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Saudi Electronic University
Health Sciences Collage
Master of Healthcare Administration
HCM 600 Research Project
Examining The Long-Term Interventions Effects of Telepsychiatry on Chronic Mental
Health Conditions in Saudi Arabia: Systematic Review
A Research Project
Submitted in Partial Fulfillment of the Requirements for the Degree
(MSc of Healthcare Administration)

HCM600-202320-LS016

Date
30/10/2024

DECLARATION

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ACKNOWLEDGEMENT

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Table of Contents
Declaration

Acknowledgement

iii

Table of Content

ivii

List of Abbreviations

List of Tables

List of Figures

Chapter 1: Introduction

Chapter 2: Literature Review

Chapter 3: Objectives

Chapter 4: Materials and Methods

Chapter 5: Results

Chapter 6: Discussion

Conclusion

Recommendations

References

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List of Abbreviations
All of the following abbreviations are to be taken in context of the study.
Abbreviations

Full-Term

HIPAA

Health Insurance Portability and Accountability Act

DSM-5

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

CASP

Critical Appraisal Skills Programme

ETSSM

Evaluating Telemedicine Systems Success Model

TOE

Technology-Organization-Environment

UTAUT

Unified Theory of Acceptance and Use of Technology

SPSS

Statistical Package for the Social Sciences

PPI

Patient and Public Involvement

Saudi Arabia

WHO

World Health Organization

APA

American Psychological Association

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ABSTRACT
Background: Telepsychiatry, as a subset of telemedicine, has become an increasingly utilized tool for
managing chronic mental health conditions by providing remote psychiatric care. In Saudi Arabia, the
integration of telepsychiatry offers potential long-term benefits in overcoming barriers to mental
healthcare access, including geographic and cultural limitations. However, there remains a lack of
systematic evidence on the sustained impacts of telepsychiatry interventions on chronic mental health
conditions within this regional context.
Aim: The purpose of this study is to examine the long-term interventions effects of telepsychiatry on
chronic mental health conditions in Saudi Arabia.
Methods: A systematic literature search was conducted on six electronic databases (PubMed, Scopus,
Google Scholar, Cochrane Library, ScienceDirect, and PsycINFO) to locate peer-reviewed articles
published in English from January 2010 to September 2024. The Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in selecting articles for
inclusion from the identified databases, Articles were selected based on relevance to the research topic,
study design, and publication in English from January 2010 to September 2024, following PRISMA
guidelines. Studies were included if they met quality criteria, such as clear methodology and valid
statistical analyses.
Results: From the nine studies included, three studies assessed the effectiveness of telepsychiatry
interventions in improving clinical outcomes, three studies identified and analyzed the barriers and
facilitators affecting the implementation and acceptance of telepsychiatry, and three studies investigated
the long-term impacts of telepsychiatry on patient experience, satisfaction, and overall quality of life.
Conclusion: The systematic review indicates that telepsychiatry shows great promise in enhancing
clinical outcomes, patient satisfaction, and accessibility to mental health care for individuals with chronic
conditions in Saudi Arabia, aligning with Saudi Vision 2030. It effectively addresses logistical barriers,
reduces wait times, and engages underserved populations, ensuring ongoing support for chronic mental
health conditions.
Keywords: Telepsychiatry, Chronic Mental Health, Saudi Arabia, Long-term Interventions

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Chapter 1: Introduction

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INTRODUCTION
1.1.Introduction
Telepsychiatry, a branch of telemedicine, leverages telecommunication technology to provide
psychiatric assessment and treatment at a distance (APA, 2018). This emerging method aims to
enhance access to mental health services, particularly for individuals facing barriers to traditional
face-to-face care. Chronic mental health conditions, including depression, anxiety disorders,
bipolar disorder, and schizophrenia, require continuous treatment and monitoring to optimize
patient outcomes (WHO, 2021). Telepsychiatry offers an innovative approach to address these
needs, especially in regions like Saudi Arabia, where accessibility challenges persist.
In recent years, the rise of telepsychiatry has revolutionized mental health care delivery,
especially in regions with limited access to mental health services, such as Saudi Arabia
(Almathami et al., 2020). Telepsychiatry, a subset of telemedicine, utilizes digital communication
technologies like video conferencing to provide psychiatric services remotely, bridging the gap
between mental health professionals and patients who cannot easily access traditional in-person
care (A P A, 2018). This innovation has become particularly relevant for managing chronic mental
health conditions, which often require consistent, long-term intervention to stabilize and improve
patient outcomes (Hubley et al., 2016).
The current global health landscape demonstrates an increasing demand for mental health
services, with chronic mental health conditions—such as depression, schizophrenia, and bipolar
disorder—posing significant long-term challenges (WHO, 2021). In Saudi Arabia, the prevalence
of mental health issues is rising, compounded by a shortage of mental health professionals and
geographic barriers that limit patient access to psychiatric care (Alangari et al., 2021).
Telepsychiatry offers a potential solution by providing virtual consultations and support, which
have been shown to improve access and continuity of care for chronic conditions that require
sustained treatment and monitoring (Yellowlees et al., 2010).
With the increasing global prevalence of chronic mental health conditions, there is a pressing
need for accessible, sustainable mental health interventions, particularly in regions where access
to mental health professionals is limited. Telepsychiatry, a specialized branch of telemedicine, has
emerged as an innovative solution to bridge this gap, offering psychiatric consultations and
ongoing mental health support through digital communication technologies like video

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conferencing (APA, 2018). This approach is particularly significant for regions such as Saudi
Arabia, where geographic, cultural, and systemic barriers often restrict access to in-person mental
health care (Alangari et al., 2021). Chronic mental health conditions—including disorders like
depression, anxiety, bipolar disorder, and schizophrenia—require consistent and long-term
management to ensure stable outcomes and improve the overall quality of life for patients (WHO,
2021).
Several studies have highlighted the benefits of telepsychiatry in reducing patient travel time,
increasing treatment adherence, and enhancing patient satisfaction, yet the long-term effects of
telepsychiatry interventions on chronic mental health conditions remain under-researched,
especially within the specific cultural and systemic context of Saudi Arabia (Almathami et al.,
2020; Hubley et al., 2016). The findings from available studies are promising but limited, with
most research emphasizing short-term effects rather than the sustained outcomes essential for
managing chronic conditions (Gajic, 2018).
Despite the potential of telepsychiatry to address access disparities in Saudi Arabia, there is
still limited evidence regarding its long-term efficacy for chronic mental health conditions, leading
to a significant knowledge gap. Existing studies often focus on immediate or short-term
improvements in patient outcomes, leaving a gap in understanding how sustained telepsychiatry
interventions might affect chronic mental health management over extended periods (Gajic, 2018).
Additionally, there is little exploration of how cultural factors, such as social stigma and family
dynamics, which are prominent in saudi society, may influence the effectiveness of telepsychiatry
for long-term mental health care (Alangari et al., 2021).
This research gap holds critical implications for Saudi Arabia’s healthcare system. Identifying
effective long-term telepsychiatry strategies could support mental health policy development,
enable better resource allocation, and improve the quality of life for individuals with chronic
mental health conditions in Saudi Arabia. Addressing this gap is essential for developing evidencebased approaches tailored to the cultural and systemic landscape in which Saudi mental health
services operate (WHO, 2021).
While short-term telepsychiatry interventions have demonstrated benefits such as increased
accessibility, treatment adherence, and patient satisfaction, the long-term impacts of these
interventions on chronic mental health conditions remain underexplored, particularly within the

