Advancing Mental Health for Women Leaders in Health through Stress Management: Six Psychological Frameworks from a Human-Centered Design Study 

Background: Women leaders in health across low- and middle-income countries (LMICs) navigate compounding stressors that threaten their mental health and leadership sustainability. Despite growing global attention to leadership diversity, the mental health experiences of women in health leadership remain under-researched in LMIC contexts, and no named psychological framework set has previously been derived from this population's lived experience.

Methods: This study employed a Human-Centered Design (HCD) co-research methodology with 23 women leaders in health across 14 countries (South Sudan, Uganda, Zambia, Zimbabwe, South Africa, Lesotho, Malawi, Angola, Rwanda, India, Botswana, Mozambique, Kenya, and the United States) representing roles from nursing officers and heads of department to country directors and CEOs. Data were collected through individual in-depth interviews and a focus group discussion, analyzed using thematic analysis, and synthesized into psychological framework development.

Findings: The analysis produced six original psychological frameworks representing the first named, evidence-based psychological framework set derived from the lived experiences of women leaders in health in LMIC contexts. The six frameworks are the Strength Invisibility Gap, the Isolation Paradox, the Internalization Default, the Double Burden Tax, the Representational Weight, and the Performative Support Trap. Each framework was grounded in participant testimony and existing leadership psychology literature, and developed into an evidence-based intervention point. The frameworks interact as an integrated system highlighting six expressions of one structural failure: the failure of professional and institutional environments to design systems around the full reality of what women leaders in health are managing.

Conclusions: Mental health stressors for women leaders in health are systemic, relational, cultural, and structural not individual failings. The six frameworks presented provide the conceptual tools for understanding the mechanisms that produce these stressors and the intervention points at which they can be addressed. Solutions require both organizational policy reform and the creation of trusted peer support ecosystems grounded in women-led co-design.