When Employee Mental Health Deteriorates: Examining the Relationship Between Health-Oriented Leadership, Disclosure, and Sickness Absence

Background/Objectives: Given the high prevalence of mental health problems in the workplace, fostering disclosure and reducing sickness absence are critical for ensuring timely support and sustaining employees’ work ability. Drawing on the health-oriented riented leadership (HoL) model, this paper examines the associations between staff care, disclosure, and sickness absence, and addresses the underexplored question of whether staff care continues to show beneficial relationships when employees experience acute health deterioration. To account for differing perspectives, we included samples with employees and with leaders. Methods: We conducted three distinct cross-sectional studies with (1) predominantly healthy employees (N₁ = 148), (2) employees with severe mental health issues or a diagnosis (N₂ = 338), and (3) leaders (N₃ = 91). Results: Staff care is positively related to disclosure across all studies. In study 1, this relationship was unexpectedly stronger for low than for high health deterioration, though still significant for high deterioration. In studies 2 and 3, the interaction was non-significant. However, a perceptual gap emerged: simple slopes showed that leaders with low staff care still expected disclosure from employees with high health deterioration (study 3), whereas employees reported higher concealment intentions (study 1). Staff care was negatively related to sickness absence only in study 2, with this relationship strengthened under high health deterioration. Conclusions: Staff care seems particularly relevant for supporting disclosure during early health declines and for mitigating sickness absence during acute deterioration among those already affected. Divergent leader–employee perceptions may hinder timely support. We provide practical recommendations for organizations.