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unique sociocultural and healthcare context of Saudi Arabia (Hubley et al., 2016; Gajic, 2018).
Thus, this systematic review seeks to explore the effects of long-term telepsychiatry interventions
on chronic mental health conditions in Saudi Arabia, filling an important knowledge gap and
providing a foundation for culturally and systemically relevant mental health policies and practices
in the region.
1.2.The Significant of the Study
This systematic review has the potential to make a significant contribution to the field of mental
health care in Saudi Arabia. By providing a comprehensive analysis of the long-term effectiveness
of telepsychiatry, this study could inform policy recommendations for integrating telepsychiatry
into Saudi Arabia’s healthcare system as a standard option for managing chronic mental health
conditions. Additionally, it may identify specific intervention components that maximize patient
outcomes, serving as a valuable resource for practitioners and policymakers to design and
implement more effective telepsychiatry models tailored to Saudi Arabia’s cultural context.
Ultimately, the findings could contribute to future research by highlighting specific areas where
telepsychiatry demonstrates promise and areas requiring further exploration, driving forward the
development of evidence-based, and sustainable mental health care solutions in Saudi Arabia.
1.3.General Objective
The primary objective of this systematic review is to evaluate the long-term effects of
telepsychiatry interventions on chronic mental health conditions in Saudi Arabia, aiming to address
the central question: How effective are long-term telepsychiatry interventions in managing chronic
mental health conditions in Saudi Arabia, and what specific outcomes are associated with their
sustained use? This review will synthesize evidence from previous research, with a focus on
assessing intervention effectiveness over time, identifying best practices, and highlighting areas
where telepsychiatry has the greatest impact. The purpose of this review is to systematically
evaluate available evidence to determine the role of telepsychiatry in improving long-term health
outcomes, patient satisfaction, and access to care for chronic mental health conditions in Saudi
Arabia.
The general objective of this study is to examine the long-term interventions effects of
telepsychiatry on chronic mental health conditions in Saudi Arabia.

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1.4.Specific Aims
1) To assess the effectiveness of telepsychiatry interventions in improving clinical outcomes
for individuals with chronic mental health conditions in Saudi Arabia.
2) To identify and analyze the barriers and facilitators affecting the implementation and
acceptance of telepsychiatry among patients and healthcare providers in the Saudi Arabia.
3) To investigate the long-term impacts of telepsychiatry on patient experience, satisfaction,
and overall quality of life in individuals with chronic mental health conditions.
1.5.Research Questions
1) What are the long-term clinical effects of telepsychiatry on chronic mental health
conditions in Saudi Arabia?
2) How do patient satisfaction levels with telepsychiatry compare to those of traditional inperson psychiatric care in Saudi Arabia?
3) What are the key barriers and facilitators affecting the implementation of telepsychiatry for
chronic mental health conditions in Saudi Arabia?

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Chapter2: Literature Review

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LITERATURE REVIEW
2.1. Literature Review
Telepsychiatry is defined as the delivery of psychiatric services through telecommunication
technologies, such as video conferencing and mobile applications, allowing mental health
professionals to provide care remotely (APA, 2018). This innovative approach extends the scope
of mental health care by making it more accessible, especially for individuals residing in rural or
underserved areas where traditional psychiatric services may not be available (Hubley et al., 2016).
2.2. Chronological Development of Telepsychiatry in Chronic Mental Health Care
Telepsychiatry is particularly relevant for managing chronic mental health conditions,
including depression, anxiety disorders, schizophrenia, and bipolar disorder, which require
consistent monitoring and long-term interventions to improve patient outcomes (WHO, 2021). By
leveraging technology, telepsychiatry can enhance the quality and continuity of care, ultimately
leading to better patient adherence and satisfaction (Gajic, 2018).
The early adoption of telepsychiatry can be traced back to the 1950s and 1960s, when
researchers and practitioners began exploring the use of telephone consultations to provide mental
health support (Mason et al., 2020). The advancement of communication technologies over the
decades has allowed telepsychiatry to evolve significantly, with the introduction of video
conferencing in the 1990s marking a pivotal moment in its development (Hilty et al., 2013). Initial
studies highlighted the potential of telepsychiatry to improve access to care and deliver effective
mental health services, particularly in remote and rural settings (Nolen-Hoeksema et al., 2021).
In the Middle East, telepsychiatry began gaining traction in the early 2000s, spurred by the
increasing recognition of mental health issues as critical public health concerns (Almathami et al.,
2020). In Saudi Arabia, the adaptation of telepsychiatry has been influenced by government
initiatives aimed at improving mental health services as part of broader health system reforms
(Alangari et al., 2021). The Saudi Vision 2030 plan emphasizes enhancing healthcare access and
quality, thus creating an enabling environment for the growth of telepsychiatry (Saudi Ministry of
Health, 2018).
Research findings from early studies on telepsychiatry suggest that it can effectively address
chronic mental health conditions. For instance, a systematic review by Hubley et al. (2016)

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indicated that telepsychiatry interventions can lead to significant reductions in symptoms for
various chronic mental health disorders, demonstrating comparable efficacy to in-person
treatments. Furthermore, long-term studies show that patients receiving telepsychiatry are more
likely to adhere to treatment regimens, which is crucial for chronic conditions that require ongoing
management (Yellowlees et al., 2010). The key outcomes associated with long-term telepsychiatry
interventions include improved patient engagement, satisfaction, and a reduction in healthcare
costs (Gajic, 2018). In Saudi Arabia, telepsychiatry has been integrated into the national health
strategy, supported by regional studies that explore its effectiveness. Key institutions, such as the
Saudi Ministry of Health, have implemented telepsychiatry programs aimed at increasing access
to mental health services (Alangari et al., 2021).
However, several cultural and systemic challenges remain in the implementation of
telepsychiatry in Saudi Arabia. Issues such as stigma surrounding mental health, limited
technological infrastructure in rural areas, and resistance from some healthcare providers hinder
widespread acceptance (Almathami et al., 2020).
When comparing the efficacy of telepsychiatry globally to its implementation in Saudi Arabia,
it is evident that while many countries have successfully integrated telepsychiatry into their
healthcare systems, Saudi Arabia faces unique challenges that impact its effectiveness. For
instance, studies from Western countries report high satisfaction rates and successful symptom
management through telepsychiatry (Hilty et al., 2013), whereas in Saudi Arabia, cultural attitudes
and systemic barriers can lead to variable outcomes (Alangari et al., 2021).
2.3. Consolidated Thematic Analysis of Telepsychiatry’s Impact on Chronic Mental Health
Conditions
2.3.1. Accessibility and availability of services
A primary advantage of telepsychiatry is its potential to improve access to mental health
services in underserved or remote regions (Hilty et al., 2013). In Saudi Arabia, telepsychiatry has
been instrumental in reducing geographical barriers, enabling patients in rural areas to receive
psychiatric care otherwise unavailable (Almathami et al., 2020). Real-time consultations via video
conferencing allow continuous patient engagement without the need for extensive travel.

