Algorithms & Data Structures Question

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)
Presented by:
Rehab Nawaf Alharbi
Supervisor:
Dr. Danyah A Aldailami
Date: 25/10/2024

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DECLARATION
All praise is due to Allah, the Lord of the worlds, for His endless mercy and blessings. May we
always be grateful for His guidance and grace.”
I declare that the research project entitle “Examining the Long-Term Interventions Effects of
Telepsychiatry on Chronic Mental Health Conditions in Saudi Arabia: Systematic Review”
submitted to the Saudi Electronic University is my own original work. I declare that the research
project does not contain material previously published or written by a third party, except where
this is appropriately cited through full and accurate referencing. I declare that the Saudi Electronic
University has a right to refuse the research project if contains plagiarism and cancel the research
project at any time and the student has the full responsibility regarding any further legal actions.

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ACKNOWLEDGEMENT
I extend my heartfelt gratitude to all who contributed to the success of this research. First, I would
like to thank my supervisor, Dr. Danyah A Aldailami, whose expertise, understanding, and
patience added considerably to my graduate experience. Her willingness to give his time so
generously has been very much appreciated. I am indebted to my colleagues in the MSc of
Healthcare Administration for their feedback and the stimulating discussions that inspired many
of the ideas explored in this study. I also express my sincere thanks to the participants and
institutions that contributed data and insights, enhancing the richness and validity of the research.
Special appreciation goes to the technical staff for their help in navigating the complex setups
required for telepsychiatry systems. Lastly, I must express my very profound gratitude to my
family for providing me with unfailing support and continuous encouragement throughout my
years of study and through the process of researching and writing this thesis. This accomplishment
would not have been possible without them. Thank you.

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Table of Contents
Declaration

ii

Acknowledgement

iii

Table of Content

ivii

List of Abbreviations

v

List of Tables

v

List of Figures

ii

Chapter 1: Introduction

8

Chapter 2: Literature Review

12

Chapter 3: Objectives

23

Chapter 4: Materials and Methods

25

Chapter 5: Results

35

Chapter 6: Discussion

48

Conclusion

56

Recommendations

57

References

58

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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

SA

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

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interventions on chronic mental health conditions remain underexplored, particularly within the
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.

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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.
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.
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).

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 1 per
10,000 (Al-Saeed et al., 2018). This imbalance contributes to long wait times for psychiatric

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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.

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:
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. 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
socioeconomic backgrounds. It can also alleviate the burden on the healthcare system by
streamlining appointments and reducing overcrowding in hospitals (Hubley et al., 2016).
3. Increased Patient Comfort and Privacy: For many individuals, the stigma surrounding
mental health care in Saudi Arabia can discourage them from seeking treatment.
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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.
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).
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).
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.
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).

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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).
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).
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

21

existing healthcare systems, especially in countries like Saudi Arabia, where traditional in-person
psychiatric services are still the norm.
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 (Al-Rukban, 2019).
Conclusion
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.

22

23

Chapter 4: Materials and Methods

24

Materials and Methods
4.1. Study Design:
The systematic review was conducted following a rigorous methodology, ensuring adherence
to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) framework. Prior to initiating the review, a search of the Prospero and Health
Systems Evidence (HSE) databases confirmed the absence of any ongoing or completed systematic
reviews relevant to the topic. A protocol for the review was subsequently registered. The study
employed a mixed methods design, integrating both qualitative and quantitative research
approaches. This design was chosen to provide a comprehensive understanding of the long-term
effects of telepsychiatry on chronic mental health conditions, facilitating a robust analysis of
complex health issues in the Saudi Arabian context (Hong et al., 2018).
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.

25

Table (1): Database Sources:
No.
1)

2)

3)

4)

5)

6)

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
26

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.

27

Figure (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.

28

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.
Table (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): Study Appraisal and Selection:

29

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

30

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

31

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.

32

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 long-term impacts of
telepsychiatry on patient experience, satisfaction, and overall quality of life. The detailed themes
are presented in Table 3 : 5 with the different shades of orange colour, representing how much the
themes were discussed. The most commonly reported theme is represented by the darkest shade.

33

Chapter 5: Results

34

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
Data Collection
Data Analysis

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
Self-administered questionnaire distributed online
MS Excel (data cleaning); SPSS v26 (statistical analyses)
35

Category
Knowledge Level
Perception Level
Key Influences
Conclusion

Details
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
Data Consistency

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
High internal consistency across TUQ items and subdomains
(Cronbach’s alpha > 0.80)

36

Category
Key Findings
Effectiveness and
Reliability
Conclusion

Details
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
Study Period

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
January 2021 – July 2021

37

Category

Details
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.

