Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality of life in patients with spinal cord injury: a cross-sectional study.

Patients with persistent somatic symptoms (PSS) often struggle to navigate healthcare, face long delays before treatment and feel dismissed or excluded from decisions about their care. Previous research has focused mainly on interventions, with little attention to how routine healthcare factors such as access, availability, affordability and quality of communication relate to patient outcomes across countries. This is the first study to compare the duration of untreated illness and healthcare factors for patients with PSS across Germany, Italy, the Netherlands and Poland. It provides new quantitative evidence suggesting that limited access, availability and affordability of care, and poor clinician–patient communication are associated with persistent or worsening symptoms, while shorter treatment delays were not reflected in higher rates of symptom improvement. The findings highlight that what happens after patients enter the healthcare system may be as important as when they gain access. Addressing barriers related to access, affordability and communication could improve patient outcomes across health systems and inform future longitudinal research.