Oral consultation needs and diagnostic patterns by psychiatric disorder subtype among psychiatric inpatients in a general hospital: a retrospective study.

Health is best viewed as a dynamic and multidimensional capacity, rather than merely the absence of disease []. It encompasses more than just the lack of illness; It is a multidimensional capacity that enables children and adults to navigate everyday challenges, fend off infections, cope with adversity, experience personal well-being, and engage with their environment in ways that foster positive development []. Experiences during early life play a pivotal role in shaping children’s neural, behavioral, and psychological development, with lasting impacts across multiple domains of life [, ]. Secure, stable, and supportive environments in the early life period are vital for fostering long-term health and well-being []. These settings—characterized by consistent, responsive relationships and nurturing physical and emotional conditions—facilitate healthy brain development and effective stress regulation, thereby enhancing resilience and reducing the risk of chronic diseases in adulthood during this sensitive period [, ]. In contrast, adverse childhood experiences—such as abuse, neglect, or family dysfunction—can disrupt the formation of brain structures and biological systems [, ]. This disruption may lead to toxic stress, which has been linked to increased risk for a variety of health conditions, including heart disease, diabetes, depression, and substance misuse later in life []. Understanding the beginnings of adult illnesses and tackling them early in life is essential for shifting our health care system from a focus on treating sickness to one that promotes overall wellness [, ]. But how early can these effects begin? Could the roots of long-term health outcomes be traced even further back—before birth? In response to this question, the British physiologist Barker was the first to propose the fetal programming hypothesis []. “Programming” is understood as the process through which a stimulus or disruption occurring during critical periods of development, when biological systems are particularly plastic and sensitive to environmental influences, can lead to long-lasting or even permanent effects. Notably, this notion conveys the idea that the physiological adaptation by which prenatal exposure to nutritional and environmental influences shapes fetal development, resulting in metabolic alterations and heightened risk for chronic conditions later in life [, ]. In this concept, adaptation refers to the physiological and developmental adjustments the fetus makes in response to prenatal stressors. In the short term, such adaptations may include down-regulation of endocrine, metabolic, or organ functions in order to reduce growth rate and minimize nutrient consumption [, ]. In the long term, these changes can influence gene expression, as well as cellular differentiation and proliferation, ultimately leading to structural and functional alterations in specific tissues and vital organs—many of which may be lasting or even permanent [, ]. Accordingly, fetal programming is often conceptualized as a form of predictive adaptive response, through which the fetus adjusts development based on anticipated postnatal environments [, ]. Prenatal exposure to elevated maternal stress hormones, particularly cortisol, represents a well-documented example of predictive adaptive response. When a fetus develops in a high-stress intrauterine environment, its hypothalamic-pituitary-adrenal (HPA) axis may become programmed to be more reactive to stress, through increased expression of glucocorticoid receptors in brain regions involved in emotional regulation [, ]. While this adaptation may enhance survival in similarly adverse postnatal conditions, it may also predispose the individual to emotional dysregulation, heightened anxiety, or depressive symptoms in later life, particularly when the early predictions do not match the actual postnatal environment []. Building on this understanding, the Eco-Bio-Developmental model offers a comprehensive framework for explaining how early environmental experiences become biologically embedded, influencing long-term health outcomes across the lifespan []. This model integrates three interrelated domains—ecological, biological, and developmental—to illustrate how early-life conditions, whether adverse or supportive, interact with genetic and physiological systems to shape developmental trajectories and future vulnerability to disease []. The ecological dimension encompasses the child’s external environment, including caregiver relationships, family dynamics, socioeconomic status, and exposure to stress or supportive interactions []. The biological dimension involves the physiological systems that respond to these environmental signals—particularly the neuroendocrine, immune, and metabolic systems—through mechanisms such as epigenetic modification, HPA axis programming, and inflammatory responses [, ]. The developmental dimension underscores the significance of sensitive periods in early life, duri