**Background:** Occupational health interventions for leaders in small and medium-sized enterprises (SMEs) are underrepresented, despite leaders' key role in employee health and organizational outcomes. The IT and technological services sector is rapidly growing due to digitalization, yet little is known about the specific work-related stressors, coping behaviors, resources, and consequences experienced by leaders in these SMEs. This study aimed to fill that gap to inform future intervention development.
**Methods:** Ten semi-structured problem-centered interviews were conducted with German-speaking leaders in IT and technological services SMEs (<250 employees, >3 years leadership experience). Participants were recruited via professional contacts and snowball sampling. Interviews lasted 30–55 minutes (mean=42.8 min) and were conducted in June–July 2021. Data were analyzed using content-structuring qualitative content analysis per Kuckartz, with deductive main categories based on the transactional stress model (Lazarus & Folkmann) and its occupational extension (Bamberg et al.), and inductive subcategories formed from the data. The COREQ checklist was applied for quality reporting.
**Key Results:** The sample comprised 9 males and 1 female, aged 34–62 (mean=43.8 years), with 3–43 years of leadership experience, managing 8–80 employees (mean=30). Seven were enterprise owners. Three major stressor categories emerged: (1) work organization stressors (high volumes of work with 60–80 hour weeks, working with humans described as 'like being a psychologist', variety of tasks, acceptance of responsibility, interruptions, delegation difficulties); (2) industry-related stressors (economic pressure, organization of balanced workload, technological progress, deadline pressure, shortage of skilled workers described as 'my main job right now'); and (3) other stressors (dissolution of boundaries, sitting work posture, videoconferences, lack of appreciation). Coping behaviors included problem-focused coping (organizational development like hiring and restructuring, work time arrangement, work organization, creating positive work atmosphere, wage sacrifice, advanced training), emotional-focused coping (balancing activities like exercise and gardening, cognitive restructuring, temper tantrums), and utilization of social support (emotional, informative, and instrumental support). Resources supporting coping were personal (proactivity, professional experience, optimism, communicativeness, self-confidence, endurance, reflectiveness), social (family, colleagues, entrepreneurs), and organizational (scope of action, financial reward). Consequences included health effects (psychological: exhaustion, sleep disorders, mental disengagement, teeth grinding; somatic: back complaints, weight gain, digestive problems, visual field loss), work effects (decreased performance and increased errors, rash decisions, lack of collegial understanding, irregular breaks), and private life effects (existential anxiety, neglect of private contacts and leisure activities, reduced family time, social incomprehension). Notably, workplace health promotion was neither mentioned as a coping strategy nor a resource by any interviewee.
**Clinical Implications:** The results reveal a pattern of self-endangering behavior where leaders cope with high stressors through strategies (e.g., permanent availability, 12-hour days) that paradoxically increase health risks by reducing recovery time. All leaders reported exhaustion—a central burnout dimension—suggesting early burnout signs in this group. Given that leader stress is linked to poorer leadership quality and follower health, and that the IT sector faces worsening skilled worker shortages (66% of executives expect this to increase), there is an urgent need for targeted health-oriented leadership interventions. Interventions should address self-endangering behaviors, promote structural organizational changes before health or economic crises occur, and educate leaders on workplace health promotion benefits.