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Despite these benefits, accessibility remains unequal across urban and rural settings. Urban
areas often have better infrastructure for telepsychiatry, while rural populations face issues like
limited internet connectivity and unfamiliarity with technology (Alangari et al., 2021). These
disparities highlight the need for targeted interventions to enhance telepsychiatry’s reach across
different demographics.
2.3.2. Quality of care and patient outcomes
The quality of care in telepsychiatry is a critical factor in its success. High levels of patient
satisfaction have been reported, with many appreciating the convenience of remote consultations
(Yellowlees et al., 2010). Improved adherence to treatment protocols and long-term outcomes,
such as symptom reduction and better quality of life, have also been observed (Hilty et al., 2013).
Research comparing telepsychiatry to in-person treatment indicates that both approaches
can effectively manage chronic mental health conditions, with some patients preferring virtual
consultations for their convenience (Mason et al., 2020). However, challenges like the absence of
non-verbal cues and limited therapeutic intimacy in virtual settings necessitate a balanced
integration of both modalities.
2.3.3. Cultural and societal influences
Cultural attitudes significantly influence the acceptance of telepsychiatry in Saudi Arabia.
Societal stigma surrounding mental health often discourages individuals from seeking care,
especially in conservative communities (Almathami et al., 2020). Family perceptions of
telepsychiatry also play a pivotal role in treatment acceptance, as families are central to healthcare
decisions in Saudi culture (Alangari et al., 2021).
To address these challenges, government initiatives that promote mental health awareness
and reduce stigma are essential. Public education campaigns highlighting the benefits of
telepsychiatry and its alignment with cultural values can increase its uptake.
2.3.4. Effectiveness of telepsychiatry vs. in-person treatment
Studies have shown that telepsychiatry can yield outcomes comparable to in-person care.
For example, a meta-analysis by Wang et al. (2020) demonstrated significant symptom
improvements in patients receiving telepsychiatry for depression. Enhanced adherence to

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treatment plans has also been observed, with remote care eliminating logistical barriers that often
hinder in-person appointments (Kourounis et al., 2021).
Despite these advantages, telepsychiatry presents challenges, such as concerns over
privacy, data security, and reduced non-verbal communication dynamics (Gajic, 2018). These
limitations underscore the importance of robust communication protocols and secure digital
platforms to foster patient trust. Given the complementary strengths of telepsychiatry and inperson treatment, a hybrid model may offer the most effective solution. Initial face-to-face
assessments followed by ongoing virtual care can provide personalized treatment while addressing
logistical and cultural challenges (Gajic, 2018).
2.4. The Evidence-Based Outcomes for Telepsychiatry in Saudi Arabia
Telepsychiatry has gained recognition as a valuable modality for delivering mental health care,
especially in settings where access to traditional psychiatric services is limited. This systematic
review aims to evaluate the long-term effects of telepsychiatry on chronic mental health conditions
in Saudi Arabia. The review addresses key research questions regarding the effectiveness,
accessibility, and patient outcomes associated with telepsychiatry interventions, particularly for
conditions such as depression, anxiety, and schizophrenia.Systematic review methodology
involves a comprehensive search for relevant studies, critical appraisal of their quality, and
synthesis of findings. By collating evidence from various studies, this review seeks to provide a
clearer understanding of telepsychiatry’s role in improving mental health care in Saudi Arabia and
to identify areas for future research and practice.The literature selection process for this systematic
review involved specific inclusion and exclusion criteria. Included studies were required to be
peer-reviewed articles published in English, focusing on telepsychiatry interventions for chronic
mental health conditions within the Saudi Arabian context. Studies had to report on clinical
outcomes, patient satisfaction, or both. Excluded studies comprised those lacking a control group,
focusing solely on acute conditions, or presenting insufficient data for analysis.The types of studies
reviewed encompassed randomized controlled trials (RCTs), observational studies, and qualitative
research, providing a diverse perspective on the effectiveness and challenges of telepsychiatry in
chronic mental health care. This approach allowed for a comprehensive analysis of existing
evidence and its implications for clinical practice in Saudi Arabia.The systematic review revealed
several key findings regarding the clinical outcomes of telepsychiatry for chronic mental health

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conditions. Studies consistently demonstrated that telepsychiatry is effective in reducing
symptoms of depression and anxiety among patients (Alghamdi et al., 2021; Alahmed et al., 2019).
For instance, a meta-analysis indicated that telepsychiatry led to significant improvements in
depressive symptoms comparable to traditional in-person therapy (Shore et al., 2018).
Long-term efficacy was also evident, with patients reporting sustained benefits from
telepsychiatry interventions over extended periods. A study by Alzahrani et al. (2022) highlighted
that patients maintained symptom reduction and improved quality of life even after the conclusion
of structured telepsychiatry sessions. Moreover, patient satisfaction levels were generally high,
with many appreciating the convenience and accessibility of telepsychiatry services (Kumar et al.,
2020).
When comparing studies focused on telepsychiatry in Saudi Arabia with international research,
several contrasts emerged. While Saudi studies predominantly reported positive outcomes,
international studies provided a more nuanced view, noting variability in effectiveness based on
factors such as technological infrastructure, clinician experience, and patient demographics
(Hossain et al., 2020).
One significant factor influencing outcome variability was the cultural context. Saudi studies
highlighted that cultural acceptance and familial support significantly enhanced the effectiveness
of telepsychiatry (Almalki et al., 2020). However, differences in health systems and regulatory
environments between Saudi Arabia and other countries may also contribute to the observed
disparities in telepsychiatry outcomes.
Despite the promising findings, gaps remain in the literature regarding the long-term
sustainability of telepsychiatry programs in Saudi Arabia. Future research should focus on
longitudinal studies to better understand the lasting effects of telepsychiatry on chronic mental
health conditions. Furthermore, more extensive studies are needed to examine the economic
implications of telepsychiatry, particularly in terms of cost-effectiveness compared to traditional
treatment models. So that, this study is to examine the long-term interventions effects of
telepsychiatry on chronic mental health conditions in Saudi Arabia.
A study conducted in Saudi Arabia by Al-Dossary et al. (2020) found that telepsychiatry
significantly improved access to care for patients with depression and anxiety, with 80% of
participants reporting satisfaction with the service. However, the study highlighted the importance

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of incorporating family involvement and culturally sensitive approaches, as these were pivotal to
patient engagement. In contrast, a study in the United States by Hubley et al. (2016) demonstrated
that telepsychiatry was equally effective as in-person therapy in treating depression and anxiety,
focusing more on individual therapy models without emphasizing family involvement. While the
Saudi study revealed a 40% reduction in missed appointments due to the stigma reduction
associated with virtual care, the U.S. study emphasized the reduction in treatment gaps in rural
areas, with 90% of patients in underserved communities benefiting from telepsychiatry services.
Both studies underscored the effectiveness of telepsychiatry in improving mental health outcomes,
but the Saudi context revealed a stronger influence of sociocultural factors compared to the U.S.,
where infrastructure and technological integration were more advanced.
Additionally, the study in Saudi Arabia emphasized the role of religion and cultural norms in
shaping the acceptance and delivery of telepsychiatry services, as religiously informed counseling
was often integrated into treatment plans (Al-Dossary et al., 2020). This cultural adaptation was
less pronounced in the U.S. study, where the primary focus remained on evidence-based practices
without significant consideration of cultural or religious elements (Hubley et al., 2016).
Furthermore, while the Saudi study noted challenges related to technological infrastructure in rural
regions, including inconsistent internet access, the U.S. study highlighted broader acceptance due
to the widespread availability of high-speed internet and telehealth platforms (Hubley et al., 2016).
Despite these contextual differences, both studies called for ongoing training for healthcare
providers and the expansion of telepsychiatry services to enhance accessibility and reduce the
burden on traditional mental health care systems (Al-Dossary et al., 2020; Hubley et al., 2016).
2.5. Limited Access to Mental Health Services in Saudi Arabia
Limited access to mental health services is a significant challenge in Saudi Arabia,
impacting individuals with chronic mental health conditions. Despite improvements in healthcare
infrastructure, mental health services remain underdeveloped, particularly in rural areas. The
World Health Organization (WHO) reports that many countries, including Saudi Arabia, face an
imbalance between mental health needs and available services, often exacerbated by societal
stigma and lack of awareness (WHO, 2013).
In Saudi Arabia, the shortage of mental health professionals is a key barrier. The country
has only one psychiatrist for every 60,000 people, compared to the WHO’s recommended ratio of

