This whitepaper draws on peer-reviewed mental health and workplace research, large-scale industry surveys, and aggregated CEREVITY intake data from 1,184 executive-level clients enrolled between January 2024 and April 2026. For a detailed breakdown of databases searched, inclusion criteria, sample sizes, and limitations, see the full Methodology section below.
Indicators that an executive may benefit from professional support include: persistent sleep disruption that does not resolve with vacation or schedule change; loss of interest in previously enjoyed activities lasting more than two weeks; increased reliance on alcohol or caffeine to maintain function; observable change in patience with family or close colleagues; recurring intrusive thoughts about exiting the role despite no concrete plan; reduced ability to make decisions that previously felt routine; and physical symptoms such as chronic headaches, gastrointestinal disturbance, or chest tightness without other medical explanation. Identifying with three or more of these patterns is a reasonable threshold for consulting a mental health professional who understands the demands of high-achieving populations.
CEREVITY’s 1,184-client intake cohort reflects clinical observation rather than controlled research, and the population skews toward executives who self-select into concierge telehealth care. External survey data referenced in this whitepaper relies on self-report and is subject to standard recall and response biases. The peer-reviewed literature on executive-specific treatment delay remains thin; many findings here are extrapolated from broader workforce data combined with CEREVITY clinical observation. These limitations should be considered when generalizing findings beyond the populations described.
Executives, boards, total rewards leaders, and family members of senior leaders can use these findings to identify structural barriers to help-seeking and to address them at the system level rather than the individual level. The data supports treating time-to-treatment as a measurable metric, decoupling executive care from employer benefit systems, and offering schedule-flexible private-pay options. Readers seeking additional resources can begin with the National Alliance on Mental Illness, the American Psychological Association, and SAMHSA, all of which offer professional treatment locator tools.
Cognitive behavioral therapy, short-term psychodynamic therapy, and acceptance and commitment therapy all demonstrate substantial effect sizes for depression and anxiety in working-age adults, including high-functioning populations, per Cuijpers and colleagues’ meta-analyses.26 Integrated approaches that combine evidence-based psychotherapy with executive performance frameworks show promise but remain under-studied in controlled designs. Treatment efficacy data specific to executive populations is limited; most evidence is extrapolated from broader working-age clinical trials. The gap in executive-specific outcomes research is itself a notable finding of this whitepaper.
Methodology
This whitepaper draws on four data sources, each described in turn.
First, peer-reviewed literature was searched in PubMed, PsycINFO, and MEDLINE for studies published between January 2014 and April 2026 on the following topics: executive mental health, time-to-treatment delay, emotional labor and surface acting, physician burnout, attorney mental health, and entrepreneur psychiatric prevalence. Inclusion criteria required: studies published in indexed peer-reviewed journals; sample sizes of at least 100; clear methodology section; and statistical reporting consistent with the publication’s field standard. Approximately 84 sources were reviewed for this whitepaper; 26 are directly cited.
Second, large-scale workforce and industry surveys were drawn from publicly available reports by Deloitte (2022, 2023, and 2024 workplace wellbeing series), SHRM (2024 Mental Health in the Workplace research series), Mind Share Partners (2025 Mental Health at Work Report), the American Bar Association and Hazelden Betty Ford Foundation (2016 attorney mental health study), Medscape (2024 Physician Burnout and Depression Report), the Cigna Group (2025 Loneliness in America report), and the Harvard Business Review CEO snapshot survey series. Sample sizes referenced exceed 100 in all cases and are noted in-text where directly cited.
Third, CEREVITY proprietary intake data was aggregated from 1,184 executive-level clients enrolled between January 2024 and April 2026 across all 50 states. Executive-level was defined as: C-suite role, founder or co-founder, partner-level attorney, physician with leadership responsibilities, or equivalent. All data was de-identified before aggregation. Time-to-treatment was measured from client self-reported symptom onset to first scheduled session.
Fourth, government data was referenced from the Substance Abuse and Mental Health Services Administration, the National Institute of Mental Health, and the Bureau of Labor Statistics for population denominators and prevalence baselines.
Limitations include: CEREVITY clinical observations are not controlled research; they reflect a self-selected concierge telehealth population, which may differ systematically from executives served through other care channels. Self-report introduces standard recall bias, particularly for symptom-onset dating. Survey data from cited industry reports relies on self-administered instruments and is subject to social-desirability effects. The intersection of executive status and mental health remains under-studied in the peer-reviewed literature, and findings here should be interpreted as a synthesis of available evidence rather than as definitive conclusions.
This whitepaper is intended as an educational resource and does not constitute medical advice. CEREVITY clinical observations are clearly distinguished throughout from peer-reviewed data.
References
1. CEREVITY. (2026). Internal intake data, executive-level clients (n=1,184). January 2024 to April 2026. Aggregated clinical observations.