38

Theme (2): The barriers and facilitators affecting the implementation and acceptance of
telepsychiatry
This study by Al-Thebiti et al., (2017) explored the challenges and acceptance of telemedicine
in hospitals in Jeddah, Saudi Arabia. Conducted as a cross-sectional study among 114 medical
providers, the research aimed to identify difficulties in implementing telehealth systems and assess
providers’ willingness to adopt these technologies. Data were collected through both paper-based
and electronic questionnaires and analyzed using SPSS. Key findings indicated a high interest in
technology among providers (59%) and a strong willingness to implement advanced telehealth
technologies (84%). However, significant barriers were identified, including a lack of awareness
(90%), concerns regarding time and cost (71%), and difficulties in finding qualified personnel
(63%). Additionally, 40% of participants perceived little need for telehealth compared to
traditional face-to-face visits. The study concluded that while there is a high acceptance of
telehealth, addressing these barriers is essential to improve healthcare quality in Jeddah hospitals.
Table (4.1): Data Extraction (Theme 2)
Category
Research Title
Background

Objective
Study Design
Participants
Data Collection
Method
Data Analysis Tool

Key Findings

Details
Telemedicine: Between Reality and Challenges in Jeddah Hospitals
Telehealth encompasses electronic information and
telecommunications to support long-distance clinical health care,
education, public health, and health administration.
Assess the difficulties and limitations of implementing telehealth in
Jeddah hospitals and evaluate the inclination of healthcare providers
to adopt this technology.
Cross-sectional study
114 medical providers working in hospitals in Jeddah, Saudi Arabia
Paper-based and electronic questionnaires
SPSS (Statistical Package for the Social Sciences)
– Interest in technology: 59%
– Willingness to implement advanced telehealth technologies: 84%
– Lack of awareness as a major barrier: 90%
– Concerns about time and cost: 71%
– Difficulty finding qualified personnel: 63%
– Lack of human resources: 62%
– Misuse of technology: 50%

39

Category

Conclusion

Details
– Perception of minimal need for telehealth compared to face-to-face
visits: 40%
High acceptance of telehealth among medical providers exists,
despite challenges such as lack of awareness, human resource
shortages, and perceived redundancy compared to in-person visits.
Identifying and addressing these barriers is crucial for enhancing the
quality of healthcare systems in hospitals.

A study by Alaboudi et al., (2016) investigated the barriers and challenges faced by healthcare
facilities in Saudi Arabia regarding the adoption of telemedicine, recognizing that despite its
benefits, many telemedicine initiatives fail, particularly in developing countries. The research,
conducted in collaboration with the Saudi Ministry of Health, aimed to identify the primary
challenges faced by decision-makers across various healthcare facilities in the Kingdom. Utilizing
three theoretical frameworks—Unified Theory of Acceptance and Use of Technology (UTAUT),
Technology-Organisation-Environment (TOE), and Evaluating Telemedicine Systems Success
Model (ETSSM)—the study employed a mixed methods approach, including literature review,
interviews, and questionnaires.
The findings revealed that the most significant barriers to telemedicine adoption included a
lack of sustainable financial support for implementing and maintaining telemedicine systems,
ensuring that telemedicine services align with the core mission and constraints of healthcare
facilities, and reimbursement challenges for telemedicine services.
Table (4.2): Data Extraction (Theme 2)
Category
Research Title

Background

Objective

Details
Barriers and challenges in adopting Saudi telemedicine network: The
perceptions of decision makers of healthcare facilities in Saudi Arabia
Despite the benefits of telemedicine, adoption rates are low, with
many projects failing, particularly in developing countries. No
comprehensive study has investigated the barriers in all healthcare
facilities across Saudi Arabia.
Identify the principal challenges and barriers to adopting telemedicine
in Saudi healthcare facilities and understand the perspectives of
decision-makers.

40

Category
Theoretical
Frameworks
Study Design
Participants

Key Findings

Conclusion

Details
– Unified Theory of Acceptance and Use of Technology (UTAUT)
– Technology-Organisation-Environment (TOE) framework
– Evaluating Telemedicine Systems Success Model (ETSSM)
Mixed methods research utilizing literature review, interviews, and
questionnaires (three-sequential-phase approach)
Decision makers from various healthcare facilities across Saudi
Arabia
The top three barriers identified were:
1. Lack of adequate sustainable financial support for implementation,
operation, and maintenance.
2. Ensuring telemedicine services align with the core mission, vision,
needs, and constraints of healthcare facilities.
3. Issues related to reimbursement for telemedicine services.
Identifying and understanding these barriers is essential for enhancing
the adoption of telemedicine in Saudi Arabia’s healthcare facilities.

