Are founders more likely to have a mental health condition?
Almost every article on founder mental health leans on one study: Dr. Michael Freeman’s survey of 242 entrepreneurs and 93 comparison participants, first shared in 2015 and published in Small Business Economics in 2019.1 It’s a careful piece of work with real limits. People reported their own lifetime history, the groups were small, and nobody was clinically assessed. The pattern is still hard to ignore.
| Condition | Entrepreneurs | Comparison | Gap |
|---|---|---|---|
| Any mental health condition | 49% | 32% | significant |
| Depression | 30% | 15% | 2× |
| ADHD | 29% | 5% | about 6× |
| Anxiety | 27% | 26% | no real difference |
| Substance use | 12% | 4% | 3× |
| Bipolar disorder | 11% | 1% | about 10×, from one comparison participant |
Look at the anxiety row. It’s the one that drops out when this study gets quoted, and it’s the most interesting: founders weren’t more anxious than anyone else. The gaps showed up in ADHD, bipolar disorder, and depression, conditions bound up with energy and mood. That’s the question in the title of Freeman’s 2015 paper, “Are entrepreneurs touched with fire?”: whether the traits that make a founder travel with real vulnerability.
How are founders doing right now?
Newer surveys ask something different. Not lifetime history, but how founders are doing this year. Most are self-selected, so read them as signals rather than a census. The signal is the same from Tel Aviv to Toronto.
- 72%of founders say building a startup has affected their mental health.3
- 62%of founders experienced anxiety in the past year, and 53% had trouble sleeping.4
- 44%of founders report high stress, 37% anxiety, and 36% burnout. 13% report depression.3
- 54%of founders are very stressed about the future of their startup. Among women founders it’s 66%.3
- 59%of founders sleep less than they did before starting their company.3
- 28%of founders in an ongoing 2026 survey score moderate-to-severe on the PHQ-9 depression screen; the survey puts the general population at about 8%.5
- 51%of French business leaders are struggling with their psychological health now, or have in the past.6
Do founders ask for help?
Mostly, no. And the people with the most say over a founder’s company are usually the last to hear about it.
- 81%of founders aren’t really open about their stress, fears, and challenges.3
- 77%of founders don’t get professional help; 23% see a psychologist or a coach.3
- 10%of founders talk to their investors about their stress.3
- 88%of founders and CEOs rarely or never turn to their investors for personal support.7
- 55%of male founders see a stigma around going to a psychologist, against 29% of women. It’s higher under 35 (59%) than over (47%).3
- 35%of Canadian business owners sought professional help for their mental health in the past year. Lack of time (26%) and cost (21%) stopped the rest most often.8
What does it do to the company?
Founders tend to treat their own state as a private matter. The data says it leaks.
- 69%of founders and CEOs say stress has hurt their work performance; 91% have felt their well-being slip.7
- 80%of startup employees say their job has affected their mental health. Only 15% are open about it with their manager.9
- 65%of troubled VC-backed companies were held back mainly by their senior management, according to the venture capitalists behind them.10
Not all pressure is the enemy, though. A 2021 meta-analysis drew a useful line: stress from a hard but meaningful challenge tends to lift a founder’s performance, while stress from obstacles and hassle wears down their well-being.11 The grinding, pointless kind is the one to cut.
Is building a company bad for you?
Not necessarily, and an honest page has to say so. The largest meta-analysis so far, 94 studies across 82 countries, found entrepreneurs report slightly higher well-being and work satisfaction than employees, and no difference in negative well-being overall.12 The effects are small and swing a lot from country to country. And a 2018 review of 144 studies found most of this research is cross-sectional, so it can’t tell us what causes what.13
Both things are true at once. On average, founders are about as well as anyone, and a bit happier with their work. Within that average sits a sizable group carrying a heavy load, often without telling a soul, and the cost shows up at home and at the office. Even ADHD cuts both ways: in a study of 14 founders diagnosed with it, impulsivity pushed them to act and hyperfocus amplified the results, good and bad.14