126 Chapter 6 could be that the severe cases are admitted to rehabilitation clinics at the time of assessment, and therefore have no residual work capacity. However, the less severe patients, and the patients who are not admitted (anymore) to a clinic, should be able to work fulltime according to the insurance physician. Having an addiction is seen as a chronic condition, but once in remission, does not seem to impact the ability to work in a way that an inability to work fulltime is indicated [27,28,29]. A notable finding is the decreased odds of multimorbidity for being assessed with no residual work capacity within most of the diagnoses groups. The association of being diagnosed with more than one disease seems counterintuitive, because one could expect that this would have an increased impact on work ability. However, we also found this result in our study on residual work capacity and inability to work fulltime within cancer patients [21]. We discussed these findings with insurance physicians, and they thought a possible explanation might be that when the primary diagnosis is so severe and has a major impact on work capacity, they feel further explanation of the medical situation is unnecessary. In these cases, they do not register any additional diagnoses. Strengths and Limitations In this study we used register-data of a year cohort of applicants assessed for a work disability benefit after 2 years of sick leave. Using register-data is a strength of our study, as it covers the entire Dutch population including data on socio-demographic variables and all mental and behavioural diagnoses. This gave us the opportunity to compare the work disability assessment outcomes of the specific diagnoses groups. Another strength of our study is the large sample size of work disability benefit assessments by skilled insurance physicians adhering to professional guidelines and assessment methods. On the other hand, using register-data is also a limitation to our study, as the data was not collected for research purposes and therefore information on the severity of the disorder, treatment and personal factors are not available. Furthermore, for the analyses on inability to work fulltime, we had to exclude 1,006 cases due to missing data mostly on educational level. This might have impacted our outcomes, as the prevalence of being assessed with a normal ability to work fulltime was higher among the excluded sample than in the selected sample. Furthermore, because of the cross-sectional design, we are not able to draw conclusions on causal relationships. Implications for Practice and Future Research The findings of our study show that the majority of the applicants with mental and behavioural disorders for a work disability benefit have residual work capacity and are assessed with a normal ability to work fulltime. This implies that (supporting) return to work is of great importance among individuals
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