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1 per 10,000 (Al-Saeed et al., 2018). This imbalance contributes to long wait times for psychiatric
consultations and treatment, particularly in non-urban areas. Moreover, mental health services are
concentrated in urban centers, leaving rural populations with limited access. A study by Al-Khaled
et al. (2015) found that 70% of psychiatric services are concentrated in just three major cities,
leaving vast areas underserved.
Cultural factors also play a role in limited access. Mental health disorders often carry social
stigma in many Arab communities, including Saudi Arabia, which discourages individuals from
seeking help (Ghubash, 2002). This stigma, coupled with a lack of awareness and understanding
of mental health issues, prevents many people from accessing the necessary services.
The rise of telepsychiatry presents a promising solution to overcoming these barriers.
Telepsychiatry has shown potential in providing remote consultations, offering a valuable
alternative for those unable to attend in-person sessions. Studies have indicated that telepsychiatry
can reduce geographic barriers, increase the accessibility of mental health services, and offer a
convenient alternative to traditional face-to-face appointments (Zarate et al., 2021). This is
particularly relevant in Saudi Arabia, where geographic isolation and the shortage of mental health
professionals remain critical challenges.
2.6. Benefits of Telepsychiatry for Chronic Mental Health Conditions in Saudi Arabia
Telepsychiatry offers numerous benefits in addressing the limited access to mental health
services in Saudi Arabia, particularly for individuals with chronic mental health conditions. The
primary benefits include:
2.6.1. Improved access to care: Telepsychiatry bridges the gap between mental health
professionals and patients, especially in rural or remote areas where psychiatric services
are scarce. It allows individuals to receive care without having to travel long distances to
urban centers, reducing barriers such as geographical isolation (Hilty et al., 2013). This is
particularly crucial in Saudi Arabia, where mental health services are concentrated in large
cities, leaving rural populations underserved (Al-Khaled et al., 2015).
2.6.2. Cost-effectiveness: Telepsychiatry can reduce the costs associated with in-person visits,
such as transportation, time off work, and other logistical expenses. This can make mental
health care more affordable and accessible, particularly for individuals from lower

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socioeconomic backgrounds. It can also alleviate the burden on the healthcare system by
streamlining appointments and reducing overcrowding in hospitals (Hubley et al., 2016).
2.6.3. Increased patient comfort and privacy: For many individuals, the stigma surrounding
mental health care in Saudi Arabia can discourage them from seeking treatment.
Telepsychiatry allows patients to access care in the privacy of their own homes, which can
reduce the fear of judgment and make individuals more likely to seek help. A study by
Rees et al. (2018) highlighted that patients often report feeling more comfortable during
remote consultations, which can improve engagement and therapeutic outcomes.
2.6.4. Continuous monitoring and support: Telepsychiatry facilitates regular follow-up
sessions, making it easier for clinicians to monitor patients with chronic conditions over
time. This continuous care can lead to better management of long-term conditions such as
depression, anxiety, or schizophrenia. Through video calls, phone consultations, or even
text-based support, mental health professionals can offer timely interventions and adjust
treatment plans as necessary (Shore et al., 2018).
2.6.5. Flexibility and convenience: Telepsychiatry provides greater flexibility in scheduling
appointments, which is especially beneficial for patients with busy schedules or those who
find it difficult to attend in-person appointments. The convenience of receiving care from
home can also encourage more individuals to follow through with their treatment plans,
potentially improving adherence to prescribed medications and therapies (Mohr et al.,
2017).
2.6.6. Increased mental health workforce reach: Telepsychiatry allows mental health
professionals to reach a larger population without being limited by geographic constraints.
This can help mitigate the shortage of psychiatrists and mental health specialists in Saudi
Arabia. By offering consultations remotely, healthcare providers can serve a broader range
of patients, improving mental health outcomes across the country (Zarate et al., 2021).
In conclusion, telepsychiatry holds great potential to improve mental health care
accessibility, affordability, and quality in Saudi Arabia. By reducing barriers such as geographic
isolation, stigma, and workforce shortages, it offers an effective solution for individuals with
chronic mental health conditions who may otherwise struggle to receive adequate care.

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2.7. Addressing Access Disparities Through Telepsychiatry
Telepsychiatry offers a promising solution to the longstanding disparities in access to mental
health services in Saudi Arabia, particularly for individuals living in underserved or remote areas.
Geographic isolation, combined with the concentration of mental health services in urban centers,
has resulted in limited access to psychiatric care for those residing in rural or less populated regions
(Al-Qudah et al., 2016). Telepsychiatry overcomes these barriers by enabling remote
consultations, thereby allowing patients to receive care regardless of their physical location. This
is particularly significant in Saudi Arabia, where healthcare infrastructure is often centralized in
major cities like Riyadh, Jeddah, and Dammam (Al-Otaibi, 2019).
Furthermore, telepsychiatry helps to mitigate the stigma associated with mental health care, which
remains a significant barrier to treatment in many Middle Eastern countries. By providing a private
and secure platform for consultations, telepsychiatry encourages individuals to seek help without
fear of judgment or social repercussions, which is crucial in societies where mental health issues
are often underreported (Al-Krenawi et al., 2016).
2.8. Long-Term Efficacy of Telepsychiatry
The long-term efficacy of telepsychiatry in managing chronic mental health conditions has
been increasingly supported by recent studies. Research indicates that telepsychiatry is effective
not only in providing immediate care but also in supporting the long-term management of chronic
conditions such as depression, schizophrenia, and bipolar disorder (Rosen et al., 2018). Regular
follow-up appointments, often facilitated through telehealth platforms, allow healthcare providers
to monitor patients continuously, adjust treatment plans, and ensure adherence to medication
protocols (Jaffe et al., 2019).
Telepsychiatry has demonstrated long-term benefits by fostering greater patient engagement
and reducing the frequency of psychiatric emergencies, particularly in rural areas where
emergency mental health services are often limited. Patients with chronic mental health issues who
receive consistent, remote monitoring report fewer episodes of mental health crises, suggesting
that telepsychiatry helps in the early identification of deteriorating conditions, leading to timely
interventions (Mohr et al., 2017).

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2.9. Short-Term Efficacy and Immediate Impact
While the long-term benefits of telepsychiatry are well-documented, its short-term impact is
equally significant. In the immediate term, telepsychiatry has been shown to reduce the barriers to
accessing psychiatric care, enabling individuals to receive timely treatment and support, especially
in emergency situations or for first-time consultations. Studies have highlighted that patients using
telepsychiatry services experience fewer delays in accessing care compared to those relying on inperson visits (Sullivan et al., 2020).
Moreover, the short-term efficacy of telepsychiatry in reducing the waiting times for
consultations is crucial in preventing the worsening of symptoms in individuals with mental health
conditions. Immediate access to mental health professionals can prevent conditions from becoming
more severe, thereby reducing the need for inpatient psychiatric care or long-term hospitalization
(Hilty et al., 2020).
2.10. Research Gap in Telepsychiatry for Chronic Mental Health Conditions
While telepsychiatry has proven effective in various settings, there remain significant gaps
in the research surrounding its long-term impact, especially in the context of chronic mental health
conditions. One major gap is the lack of large-scale longitudinal studies that track the efficacy of
telepsychiatry over extended periods (Shore et al., 2019). Many existing studies focus on shortterm outcomes such as patient satisfaction and immediate symptom relief, but few examine the
sustained impact on the quality of life, functional improvement, or overall well-being of patients
over months or years.
Additionally, there is limited research that specifically addresses how telepsychiatry can be
optimized for different mental health conditions, particularly those that require intensive,
personalized interventions, such as severe mood disorders or psychotic disorders (Zwerling et al.,
2020). Further investigation is needed to understand how telepsychiatry can be integrated into
existing healthcare systems, especially in countries like Saudi Arabia, where traditional in-person
psychiatric services are still the norm.

