Objectives: In this paper, we examined the impact of abusive leadership (AB) on psychological well-being (PWB) and presenteeism (PR) by considering the moderating effect of mental health (MH) of employees in Saudi small and medium enterprises (SME's). Methods: We used non-probability sampling to collect data from employees in the Saudi SME's. We used 152 complete questionnaires for statistical analysis, including descriptive statistics, validity and reliability tests, confirmatory factor analysis, and structural equation modeling. Results: AB significantly and negatively impacted the PWB of employees in the Saudi SME's (p<.05). Furthermore, we found a statistically significant association (p<.05) between AB and PR, where increased AB increased presenteeism. Regarding the moderation effect, findings revealed that MH significantly suppressed the negative association between AB and PWB and significantly dampened the positive relationship between AB and PR. Conclusion: Leadership plays a ctitical role in employees' well-being and presenteeism; therefore, our study has important implications for managers, workers, and policymakers to promote healthy leadership for improved employee well-being and productivity.