Tyrannical leadership predicts psychotropic use over time: a longitudinal study of healthcare workers in Chile

Introduction Healthcare workers are exposed to intense organizational pressures and demanding interpersonal dynamics that may undermine psychological wellbeing. Tyrannical leadership—characterized by hostile, controlling, and humiliating supervisory behaviors-represents a particularly harmful organizational stressor in healthcare settings. Under such conditions, psychotropic medication may be used as a coping response to sustained psychological strain. This study examined whether exposure to tyrannical leadership predicts subsequent psychotropic drug use among healthcare workers. Methods A longitudinal panel study was conducted among healthcare workers employed in high-complexity public hospitals in Chile. Two waves of data were collected 10 months apart. The analytic sample included 683 participants who completed both measurements. Tyrannical leadership exposure was assessed using a validated scale. Psychotropic medication use was measured through self-reported intake of hypnotics, anxiolytics, or antidepressants. Logistic regression models were used to estimate crude and adjusted associations between baseline tyrannical leadership and psychotropic drug use at follow-up, controlling for baseline medication use, sex, and key psychosocial work stressors, including effort-reward imbalance and emotional demands. Results At follow-up, 39.8% of participants reported psychotropic medication use. In crude models, exposure to tyrannical leadership at baseline was associated with approximately twice the odds of psychotropic use at follow-up. In the fully adjusted model, baseline psychotropic use was the strongest predictor of subsequent consumption, with nearly tenfold higher odds of continued or increased use. After adjustment, tyrannical leadership remained significantly associated with psychotropic drug use, doubling the odds of consumption. Effort-reward imbalance also showed a significant association, whereas sex and emotional demands were not significant predictors. Discussion These findings identify tyrannical leadership as a significant and potentially preventable organizational risk factor linked to increased psychotropic medication use among healthcare workers. By highlighting leadership as a modifiable determinant of mental health outcomes, the study underscores the importance of organizational interventions aimed at improving supervisory practices in high-stress healthcare environments.