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2.11. Interventions and Their Role in Telepsychiatry Implementation
Telepsychiatry interventions vary based on the patient’s needs and the healthcare setting, but
common interventions include video consultations, remote monitoring of symptoms, medication
management, and virtual cognitive-behavioral therapy (CBT) (Perron et al., 2019). These
interventions are designed to be flexible and adaptable to different patient demographics, including
those with chronic mental health conditions who require ongoing support.
In Saudi Arabia, the integration of telepsychiatry interventions has the potential to
revolutionize mental health care by reducing strain on existing psychiatric facilities and making
mental health services more accessible to people in both urban and rural settings. Implementing
these interventions requires the establishment of secure digital platforms, training for healthcare
providers, and a concerted effort to overcome cultural barriers surrounding mental health (AlGhamdi, 2020).
Additionally, the introduction of telepsychiatry could complement existing interventions in
mental health care, such as in-person psychotherapy, pharmacotherapy, and social support
systems, by providing an alternative for patients who may have difficulty accessing traditional
services due to mobility, financial constraints, or stigma. The successful implementation of
telepsychiatry interventions could create a more robust, holistic mental health system capable of
addressing the diverse needs of individuals with chronic conditions across Saudi Arabia (AlRukban, 2019).
Telepsychiatry addresses critical access disparities, offering both short-term and long-term
benefits for individuals with chronic mental health conditions in Saudi Arabia. While its immediate
impact includes improved access and reduced wait times, its long-term efficacy is demonstrated
through better management of chronic conditions, regular monitoring, and prevention of mental
health crises. Despite its potential, there is a need for more research to explore the sustained
benefits and effectiveness of telepsychiatry, especially in the context of chronic mental health
disorders. The implementation of telepsychiatry interventions has the capacity to significantly
transform mental health care in Saudi Arabia by overcoming barriers such as geographic isolation,
stigma, and workforce shortages.

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Chapter 4: Materials and Methods

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Materials and Methods
4.1. Study Design
The systematic review was conducted using a rigorous methodology aligned with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Before
initiating the review, a thorough search of databases such as Prospero and Health Systems
Evidence (HSE) ensured no similar or ongoing systematic reviews on the topic existed. A protocol
for the study was registered to ensure transparency and methodological integrity.
The review adopted a mixed-methods approach, combining qualitative and quantitative
research to analyze the long-term impacts of telepsychiatry on chronic mental health conditions.
This approach was specifically chosen to integrate patient experiences, satisfaction levels, and
clinical outcomes, enabling a comprehensive understanding of telepsychiatry’s role in managing
conditions like depression, anxiety, bipolar disorder, and schizophrenia. The selected methodology
also facilitated a robust examination of patient-centered care and service delivery challenges
within the Saudi Arabian context, as supported by studies such as Al-Harbi et al. (2020) and AlKhathami et al. (2021).
4.2. Search Strategy
This systematic review utilized a structured search strategy aligned with PRISMA-P standards.
The selection process, including the criteria for including and excluding studies, is visually
summarized in a PRISMA flow diagram (See Figure 1), adapted from Page et al. (2021). The
search was conducted systematically to ensure the identification of relevant studies pertaining to
telepsychiatry interventions in chronic mental health conditions.
4.2.1. Database sources
The review searched six electronic databases (PubMed, Scopus, Google Scholar, Cochrane
Library, ScienceDirect, and PsycINFO) to locate peer-reviewed articles published in English from
January 2010 to September 2024. These databases were selected due to their comprehensive
coverage of health and psychological literature, ensuring a broad representation of studies on
telepsychiatry interventions in Saudi Arabia. The review included both open access and
subscription-based articles to maximize accessibility to the relevant literature.

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Table2.1. Database Sources
No.
1)

Database

Reason

PubMed

Maintained by the National Library of Medicine, PubMed is a free
database specializing in biomedical and life sciences literature, offering
access to a vast collection of articles, clinical studies, and research papers.

Scopus

Scopus is a comprehensive abstract and citation database, covering a wide
range of disciplines, providing access to scholarly articles, conference
proceedings, and patent records.

Google
Scholar

Google Scholar is a freely accessible search engine that indexes scholarly
articles across various disciplines, providing a user-friendly interface and
encompassing both peer-reviewed and non-peer-reviewed sources.

Cochrane
Library
Science
Direct

PsycINFO

Cochrane Library is a multidisciplinary database platform, offering
access to a diverse range of content, including academic journals,
newspapers, dissertations, and other research materials.
Science Direct is an extensive full-text scientific database offering access
to a wide array of journals covering physical sciences, life sciences, and
health sciences, among other disciplines.
Developed by the American Psychological Association, PsycINFO is a
specialized database covering psychology and related fields, offering
access to scholarly articles, books, and conference proceedings in the
realm of behavioral sciences.

4.2.2. Keywords
The search utilized a set of targeted keywords based on three primary concepts:
“telepsychiatry,” “chronic mental health conditions,” and “Saudi Arabia.” The keywords included
“telepsychiatry,” “remote psychiatric care,” “mental health disorders,” “depression,” “anxiety,”
“bipolar disorder,” “schizophrenia,” and “Saudi Arabia” to ensure a comprehensive search.
4.2.3. Search terms
The systematic search incorporated Medical Subject Headings (MeSH) terms and keywords
related to telepsychiatry and chronic mental health conditions. The selected databases were
supplemented with keyword searches to enhance the identification of relevant studies. The search
string included variations and synonyms to encompass the breadth of the topic. Specifically, the
search string was formulated as follows: (telepsychiatry OR remote psychiatry OR telehealth OR
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teletherapy) AND (chronic mental health conditions OR mental disorders OR psychiatric illnesses)
AND (Saudi Arabia). Additionally, citation searches were conducted on key articles, and relevant
journals focused on mental health and telemedicine were manually reviewed. A detailed overview
of the search strategy, including all keywords and MeSH terms.
4.3. Study Selection
4.3.1. Eligibility criteria
The researcher established a priori inclusion and exclusion criteria to guide the selection of
studies for inclusion in the systematic review. Specifically, studies were included if they: (1)
focused on telepsychiatry interventions for chronic mental health conditions, (2) involved
participants located in Saudi Arabia, (3) reported long-term outcomes (defined as follow-up
periods of at least six months), and (4) were published in peer-reviewed journals between January
2010 and September 2024. Exclusion criteria comprised studies that did not involve a
telepsychiatry component, lacked a focus on chronic mental health conditions, or were not
published in English.
4.3.2. Study selection process
The study selection process was conducted in accordance with the PRISMA guidelines. The
researcher exported the search results from all databases and citation searches into EndNote for
initial screening. Using Covidence, a web-based systematic review management software, the
researcher removed duplicate entries. Titles and abstracts of the remaining articles were
independently screened against the eligibility criteria. Full-text articles were retrieved and
evaluated for relevance, and any disagreements were resolved through discussion with co-authors.
Additionally, a forward and backward citation search was performed on the included articles to
identify additional relevant studies. This screening process continued until data saturation was
achieved, and all eligible articles were then selected for qualitative synthesis.

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Figure 2.1. PRISMA Flowchart, Preferred Reporting Items for Systematic Reviews and

Screening

Identification

Meta-Analyses of the systematic review selection process
Studies identified through Scopus (n = 87), PubMed (n = 61), Google Scholar (n = 37), Science Direct (n
= 12), Cochrane Library (n = 10), and PsycINFO (n = 8)
Total Studies (n = 215)

Records after first level search and
screened for duplicates (n = 174)

Duplicates and Records
excluded (n = 41)

Pre-Titles and abstracts screened
(n = 174)

Records excluded after title and
abstract screening: irrelevant,
abstract only, query study
design/topic
(n = 96)
▪
▪
▪
▪

Included

Eligibility

▪

Full-text articles assessed for eligibility*
(n = 78)

Non English (n = 32)
Irrelevant title (n = 25)
Rejected on abstract review (n = 18)
Did not examine telepsychiatry (n =
12)
Did not examine chronic mental
health conditions (n = 9)

Full text articles excluded, with reasons
(n = 69)
▪
Did not examine the long-term
interventions effects of
telepsychiatry (n = 46)
▪
Did not focused on chronic mental
health conditions (n = 14)
▪
Non-empirical research (n = 9)

Studies included into qualitative
synthesis
(n = 9)

* No additional studies were identified through screening of the references of the included articles.

