Abstract
The objective of this study was to understand how socio-economic disadvantages relate to mental health problems (MHP) among children with mild intellectual disability or borderline intellectual functioning (MID-BIF) in outpatient care by extending beyond traditional economic measures, incorporating cumulative risks, and analyzing variations across clinical subgroups. Using a population-based case-control design, data from Statistics Netherlands and mental health records were analyzed for 1,742 children with MID-BIF receiving mental health care (M = 9.6, 33.1% girls) and 8,710 ageand age sex-matched controls aged 0–17. Logistic regression revealed that children with MID-BIF and MHP were significantly more likely than controls to come from families facing socio-economic disadvantages, such as single parenthood, lower parental education, reliance on social benefits, low income, and subsidized housing. Socio-economic risks were more likely to cluster in the case group, with 15.3% of children exposed to five risk categories and 6.7% to all six, compared to 6.7% and 3.6% in controls, respectively. Children in the internalizing and externalizing symptom-based groups faced more pronounced socio-economic disadvantages than those in the developmental group. Additionally, more extensive care was unexpectedly linked to more favorable socio-economic conditions, suggesting a complex interplay between care needs and socio-economic conditions. Taken together, this study showed that children with MID-BIF receiving outpatient care for their MHP often face greater and more clustered socio-economic disadvantages. Simultaneously, children from socioeconomically disadvantaged backgrounds received less specialized mental health care. This underscores the importance of addressing barriers in mental health care and promoting familyand community-based care.