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Although managers should be looking for signs of increased stress among employees and willing to raise it, this becomes much more difficult with senior executives, who are likely to become defensive.

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Last year Ton Buechner, the chief executive officer of AkzoNobel NV, the Dutch chemicals group, was granted special leave to recover from what the company described as "temporary fatigue." Akzo said Mr. Buechner had taken "a bit too much hay on his pitchfork" and added that "CEOs are also human beings."

Mr. Buechner is not the first CEO to be given time off for a stress-related illness and lawyers warn that they are seeing more cases like this as the recession adds to pressure on senior managers.

Not only are CEOs faced with the relentless need to outperform their competitors, but they are doing so amid turbulent economic conditions, often in the glare of the media spotlight.

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As Fraser Younson, a partner at Berwin Leighton Paisner, a law firm, puts it: "It's easy being chief executive when you're pedalling downhill but when you have headwinds, it is a whole lot harder.

"The pressure to deliver acceptable returns for shareholders is greater and more difficult. Many CEOs simply haven't got the experience to deal with this economic environment where they are being asked to do more with fewer resources."

Although managers should be looking for signs of increased stress among employees and willing to raise it, this becomes much more difficult with senior executives, who are likely to become defensive.

"It takes quite a brave person to say to a chief executive 'you're under stress,', because they may take it that someone is after their job," Mr. Younson says. "As soon as the individual starts thinking this way, their behaviour will start reflecting that and it will become a self-fulfilling prophesy."

Mr. Younson says even attempts to reduce their work can backfire. "One option is to try and lose parts of the role for the chief executive. But, again, any suggestions like this can run the risk of making the chief executive defensive, as he can perceive it as trying to undermine his command."

Despite attempts to reduce the stigma surrounding mental illness, CEOs are often reluctant to raise it for fear it will be seen as a sign of weakness. It is also hardly surprising they are under stress.

"Chief executives are paid a lot of money to make tough decisions and, despite the law often providing them with protection, they often don't want to tell anyone because it will make them seem vulnerable or not up to the job," says Edward Goodwyn, a partner at law firm Pinsent Masons. "This can add to the stress and send it spiralling further."

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Added to this is the problem that CEOs are unlikely to use any counselling services made available to employees. Chief executives need their own support mechanism, particularly if, like Mr. Buechner, they have moved from smaller, less complex jobs.

Although the law provides protection for employees, including chief executive officers suffering from long-term illnesses, stress can be nebulous, making proper assessments difficult.

"It's hard to measure because stress thresholds vary greatly from person to person. While some people thrive under pressure, others wilt," Mr. Younson says.

Nevertheless, he says non-executive directors should be vigilant, looking for any indications that a CEO is struggling. Signs can include poor-quality decision making, a lack of attention to detail, irritability and impatience. Proper medical advice is key.

"The first thing any employer should do when any employee goes off sick is to get independent advice on what is really going on and how long the illness is likely to last," Mr. Goodwyn says.

In many cases, the illness is short-lived. Antonio Horta-Osorio, chief executive officer of Lloyds Banking Group PLC, took two months off for stress-related sleep deprivation last year after taking over the job amid intense political and public scrutiny of banking. He said later that he had been "like a battery going to zero."

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Although his fitness for the job was called into question at the time, the share price – which fell 5 per cent when Mr Horta-Osorio's condition became publicly known – soon recovered, and he continued with a significant restructuring of the group soon after his return to work.

All the same, Mr. Horta-Osorio has reduced the number of people reporting to him and strengthened the roles of his senior management team.

In both the AkzoNobel and the Lloyds cases, both men became ill just months after taking the job.

This suggests that the biggest stress may be at the beginning of new employment, when external expectations are at their highest and internal support networks have yet to develop.

It may also just be that work is inherently stressful.

A survey from Towers Watson, the consultancy, and WorldatWork, an association of human resources professionals, found that 32 per cent of U.K. companies, 47 per cent of businesses in the rest of Europe and the Middle East, and 61 per cent of those in the U.S. said employees often experienced "excessive pressure" in their jobs.

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Managers in particular, according to an earlier survey of 32,000 employees worldwide, are "generally unhappy [and] pressed for time."

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