A research paper by Aldeghaither et al., (2022) investigates the implementation of teletherapy
in Saudi Arabia and its potential impact on the healthcare system, particularly in the context of the
ambitious goals set forth in Saudi Vision 2030. By synthesizing insights from key academic
studies, the paper highlights both opportunities and challenges associated with the integration of
teletherapy.
One significant study by Alghamdi et al. (2022) examines healthcare providers’ perceptions
and barriers to adopting telehealth applications, revealing critical challenges such as technological
infrastructure, regulatory frameworks, and cultural considerations that must be addressed for
successful implementation. Additionally, Alhefzi (2020) emphasizes the importance of integrating
telehealth elements into Saudi Vision 2030 to effectively achieve healthcare goals. The experience
during the COVID-19 pandemic, as discussed by Banjar and Alfaleh (2021), showcases the rapid
adoption of telemental health services in response to emerging healthcare needs.
The findings suggest that to maximize the positive impact of teletherapy on Saudi Arabia’s
healthcare landscape, tailored strategies must be developed to address these challenges while
capitalizing on the opportunities presented by teletherapy. The research ultimately underscores the
need for concerted efforts to enhance healthcare accessibility and optimize resource utilization
within the Kingdom.

41

Table (4.3): Data Extraction (Theme 2)
Category

Details

Teletherapy Implementation and Its Impact on Saudi Arabia’s
Healthcare System: Opportunities and Challenges
Teletherapy has the potential to improve healthcare accessibility and
Background
delivery in Saudi Arabia, aligning with Saudi Vision 2030.
To explore the opportunities and challenges associated with
Objective
integrating teletherapy into the Saudi healthcare system.
– Alghamdi et al. (2022): Cross-sectional study on healthcare
providers’ perceptions and barriers regarding telehealth adoption.
Key Studies
– Alhefzi (2020): Discusses incorporating telehealth elements into
Referenced
Saudi Vision 2030.
– Banjar and Alfaleh (2021): Insights on telemental health services
implementation during the COVID-19 pandemic.
– Challenges to teletherapy implementation include:
1. Technological infrastructure
2. Regulatory frameworks
Key Findings
3. Cultural considerations
– Emphasizes the need for tailored strategies to maximize the impact
of teletherapy on the healthcare landscape.
Incorporating telehealth into Saudi Vision 2030 is crucial for
Implications for Policy
achieving healthcare objectives and enhancing patient outcomes.
The successful integration of teletherapy in Saudi Arabia requires
Conclusion
addressing identified challenges and leveraging opportunities to
optimize healthcare delivery.
Research Title

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Theme (3): The long-term impacts of telepsychiatry on patient experience, satisfaction, and
overall quality of life:
A study by Almalky & Alhaidar, (2021) conducted at King Khalid University Hospital in
Riyadh, explored patient satisfaction with telepsychiatry services during the COVID-19 pandemic.
Telepsychiatry was essential during this period due to pandemic-related restrictions, providing a
means for patients to receive psychiatric care remotely. The cross-sectional survey gathered
responses from 141 psychiatric patients who used the telepsychiatry program, analyzing
satisfaction across three main categories: structure, process, and outcome.
The results indicated high satisfaction levels, with 94.3% of patients expressing overall
satisfaction. Patients particularly valued the ease of access, comfort, privacy, and skill of clinicians
during their sessions. While the study found no significant link between demographic factors and
satisfaction levels, 48.9% of patients reported a strong likelihood of using telepsychiatry services
in the future.
The findings suggest that telepsychiatry was effective in meeting patient needs during the
pandemic, though additional research is needed to determine if satisfaction levels and usage
intentions remain consistent in a post-pandemic setting.
Table (5.1): Data Extraction (Theme 3)
Category
Research Title

