But at worst, companies don't pay attention to the psychological impact.
If you're a manager or leader in this sort of environment, I suggest telling your teams something like "I consider 4-6 weeks of PTO to be a healthy amount. You should take somewhere around that. If you need to take more, I'd appreciate it if we talked about that. And if you still feel pressure to take less, let's talk about that too so I can help you feel more comfortable."
taking no PTO isn't mentally healthy. I've never felt like we got "more done" over the course of a year because no one took PTO. Eventually it was just burnt out employees grinding through the days.