What makes senior executive leaders vulnerable to mental ill health?

A well-established model, first proposed by Siegrest (1996[1]), helps to explain how work roles can result in poor mental health. The model is built round the concept of “Effort- Reward imbalance” and focuses on the work contract and the social reciprocity principle. Rewards are reciprocally received in return for efforts expended. Where there is a detrimental imbalance between these – be it money, esteem, satisfaction, promotions, or job security, versus excessive and outweighing effort, strong, negative emotions and responses occur, which can impact on mental health. Put simply, this model would suggest that those who have made it to the top of organisations should enjoy a strong tilt in their favour creating advantageous effort-reward balances. Specific patterns of addressing demanding situations however, characterised by excessive engagement and a desire to be in control, with over-commitment, were identified by Siegrest as increasing the susceptibility to stress responses. Furthermore, Barnard (2008[2]) theorised that the trappings of corporate leadership, such as high salaries and prestige are readily offset by effort – “long hours, tight schedules, lack of privacy, gruelling travel obligations, intense market scrutiny, second guessing from the board, and often (perhaps ironically), social isolation”. He further theorised that CEOs, buckling under these pressures regularly seek escape through, “substance abuse, adultery, sexual adventurism, extreme physical exertion, creation of a fantasy life, or immersion in extra- corporate activities.”

It should also be considered that making it to the top of the organisation is not the norm. The very fact that this has been achieved, immediately marks people out as being significantly different from those around them. These differences can occur for a variety of positive reasons that confer resilience, but they can also stem from traumas, such as the way punitive pressures may have been inflicted on them as children. These distinctions can also, of course, be simply hardwired into their unique personalities. Psychiatrists are always interested in childhood experiences and personalities, as certain patterns are known to create both strengths and weaknesses, when it comes to maintaining good mental health. Adverse childhood histories and perfectionist traits, which can, for example, drive high performance, are also associated with a vulnerability to depression. Over pressurised, hyper critical parenting can imprint a desire to achieve, but may leave an emptiness too, when, or after achieving, that is difficult to ever fill.

Despite this, those applying for CEO positions have generally done so with their eyes wide open to the pressures that they will face. They are selected by panels and processes, which delve into their occupational histories, with the hope of appointing highly resilient achievers. Perhaps, unsurprisingly, given the care that is taken around recruitment at this level, one Swedish study (Keloharju et al 2020[3]) has shown lower than average levels of mental illness in CEOs before the Pandemic. This study however, primarily examined the prevalence with which groups reported problems in their mental health, and as mentioned before, executives often do their best to ignore their psychological struggles, rather than seeking help, by reporting them.

In addition, the 2020 Pandemic accelerated such rapid change in how organisations are led, that research conducted before that time can lack relevance in the post pandemic era. Since Covid the pressure of running multi-million-pound businesses, in an increasingly VUCA (volatile, uncertain, complex and ambiguous) world, has seemingly been simply too much for many to navigate without their mental health being damaged.  Certainty is a great anxiety reliever, but, in this post pandemic era, it has been rarely found.

[1] Siegrist J. Adverse health effects of high-effort/low-reward conditions. J. Occup. Health Psychol. 1996;1:27–41

[2] Barnard, J. (2008) The interior lives of corporate leaders. William & Mary Law School Scholarship Repository. Last accessed online 21.5.2023. [Available at]: https://scholarship.law.wm.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1010&context=facpubs

[3] Keolharju, M. Knupfer, S. Tag, J. (2020) CEO Health and corporate Governance. Research Institute of industrial economics. IFN Working Paper No. 1326, 2020. Last accessed online 21.5.2023. [Available at]: https://www.econstor.eu/bitstream/10419/240469/1/wp1326.pdf