After navigating COVID-19, high inflation, persistent labor shortages, and return-to-office mandates, managers are burnt out. Some 46% of middle managers say it’s likely they’ll quit their jobs within the next 12 months because of work-related stress, according to a new survey of 3,400 people across 10 countries from the Workforce Institute at UKG.

The mental health issues of middle managers aren’t news to executives. Throughout the pandemic, many managers warned that they were struggling to cope with their workloads. By October of last year, a record 43% of middle managers said they were burnt out, a Slack Technologies’ Future Forum survey found.

“What we’ve seen, quarter after quarter, is that middle managers have been struggling,” Sheela Subramanian, co-founder of Future Forum, told Bloomberg at the time.

Now, more than half of middle managers surveyed by the Workforce Institute said that they wish someone told them not to accept their current job, and 70% said they would take a pay cut for a new position that “better supports their mental wellness.”

“The chronic anxiety that comes from working through one global crisis after another is wearing on employees,” Dr. Jarik Conrad, executive director of The Workforce Institute at UKG, said of the results. “Being overwhelmed consumes human energy and impacts retention, performance, innovation, and culture.”

Why middle managers matter

With many CEOs preparing for a recession, the increased focus on employee wellness that began during the pandemic is fading in some sectors.

Facebook-parent Meta is leaning into what CEO Mark Zuckerberg calls his “Year of Efficiency,” putting some middle managers on the chopping block and asking others to move into rank and file positions to help the company cut costs; Elon Musk has opted for an “extremely hardcore” work culture after his $44 billion acquisition of Twitter; and investment banks like Goldman Sachs have aggressively pushed for workers to return to the office.

Michael Friedman, chief executive of the New York investment firm First Level Capital, told The Wall Street Journal last November that successful CEOs are getting “tired of all the whining” from employees. But it may make sense for the C-Suite to prioritize the mental health of middle managers.

“At workplaces around the world, leaders and managers may hold more influence over their people’s mental health than they ever thought possible,” researchers at the Workforce Institute at UKG explained. “Managers have just as much of an impact on people’s mental health as their spouse—and even more of an impact than their doctor or therapist.”

Unhappy middle managers could be sabotaging companies’ mental health initiatives by closing lines of communication with employees. Some 40% of employees are “often” or “always” stressed about work, but 38% “rarely” or “never” talk with their manager about it, the Workforce Institute’s study showed. And with some 78% of workers saying that stress negatively impacts their work performance, executives might want to pay attention.

Additionally, 64% of employees said they would take a pay cut for a new job that “better supports their mental wellness,” which means ignoring middle managers’ mental health concerns can get expensive.  The cost to replace an employee these days can often top three times their annual salary.

“I think we put so much pressure on the manager, and we don’t give them enough scaffolding,” Pat Wadors, chief people officer at UKG, told Fortune’s Amber Burton and Paolo Confino Tuesday. “It’s this tension of giving [managers] the foundational skills, the emotional intelligence, the compassion, the empathy, and the listening skills just to be present…That humanity side of managers is usually not in your manager 101 courses.”

This story was originally featured on Fortune.com

More from Fortune:
Olympic legend Usain Bolt lost $12 million in savings to a scam. Only $12,000 remains in his account
Meghan Markle’s real sin that the British public can’t forgive–and Americans can’t understand
‘It just doesn’t work.’ The world’s best restaurant is shutting down as its owner calls the modern fine dining model ‘unsustainable’
Bob Iger just put his foot down and told Disney employees to come back into the office