Mental health of high-level politicians: diagnostics, public discussion and treatment―a narrative review

Abstract

Objectives: To narratively review the presence and treatments of mental health problems among high-level political leaders. These questions have been noted in few epidemiologically sound studies and in the media. Methods: The literature search was performed and it resulted well-described cases and case series, but lacks properly designed studies focusing on medical issues. Results: High-level political leadership is a high-risk occupation, especially during crises and wartime, but also stressful in modern, democratic society. Leadership positions do not necessary facilitate the early detection of and intervention in mental disorders. In the media, psychiatrists should ensure that leaders with mental disorders are treated in a manner that preserves their dignity. Commonly accepted ethical principles stress that psychiatrists should not make announcements to the media about presumed psychopathology and diagnosis of any individuals. Conclusions: Current top leaders are mostly in midlife and rarely seriously mentally ill, but many are prone to anxiety, depression, addictions or stress-related disorders. The care of these eminent persons presents a clinical challenge that requires experience, clinical skills and multidisciplinary team work, usually within the occupational health system which is familiar with the working conditions and state of health of each patient.