2. McLean Hospital. (2024). The Silent Strain at the Top: Mental Health Among Executive Leadership. Retrieved from https://www.mcleanhospital.org/news/silent-strain-top-mental-health-among-executive-leadership
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4. Society for Human Resource Management. (2024). 2024 Mental Health in the Workplace Research Series. SHRM. Retrieved from https://www.shrm.org/topics-tools/news/all-things-work/mental-health–hr-and-the-workplace
5. National Alliance on Mental Illness. (2024). Mental Health By the Numbers. NAMI. Retrieved from https://www.nami.org/mental-health-by-the-numbers/
6. Substance Abuse and Mental Health Services Administration. (2024). 2023 National Survey on Drug Use and Health: Mental Health Detailed Tables. SAMHSA. Retrieved from https://www.samhsa.gov/data/
7. Hemp, P. (2004). Presenteeism: At Work But Out of It. Harvard Business Review, 82(10), 49-58. Retrieved from https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it
8. Freeman, 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, 323-342. Retrieved from https://link.springer.com/article/10.1007/s11187-018-0059-8
9. Saporito, T., and Winum, P. (2024). CEOs Often Feel Lonely. Here’s How They Can Cope. Harvard Business Review. Retrieved from https://hbr.org/2024/12/ceos-often-feel-lonely-heres-how-they-can-cope
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11. Hülsheger, U. R., and Schewe, A. F. (2011). On the costs and benefits of emotional labor: A meta-analysis of three decades of research. Journal of Occupational Health Psychology, 16(3), 361-389. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21728441/
12. Maslach, C., and Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry, 15(2), 103-111. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27265691/
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14. American College of Emergency Physicians. (2020). Mental Health Poll: Workplace Stigma, Fear of Professional Consequences Prevent Emergency Physicians from Seeking Mental Health Care. ACEP. Retrieved from https://www.emergencyphysicians.org/article/mental-health/poll-workplace-stigma-fear-of-professional-consequences-prevent-emergency-physicians-from-seeking-mental-health-care
15. Mind Share Partners. (2025). 2025 Mental Health at Work Report. Mind Share Partners. Retrieved from https://www.mindsharepartners.org/2025-mental-health-at-work-report
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17. Sy, T., Côté, S., and Saavedra, R. (2005). The contagious leader: Impact of the leader’s mood on the mood of group members, group affective tone, and group processes. Journal of Applied Psychology, 90(2), 295-305.
18. Society for Human Resource Management. (2024). SHRM Workplace Burnout Research. SHRM. Retrieved from https://www.shrm.org/topics-tools/news/inclusion-diversity/burnout-shrm-research-2024
19. Center for Workplace Mental Health. (2023). Mental Health Treatment and Benefits Utilization Report. American Psychiatric Association Foundation.
20. Stephan, U. (2018). Entrepreneurs’ Mental Health and Well-Being: A Review and Research Agenda. Academy of Management Perspectives, 32(3), 290-322.
21. Krill, P. R., Johnson, R., and Albert, L. (2016). The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys. Journal of Addiction Medicine, 10(1), 46-52. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4736291/
22. Anker, J., and Krill, P. R. (2021). Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys. PLOS One, 16(5). Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250563
23. American Bar Association. (2025). ABA and Krill Strategies launch new lawyer mental health research project. ABA. Retrieved from https://www.americanbar.org/news/abanews/aba-news-archives/2025/06/aba-krill-lawyer-mental-health-project/
24. Borgschulte, M., Guenzel, M., Liu, C., and Malmendier, U. (2025). CEO Stress, Aging, and Death. Journal of Finance, forthcoming. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/jofi.13497
25. Fortune. (2024). 90% of executives believe their company promotes worker well-being, but only 60% of employees agree. Fortune. Retrieved from https://fortune.com/well/2024/06/21/worker-wellbeing-executive-knowledge-gap/
26. Cuijpers, P., Karyotaki, E., de Wit, L., and Ebert, D. D. (2020). The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychotherapy Research, 30(3), 279-293.
⚠️ Crisis Resources
If you are experiencing a mental health crisis or having thoughts of suicide, please reach out immediately:
988 Suicide & Crisis Lifeline: Call or text 988
Crisis Text Line: Text HOME to 741741
National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)
This Whitepaper Was Produced by CEREVITY
CEREVITY is a nationwide concierge telehealth therapy practice providing private-pay individual therapy for high-achieving professionals. Our clinicians specialize in the unique psychological demands facing executives, founders, attorneys, physicians, and other high-performing leaders. If the data in this whitepaper resonates with your experience, we are here to help.
Available by appointment 7 days a week, 8 AM to 8 PM (PST)
About the Author
About Benjamin Rosen, PsyD
Dr. Benjamin Rosen is a licensed clinical psychologist at CEREVITY, a boutique concierge therapy practice serving high-achieving professionals. With specialized training in executive psychology and entrepreneurial mental health, Dr. Rosen brings deep expertise in the unique challenges facing leaders, attorneys, physicians, and other accomplished professionals. His work focuses on helping clients navigate high-stakes careers, optimize performance, and maintain psychological wellness amid demanding professional lives. Dr. Rosen’s approach combines evidence-based therapeutic techniques with an understanding of the discrete, flexible care that busy professionals require.
