While the image of the stressed-out executive or the politician under pressure has been firmly planted in the American mind, research increasingly suggests that it’s actually people lower down on the social scale — not those in leadership positions at the top — who suffer the worst health effects of stress.
Now a new study of military officials and government staffers at a Harvard executive-training program confirms these findings, showing that as people climb the organizational rungs, their stress hormone levels and anxiety typically go down. “Being a leader, especially a high-ranking leader, is associated with lower levels of the stress hormone cortisol,” says study co-author Gary Sherman, a postdoctoral fellow at Harvard’s Kennedy School of Government, noting that chronically high cortisol is a physiological indicator of stress.
Indeed, while everyone needs some amount of cortisol to cope with short-term stress, having consistently high levels of the hormone has been linked to depression, obesity, heart disease, high blood pressure, stroke and other major causes of illness and death. The new study found that cortisol levels were 27% higher, on average, in non-leaders compared with leaders.
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For the paper, two experiments were conducted. The first involved simply measuring cortisol and anxiety levels in 216 people, including government officials and military officers, and then comparing those levels to those in people recruited from the Boston area who did not hold managerial positions.
The second study included 88 leaders and analyzed whether their sense of social control over their circumstances was linked to how stressed they felt. Previous research has found that even people in low-ranking positions don’t have overly high levels of stress as long as they have a perceived sense of control; but for those who don’t have a sense of power, even being at the top won’t protect them from hazardous stress.
“When we compared leaders of different ranks and levels, we found that higher-ranking leaders reported a greater sense of control in their lives. This helped explain why they had lower levels of stress,” says Sherman. Simply thinking that you have control, whether or not you actually do, changes the way the brain responds to stress and makes it less toxic.
It’s an “interesting and nicely constructed series of studies,” says Scott Lilienfeld, professor of psychology at Emory University, who was not associated with the research.
“Our findings suggest that despite the complexities inherent in human hierarchies, differences in rank do have implications for understanding health. Because cortisol impacts immune function, differences in one’s rank within an organization may have health implications,” says Sherman, adding that this means that increased income inequality could increase health disparities between the rich and the rest.
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But, interestingly, while higher rank was generally linked with both lower anxiety and lower stress hormone levels, the study found that anxiety and stress were not related to each other. A person might be extremely anxious and have low stress hormone levels — or be completely nonplussed while having elevated cortisol. In a commentary published along with the study, Stanford’s Robert Sapolsky, a leading researcher on stress and rank, noted that while both stress and anxiety respond to stress, they’re linked with different branches of the stress-response system.
Having low cortisol and low anxiety levels have also been linked with psychopathic traits, which Lilienfeld in turn found to be associated with leadership in a recent study of American presidents. “As the authors themselves acknowledge, their results pose something of a chicken-and-egg conundrum,” he says. “Does leadership produce lower levels of cortisol, or do some of the same personality traits that might be tied to low cortisol, like [the psychopathic trait of] boldness, contribute to leadership?”
Lilienfeld suggests that it’s possible that a certain subset of psychopathic traits, such as physical and social boldness, could predispose a person to have both low cortisol and to be an effective leader — so, low cortisol could be a marker of sorts for both traits. “This hypothesis would be worth pursuing in further research,” he says.
Sherman agrees that it’s “highly plausible” that people with low cortisol levels might tend to become leaders because of their ability to stay cool.
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Cortisol research is notoriously hard to interpret, however, as Lilienfeld cautions. Some research has found that low cortisol is associated with anxiety and post-traumatic stress disorder, for example, which conflicts with the idea that it is a marker of fearlessness or a psychopathic lack of concern.
In any case, the early scientific evidence that first suggested that higher rank necessarily means higher stress hasn’t held up to scrutiny. Generally, life — and health — are better at the top. As Sapolsky notes in his commentary, “As a final bonus, the work offers an immediate practical benefit for this campaign season: if a politician asserts that his adrenal glands have hypertrophied [i.e., that he’s overstressed by the job] but that this is a sacrifice he is willing to bear for the rest of us, consider this a good indicator that anything else he claims should be viewed skeptically.”
The research was published in the Proceedings of the National Academy of Sciences.
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.