At 7 a.m., Tung, 36, head of sales at a Hanoi technology company, arrives at the office to find 17 unread messages.

Three are from his director: “How are sales looking this month?”, “Do you have a recovery plan yet?” and “Send me the report this afternoon.”

The other 14 are from his team. One employee needs leave to care for a sick child, another says a client wants to cancel a contract, and several others complain that their targets are too stiff.

Before Tung can boot up his computer, the phone rings and his director is on the line, saying: “Your department must hit 100% of its target this month. Last month’s results were already unsatisfactory.”

“Yes, I’ll do my best,” Tung replies quietly, omitting the fact that his team is short of two key workers. “Explaining my circumstances at this time would make me look incompetent to my superiors,” he says.

In team meetings, Tung repeats his boss’s message word for word: “I know everyone is under pressure, but this is our collective target. We have to try to make it work.”

As soon as he finishes, an employee asks to speak with him and tells him they want to quit. To keep the team on schedule, Tung had spent the previous two months working until midnight. Persistent insomnia and the tightness in his chest whenever his phone rang at 10 p.m. eventually sent him to the hospital.

He was diagnosed with an anxiety disorder and told he needed medication and psychotherapy.

Dr. Nguyen Khac Dung of Dai Nam University’s Faculty of Psychology and Educational Sciences likens the plight of middle managers to being the filling in a sandwich: squeezed by pressure from above and demands from below.

In organizational psychology, this is a textbook case of role conflict and role overload, he said.

Sales targets and deadlines are often handed down quickly, and middle managers have no control over staffing or budgets but are held responsible for results without control over resources, and this creates prolonged psychological strain, Dung said.

Middle managers must assign work, chase progress, resolve internal disputes and explain policies they had no hand in developing. Over time, this can develop into chronic stress and occupational burnout.

The World Health Organization recognizes burnout as an occupational phenomenon.

Lan, 39, who manages a retail chain in Ho Chi Minh City, once thought becoming a manager would make her job easier because she would no longer have to work the sales floor. Instead, she became the “shock absorber” for every problem: customer complaints, sudden sick calls and abrupt increases in regional sales targets amid staff shortages all ended up on her desk.

“I keep my phone on vibrate day and night because I’m afraid of hearing it ring unexpectedly,” she says.

“The first question I think of when I wake up in the morning is: Where am I going to find enough staff today to hit the sales target?”

As the pressure mounted, Lan began snapping at family members for no apparent reason. She also started skipping meals, losing over three kilograms over two months.

A 2024 CoderPad survey published by Forbes found that 36% of technology workers did not want to become managers. The technical interviewing platform attributed the reluctance to workers placing greater value on work-life balance than previous generations.

For this group, a modest pay rise is not worth the extra time or the stress of supervising employees. A 2022 Future Forum survey similarly found that middle managers were the most stressed employees across all levels of post-Covid organizations, with 45% reporting burnout.

Loneliness and a sense of no longer belonging to the team also make management unappealing. One expert said: “When you walk into a room, you are no longer part of the group. People stop talking and become more formal because you are there.”

Hoang Minh Tri, CEO of a human resources consultancy in Hanoi, said economic volatility had forced businesses to tighten discipline and raise targets to maintain growth. “Senior leaders are under pressure from the market and shareholders, and they pass that pressure down to middle management.”

In March, the Ministry of Health proposed for the first time that people facing intense pressure at work, in school or over finances be monitored for signs of mental issues to improve early detection and prevention.

A Read survey of more than 5,000 readers found that 24% faced constant pressure from KPIs and deadlines, while another 24% had to remain connected to work around the clock, including on days off. Another 13% were exhausted by toxic workplaces, and 39% faced all these pressures at once.

Vietnam currently has no data on the prevalence of mental health disorders among “sandwiched” middle managers, but hospital figures show that a growing number of people over 30 are seeking mental health care.

After three weeks of treatment, Tung changed his approach. At the next weekly briefing, instead of nodding through every target, he presented his director with figures on each employee’s actual workload and proposed hiring more staff and revising the sales plan.

“I realized that if I collapsed trying to appear superhuman, the whole team behind me would fall apart too,” he adds.