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PRISMA 2020 flow diagram illustrating the overall selection process to show studies included and
excluded (Modified from Page et al, 2021).
The PICO framework is designed to guide this systematic review by specifying the relevant
population, intervention, comparison, and outcomes (Table 2). It assists in formulating clear
research questions and criteria for selecting studies that will contribute to define the focus and
parameters of your systematic review on telepsychiatry’s long-term effects on chronic mental
health conditions in Saudi Arabia.
Table2.2. PICO Framework for Systematic Review
Component
Population (P)
Intervention (I)
Comparison (C)
Outcome (O)

Description
Individuals in Saudi Arabia with chronic mental health conditions, such as
depression, anxiety disorders, bipolar disorder, and schizophrenia
Long-term interventions utilizing telepsychiatry services (e.g., video
consultations, teletherapy, and remote psychiatric care)
Traditional face-to-face psychiatric interventions or no intervention
Improvement in mental health outcomes, patient satisfaction, access to
mental health services, and adherence to treatment over time

4.3.3. Study appraisal and selection
The appraisal of studies leading to the selection process involved three main phases focused
on ensuring each study met both the eligibility criteria and quality benchmarks. The first phase
involved an initial screening of titles and abstracts, followed by a detailed examination of full texts.
The third phase consisted of a quality assessment of the included studies using established
appraisal tools, such as the Critical Appraisal Skills Programme (CASP) checklist. The steps of
this appraisal process are depicted in the PRISMA flow diagram (See Figure 1).

Telepsychiatry OR
remote psychiatry
OR telehealth OR
teletherapy

AND

Chronic
mental
health
conditions
OR mental disorders
OR
psychiatric
illnesses

AND

GCC
OR
gulf
cooperation council
OR gulf countries
OR Saudi Arabia
(KSA), OR Middle
East

Figure 2.2 Study Appraisal and Selection.

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4.3.4. Data verification
To maintain the reliability and integrity of the systematic review, stringent data verification
procedures were implemented. Acceptance and rejection protocols ensured that each study was
consistently assessed against the predefined criteria. The outcomes reported in each study were
carefully evaluated in relation to study designs, participant demographics, and publication quality.
Any discrepancies or inconsistencies found during this evaluation were addressed through
collaborative discussions among the research team, fostering transparency and accuracy in the
findings.
4.3.5. Outcomes
Following the application of exclusion criteria, 9 articles were identified as relevant to the
long-term effects of telepsychiatry on chronic mental health conditions in Saudi Arabia. These
studies were included for detailed analysis and thematic synthesis (See Figure 1). The synthesis
revealed three primary themes: (1) the effectiveness of telepsychiatry interventions in improving
clinical outcomes, (2) the barriers and facilitators affecting the implementation and acceptance of
telepsychiatry, and (3) the long-term impacts of telepsychiatry on patient experience, satisfaction,
and overall quality of life. These themes were defined collaboratively among the authors, and
relevant definitions and examples.
4.4. Critical Appraisal
4.4.1. Quality assessment
In this phase, the researcher conducted a comprehensive review of each included article to
evaluate its relevance and quality concerning the study objectives. The assessment utilized the
Critical Appraisal Skills Programme (CASP) tool, recognized for its effectiveness in evaluating
both quantitative and qualitative evidence in healthcare research. This approach aimed to enhance
the rigor of the appraisal process, ensuring that only high-quality studies were included in the
review (CASP, 2017).
The quality assessment employed a series of questions tailored for quantitative studies, where
the initial two questions acted as screening criteria. If both were answered affirmatively, the
remaining questions were assessed. Responses were categorized as “yes,” “no,” or “can’t tell,” with
prompts provided to underline the critical nature of each question. Additionally, the CASP

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qualitative checklist was applied to ascertain methodological rigor and validity in the qualitative
studies included.
Furthermore, the Quality Assessment Tool for Qualitative Studies, endorsed by the Cochrane
Collaboration, was utilized to evaluate a wide range of qualitative study designs (Robbiati et al.,
2022). This tool was designed with considerations for interrater reliability, content, and construct
validity. Each study was appraised based on 18 criteria across six domains: selection bias, study
design, confounders, blinding, data collection methods, and withdrawals/drop-outs. Studies were
classified as ‘strong,’ ‘moderate,’ or ‘weak’ within each domain. An algorithm consolidated these
ratings into an overall quality score, facilitating a transparent and systematic approach to quality
assessment. The researcher independently conducted this quality evaluation, and the final
classification for each study was established based on the cumulative assessments.
4.5. Ethical Appraisal
4.5.1. Patient and public involvement
The systematic review did not require a budget or ethics approval, as it involved the synthesis
of existing literature rather than original research with human subjects. Consequently, Patient and
Public Involvement (PPI) was not incorporated into the study design, recruitment, or execution
phases. The research did not engage directly with patients or the public, and therefore, the
dissemination of findings did not involve participants from the trials under review. Ethical
considerations focused on ensuring the integrity and transparency of the systematic review process,
adhering to established guidelines for conducting literature reviews in healthcare.
4.6. Data Extraction
Data extraction is a critical process that entails gathering essential information from the studies
included in the systematic review. The primary researcher was responsible for this process to
ensure accuracy and reduce potential biases, thereby maintaining the internal validity of the study.
Data extraction forms were meticulously designed and implemented using Microsoft Excel 2016
(V.14.7.2; Microsoft, Redmond, Washington, USA), facilitating systematic collection and
organization of relevant findings.
Key information extracted from each article included the following elements: Date/Author,
Title, Study Design, Methodology, Primary Outcomes, and Secondary Outcomes. This structured

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approach helped to maintain clarity and consistency across the collected data. The extraction
process was guided by predefined criteria, summarized in Tables 3: 5, to ensure that critical aspects
pertinent to the research questions were captured. The researcher collaborated with mentors to
evaluate and categorize the extracted data, highlighting trends and key themes in the literature
concerning telepsychiatry interventions for chronic mental health conditions in Saudi Arabia.
4.7. Data Analysis
4.7.1. Systematic review process
The data analysis phase commenced by identifying and extracting key concepts relevant to the
research questions. Each concept represented a significant finding from the studies reviewed,
forming the backbone of the analysis. Data were organized into a Microsoft Word document under
clear headings, including Author/s, Year of Publication, Country, Study Design, Study Setting,
Types of Participants, Number of Participants, and the Purpose of the Studies. This organization
aimed to facilitate a comprehensive understanding of the findings across different studies.
The analysis focused on critical aspects of telepsychiatry, including intervention effectiveness,
patient satisfaction, accessibility issues, and mental health outcomes. A content analysis approach
was employed to categorize and synthesize findings related to the benefits, barriers, and
influencing factors associated with telepsychiatry interventions. The evidence was systematically
compared and contrasted with existing literature, providing a robust framework for understanding
the impact of telepsychiatry on chronic mental health conditions in the context of Saudi Arabia.
4.7.2. Data synthesis
The initial literature search yielded a total of 215 studies. After removing duplicates, 174
studies were identified for screening. During the initial assessment, 86 studies were excluded due
to irrelevance, being abstracts only, or unsuitable study designs. A detailed analysis of the
remaining 78 studies was conducted, leading to the exclusion of 61 studies that did not address
telepsychiatry’s effects on chronic mental health conditions. Ultimately, 9 studies met the inclusion
criteria and were incorporated into the review. The process is illustrated in Figure 1.

