125 Residual work capacity and (in)ability to work fulltime among applicants with mental disorders DISCUSSION The findings of our study are in line with our expectations. Especially the diagnoses groups that are associated with a decreased self-reliance (e.g., (post-traumatic) stress disorders, mood affective disorders, schizophrenia and delusional disorders), are associated with increased odds for no residual work capacity. These diagnoses are known to affect the energy levels as well, resulting in increased odds for inability to work fulltime, when there was residual work capacity. On the other hand, diagnoses that affect energy levels less (e.g., ADHD, somatoform disorders) or that are related with emotional disturbances (e.g., personality disorders), showed decreased odds for being assessed with inability to work fulltime. We conducted a similar study regarding applicants diagnosed with cancer as the primary diagnosis [21]. Although when being diagnosed with cancer, other factors, like survival rate, play a role. Our results, indeed, showed that cancers with a low survival rate (like respiratory cancers) were associated with no residual work capacity. However, with regards to being assessed with inability to work fulltime, the results are comparable. Especially cancers that have a negative impact on energy levels (lymphoid and haematopoietic cancers, and cancers of the respiratory organs) showed increased odds for inability to work fulltime [21]. This might not be surprising, as energy deficit and fatigue are mentioned as the primary indicators of inability to work fulltime [11, 12]. Other mental and behavioural disorders, like mental retardation, autism spectrum disorders, ADHD, somatoform disorders, adjustment disorders (including burn-out), and anxiety disorders showed decreased odds for being assessed with no residual work capacity. Additionally, for adjustment, anxiety and personality disorders we found decreased odds for being assessed with inability to work fulltime. This confirms the high variety among mental and behavioural disorders with regards to the ability to work. In other words, diagnosis matters. For mental retardation and developmental disorders like autism spectrum disorders and ADHD, these results may seem surprising, as the employment rates of individuals with these disorders are very low [22,23,24,25]. It is therefore important to realize that our study population concerns individuals who were employed and on sick leave for about 2 years. In the Netherlands young adults with congenital disabilities or disabilities originated during childhood (before the age of 18) can apply for a disability benefit based on ‘Invalidity Insurance Act for Young Disabled Persons’ (Wajong Act) [26]. As the current sample was already active on the labour market, it is quite possible that insurance physicians are less inclined to assess them with no residual work capacity. For addiction the results seem counterintuitive, as there is an increased risk for being assessed with no residual work capacity, but a decreased risk for being assessed with an inability to work fulltime. An explanation for this result 6
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