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4.7.3. Final outcomes
Among the included studies, 9 were conducted in Saudi Arabia, making it the country with the
highest representation in this systematic review within the Middle Eastern context. From the
reviewed articles, three main themes related to the long-term interventions’ effects of
telepsychiatry on chronic mental health conditions in Saudi Arabia emerged. These included: (1)
the effectiveness of telepsychiatry interventions in improving clinical outcomes, (2) the barriers
and facilitators affecting the implementation and acceptance of telepsychiatry, and (3) the longterm impacts of telepsychiatry on patient experience, satisfaction, and overall quality of life. The
detailed themes are presented in Table 2.1. with the different shades of orange color, representing
how much the themes were discussed. The most reported theme is represented by the darkest
shade.

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Chapter 5: Results

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Results
From the reviewed articles, three main themes related to the long-term interventions’ effects
of telepsychiatry on chronic mental health conditions in Saudi Arabia emerged. These included:
(1) the effectiveness of telepsychiatry interventions in improving clinical outcomes, (2) the barriers
and facilitators affecting the implementation and acceptance of telepsychiatry, and (3) the longterm impacts of telepsychiatry on patient experience, satisfaction, and overall quality of life.
Theme (1): The Effectiveness of Telepsychiatry Interventions In Improving Clinical
Outcomes
A study by Alghamdi et al., (2022) aimed to evaluate Saudi psychiatrists’ knowledge,
perception, and willingness toward adopting telepsychiatry. Conducted between November 2020
and May 2021, the cross-sectional study surveyed 328 psychiatrists predominantly aged 25–35
years, mostly Saudi nationals (83.5%) with a male majority (70.4%). Results indicated a mixed
knowledge level, with 51.8% having poor knowledge and 48.2% good knowledge of
telepsychiatry. However, the majority had a favorable perception (80.8%). Knowledge appeared
to be linked with factors such as age, professional experience, and frequent online patient
interaction. Despite a positive perception, knowledge about telepsychiatry remains inadequate
among psychiatrists in Saudi Arabia.
Table 3.1. Data Extraction (Theme 1)
Category
Research Title
Objective
Study Design
Study Period
Participants
Age Range
Nationality
Gender
Key Variables

Details
Telepsychiatry: knowledge, effectiveness, and willingness;
assessments of psychiatrists in Saudi Arabia
Assess psychiatrists’ knowledge and perceptions of telepsychiatry and
their willingness to adopt it in Saudi Arabia.
Cross-sectional study
November 2020 – May 2021
328 psychiatrists in Saudi Arabia
Predominantly 25–35 years (48.8%)
Majority Saudis (83.5%)
Male (70.4%) and Female (29.6%)
Knowledge, perception, willingness, barriers, and effectiveness of
telepsychiatry

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Category
Data Collection
Data Analysis
Knowledge Level
Perception Level
Key Influences
Conclusion

Details
Self-administered questionnaire distributed online
MS Excel (data cleaning); SPSS v26 (statistical analyses)
Poor: 51.8%, Good: 48.2%
Good: 80.8%, Poor: 19.2%
Higher knowledge among older psychiatrists, consultants, those with
11–15 years of experience, and frequent online patient interactions
Positive perception of telepsychiatry, but knowledge was limited and
influenced by factors such as experience and role.

A study by Khalil et al., (2023) investigated the attitudes of psychiatrists toward telepsychiatry
at King Fahad University Hospital and Dammam Eradah Complex in Saudi Arabia. Conducted
among 82 psychiatrists, the cross-sectional survey used a modified Telehealth Usability
Questionnaire (TUQ), demonstrating high internal consistency. Findings revealed that 72% of
psychiatrists found telepsychiatry useful, with over 75% acknowledging its role in improving
healthcare accessibility and saving time. Although 58% were satisfied with telepsychiatry, fewer
than half rated its effectiveness and reliability positively. While overall attitudes were favorable,
understanding challenges faced by clinicians could help enhance telepsychiatry services.
Table 3.2. Data Extraction (Theme 1)
Category
Research Title

Background
Objective
Study Design
Study Sites
Sample Size
Sampling Method
Exclusion Criteria
Data Collection Tool

Details
Attitudes toward telepsychiatry among psychiatrists at King Fahad
University Hospital and Eradah Complex and Mental Health: a Saudi
Arabian study
Telepsychiatry enables remote psychiatric care via technology. This
study explores psychiatrist satisfaction and acceptance of
telepsychiatry as a healthcare delivery method.
Evaluate psychiatrists’ attitudes toward telepsychiatry and identify
influencing factors.
Cross-sectional study
King Fahad University Hospital and Dammam Eradah Complex and
Mental Health, Eastern Province, Saudi Arabia
82 psychiatrists (residents, specialists, consultants)
Convenience sampling
Nurses and psychologists were excluded
Modified Telehealth Usability Questionnaire (TUQ), administered
online via Google Forms

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Category
Data Consistency
Key Findings
Effectiveness and
Reliability
Conclusion

Details
High internal consistency across TUQ items and subdomains
(Cronbach’s alpha > 0.80)
72% found telepsychiatry useful, >75% believed it improves
accessibility and saves time, 58% reported satisfaction
Less than 50% responded positively to the effectiveness and
reliability of telepsychiatry
Positive attitudes toward telepsychiatry with reported satisfaction.
Widespread acceptance and expansion are anticipated, although
recognizing clinicians’ obstacles is essential for service improvement.

An observational cross-sectional study by Wafia et al., (2022) aimed to evaluated the quality
of telepsychiatry services in King Abdulaziz Medical City, addressing the increasing demand for
psychiatric care through virtual appointments. Conducted from January to July 2021, the study
included 182 psychiatric patients aged over 18 years, utilizing a validated Client Satisfaction
Questionnaire-18 (CSQ-18) for data collection. Results indicated a generally high level of
satisfaction among patients: 56.6% were satisfied with accessibility and timeliness, 81.9% with
appropriateness, 86.8% with effectiveness, and 91.2% with safety. Additionally, 58.3% of
participants reported overall satisfaction. The most common psychiatric disorders among
participants were depression and anxiety. The analysis revealed no significant correlations
between satisfaction levels and demographic factors. These findings suggest strong support for the
ongoing use of telepsychiatry services, with a recommendation for future studies to compare
patient and provider satisfaction levels.
Table 3.3. Data Extraction (Theme 1)
Category
Research Title

Background

Objective
Study Design

Details
The quality of telepsychiatry in terms of accessibility,
appropriateness, effectiveness, and safety among psychiatric patients
in King Abdulaziz Medical City: An observational cross-sectional
analytical study
Telepsychiatry emerged to address the increasing demand for
psychiatric care, offering virtual services like therapy, counseling,
and medication management.
Assess patient satisfaction with telepsychiatry regarding accessibility,
appropriateness, effectiveness, and safety, and evaluate the influence
on future service usage.
Observational cross-sectional analytical study

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Category
Study Period

Details

January 2021 – July 2021
182 psychiatric patients aged over 18 years with virtual appointments
Participants
(106 female, 76 male)
Prestructured survey based on the Client Satisfaction QuestionnaireData Collection Tool
18 (CSQ-18)
– Accessibility and Timeliness: 56.6% satisfied
– Appropriateness: 81.9% satisfied
Key Satisfaction
– Effectiveness: 86.8% satisfied
Metrics
– Safety: 91.2% satisfied
– Overall Satisfaction: 58.3% strongly agree or agree
Depression and anxiety disorders were the most frequently reported
Common Disorders
psychiatric conditions.
No significant relationships were found between patient satisfaction
Demographic Analysis
and demographic characteristics.
Patients expressed high satisfaction with telepsychiatry services,
Conclusion
supporting its continued use. Future research could focus on
comparing satisfaction levels between patients and providers.

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Theme (2): The barriers and facilitators affecting the implementation and acceptance of
telepsychiatry
The implementation and acceptance of telepsychiatry face several barriers and are supported by
key facilitators that influence its success.
Barriers include a lack of awareness and a perceived need for telepsychiatry among patients and
healthcare providers. For example, Al-Khathami et al. (2021) highlighted skepticism regarding
the effectiveness of virtual consultations compared to in-person care. Additionally, technological
challenges, such as poor internet infrastructure and low digital literacy, particularly in rural areas
and among older populations, remain significant obstacles (Al-Harbi et al., 2020). Concerns over
privacy and confidentiality when discussing sensitive information on digital platforms further
hinder acceptance. Healthcare providers’ resistance, rooted in limited training and doubts about
building therapeutic connections virtually, has also been reported (Al-Otaibi et al., 2021).
On the other hand, facilitators include improved accessibility, enabling individuals in
underserved or remote regions to receive timely psychiatric care. Telepsychiatry has also been
effective in reducing stigma associated with seeking mental health services, as virtual platforms
offer greater privacy and discretion (Al-Qahtani et al., 2022). Additionally, the cost-effectiveness
and flexibility of telepsychiatry, such as reduced travel expenses and convenient scheduling,
have led to high patient engagement. Studies consistently show high satisfaction levels, with
patients appreciating the continuity and convenience of virtual psychiatric services.
To ensure successful implementation, addressing these barriers while leveraging facilitators like
accessibility, privacy, and patient satisfaction is critical for widespread acceptance and
sustainability.
Table 3.4. Data Extraction (Theme 2)
Category

Details
Effectiveness and Satisfaction with Telepsychiatry for Managing Chronic
Research Title
Mental Health Conditions in Saudi Arabia: A Systematic Review
Telepsychiatry has become increasingly popular in Saudi Arabia due to its
Background
ability to overcome barriers to mental health services, such as distance and
stigma.
Evaluate the long-term impact of telepsychiatry on clinical outcomes,
Objective
satisfaction, and quality of life for patients with chronic mental illnesses.
Systematic review of observational studies, randomized controlled trials
Study Design
(RCTs), and qualitative studies from 2010 to 2022.
Study Period
Reviewed literature spanning January 2010 – December 2022.
Studies included patients diagnosed with chronic mental health conditions
Participants
(e.g., depression, bipolar disorder, schizophrenia).
Data Collection Systematic database search (PubMed, Scopus, Cochrane Library) and
Tool
PRISMA checklist for systematic reviews.
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Category
Key Findings

Common
Disorders
Demographic
Analysis
Conclusion

Details
– Significant reduction in symptom severity and hospitalization rates for
patients using telepsychiatry.
– High patient satisfaction: 80%-90% reported convenience and improvement
in access to care.
– Positive clinical outcomes for patients with depression and anxiety disorders.
Chronic depression, bipolar disorder, and schizophrenia were the primary
conditions assessed.
Studies revealed telepsychiatry was effective across all age groups, with
younger adults (20-40 years) reporting the highest satisfaction levels.
Telepsychiatry demonstrates substantial long-term benefits for managing
chronic mental health conditions in Saudi Arabia. Future studies should
explore provider perspectives and economic impact.

This study systematically reviewed the effectiveness of telepsychiatry in managing chronic
mental health conditions in Saudi Arabia. Telepsychiatry emerged as a solution to overcome
barriers like distance, stigma, and the growing demand for mental health services. The research
focused on assessing its impact on clinical outcomes, patient satisfaction, and quality of life for
individuals with chronic mental illnesses such as depression, bipolar disorder, and schizophrenia.
Findings revealed that telepsychiatry significantly reduced symptom severity and
hospitalization rates while improving access to care. Patient satisfaction levels were high, with
80%-90% of participants reporting convenience and positive outcomes. Younger adults aged 2040 expressed the highest satisfaction. The review highlighted that telepsychiatry effectively
delivers therapy, counseling, and medication management, ensuring continuity of care for chronic
conditions.
No significant differences were noted based on demographic factors like gender or
socioeconomic status. The study concluded that telepsychiatry offers substantial long-term
benefits and supports its integration into mental healthcare systems in Saudi Arabia. Future
research should focus on providers’ perspectives and the cost-effectiveness of telepsychiatry.

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Table 3.5. Data Extraction (Theme 2)
Category
Research Title
Background
Objective
Study Design
Study Period
Participants
Data Collection
Tool
Key Findings

Common
Disorders
Demographic
Analysis
Conclusion

Details
The Impact of Telepsychiatry on Reducing Depression and Anxiety
Symptoms in Saudi Arabia: A Randomized Controlled Trial
Telepsychiatry has become a vital tool to deliver mental health services,
particularly during the COVID-19 pandemic, addressing the rise in mental
health issues.
To examine the effectiveness of telepsychiatry in reducing symptoms of
depression and anxiety among patients in Saudi Arabia.
Randomized Controlled Trial (RCT) with pre- and post-intervention
assessments.
August 2020 – March 2021
120 patients diagnosed with depression or generalized anxiety disorder (65
female, 55 male), aged between 18-50 years.
Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7
(GAD-7) scales were used to measure symptom severity.
– Significant improvement in PHQ-9 scores: 72% reduction in depressive
symptoms.
– GAD-7 scores showed a 65% reduction in anxiety symptoms posttelepsychiatry intervention.
– 89% of patients reported satisfaction with the ease of accessing virtual care.
Depression and Generalized Anxiety Disorder (GAD).
Patients aged 30-40 demonstrated the greatest reduction in symptoms, while
no significant gender differences were observed.
Telepsychiatry effectively reduced symptoms of depression and anxiety,
showing strong potential for integrating virtual care into mental health
services.

This randomized controlled trial investigated the effectiveness of telepsychiatry in reducing
symptoms of depression and anxiety in Saudi Arabia. Conducted between August 2020 and
March 2021, the study involved 120 patients diagnosed with either depression or generalized
anxiety disorder (GAD), aged between 18 and 50 years. The Patient Health Questionnaire-9
(PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales were used to assess symptom
severity before and after the telepsychiatry intervention.
The findings demonstrated a significant reduction in symptoms, with a 72% improvement in
depressive symptoms and a 65% reduction in anxiety scores. Participants reported high
satisfaction, with 89% highlighting the convenience and accessibility of virtual mental health
care. The greatest improvements were observed among patients aged 30-40 years, while no
significant gender differences were identified.

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The study concluded that telepsychiatry is an effective tool for managing depression and anxiety,
providing an accessible and efficient solution for mental health care delivery in Saudi Arabia. It
recommends integrating telepsychiatry into regular healthcare services to address the rising
burden of mental health disorders.
Table 3.6. Data Extraction (Theme 2)
Category

Details

Research Title

Effectiveness of Telepsychiatry for Patients with Schizophrenia in Saudi
Arabia: A Longitudinal Cohort Study

Background

Schizophrenia is a chronic mental health condition that requires consistent
care, and telepsychiatry offers an alternative to traditional face-to-face
treatment.

Objective

To evaluate the clinical outcomes and adherence to treatment plans for
schizophrenia patients using telepsychiatry services.

Study Design

Longitudinal cohort study over 12 months

Study Period

March 2019 – February 2020

Participants

98 schizophrenia patients (56 male, 42 female), aged 25-55 years, receiving
regular virtual psychiatric consultations.

Data Collection
Tool

Positive and Negative Syndrome Scale (PANSS) for symptom severity and
medication adherence reports.

Key Findings

– 68% reduction in positive symptoms (hallucinations, delusions) after 12
months of telepsychiatry.
– 72% improvement in medication adherence due to consistent follow-up and
reminders.
– 84% of participants reported satisfaction with virtual care, citing
convenience and reduced stigma.

Common
Disorders

Schizophrenia and related psychotic disorders.

Demographic
Analysis

Younger patients (25-35 years) showed better adherence and symptom
improvement. No significant difference between genders.

41
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