Background

Objective

Methodology

Data Analysis Tool

Details
Patients’ Satisfaction With Telepsychiatry Services at a University
Hospital in Riyadh During the COVID-19 Pandemic
Telepsychiatry provides psychiatric care remotely, intended to meet
the needs of patients in remote areas. The COVID-19 pandemic
increased the necessity for such services, leading to this study on
patient satisfaction.
Assess patients’ satisfaction with telepsychiatry services and examine
whether satisfaction levels influence the future use of telepsychiatry.
Cross-sectional survey conducted at King Khalid University Hospital
in Riyadh, Saudi Arabia. Surveyed psychiatric patients who received
telepsychiatry services during COVID-19 restrictions, with data
collected via a Google Forms questionnaire. Sample size: 141 out of
an initial target of 337.
SPSS Statistics (IBM)

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Category

Key Findings

Conclusion

Details
– Satisfaction with structure: 80.1%
– Satisfaction with process: 95.7%
– Satisfaction with outcome: 96.5%
– Overall satisfaction: 94.3%
– No significant relationship between satisfaction and demographic
characteristics
– 48.9% indicated willingness to use telepsychiatry in the future.
Patients expressed high satisfaction with telepsychiatry, valuing
comfort, privacy, access, clinician skill, and care. Most would
continue using the service, but further research is needed to evaluate
if perceptions remain stable post-pandemic.

A cross-sectional study by Alfaleh et al., (2021) examined patient satisfaction with two key
telemedicine services in Saudi Arabia—the 937 Call Center and the Sehha Application—both of
which are provided by the Ministry of Health. Using systematic random sampling, the study
surveyed 249 users on various aspects of these services, including physician recommendations,
communication and listening skills, and waiting times.
The results demonstrated that a large majority of users (83.14%) were generally satisfied with
the telemedicine services, with only 8.03% expressing dissatisfaction. Satisfaction with specific
aspects included high ratings for communication skills (83.53%) and listening skills (85.14%),
although satisfaction with waiting times was relatively lower at 67.87%.
The findings suggest that telemedicine services in Saudi Arabia are well-received, with high
overall satisfaction and users expressing willingness to recommend these services. The study
highlights the growing importance of telemedicine in enhancing healthcare accessibility and
service quality.
Table (5.2): Data Extraction (Theme 3)
Category
Research Title
Objectives
Methods

Details
Telemedicine and Patient Satisfaction in Saudi Arabia
To assess patient satisfaction with telemedicine services (937 Call
Center and Sehha Application) provided by the Ministry of Health in
Saudi Arabia.
Cross-sectional study using systematic random sampling to select
participants from the 937 Call Center and Sehha Application users.

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Category

Sample Size

Key Findings

Conclusion

Details
Participants completed a predesigned questionnaire assessing
satisfaction with telemedicine services.
249 randomly selected consumers of 937 Call Center and Sehha
Application
– Overall satisfaction: 83.14%
– Not satisfied: 8.03%
– Satisfaction with physicians’ recommendations: 77.29%
– Communication skills: 83.53%
– Listening skills: 85.14%
– Waiting time satisfaction: 67.87%
Telemedicine services in Saudi Arabia have high satisfaction rates,
with no significant differences in satisfaction levels between the 937
Call Center and Sehha Application users. Most users were generally
satisfied and likely to recommend these services to others.

A nationwide cross-sectional study by AlShareef & AlWabel, (2024) aimed to gauge patient
opinions on virtual consultations across Saudi Arabia, with a focus on factors influencing
satisfaction and perceptions of telehealth. Conducted between November 2023 and January 2024,
the study surveyed 916 adults who recently experienced a virtual healthcare consultation.
Participants answered the Telehealth Usability Questionnaire to assess their experiences and
overall satisfaction.
The results indicated a strong preference for virtual consultations, with over 90% of
respondents favoring virtual over in-person appointments. While about half of the consultations
were conducted by telephone and one-third via video calls on hospital-provided platforms, over
90% of participants reported high usability, convenience, and satisfaction with telehealth. Despite
occasional technical interruptions, 97.4% were satisfied with the overall experience. Lower
satisfaction was reported among younger participants, urban residents, specialty clinic patients,
those who consulted with psychologists, and individuals preferring in-person visits or telephone
consultations.
The findings support the expansion of telehealth services in Saudi Arabia, especially video
consultations, and highlight the importance of educational initiatives to enhance the telehealth
experience.

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Table (5.3): Data Extraction (Theme 3)
Category
Research Title
Objectives

Methods
Sample Size
Demographics
Consultation Types

Key Findings

Factors Influencing
Satisfaction
Conclusion

Details
Patient Opinions about Virtual Consultations in Saudi Arabia: A
Nationwide Cross-Sectional Study
To assess patient opinions on virtual consultations and identify
factors affecting perceptions and satisfaction with telehealth across
Saudi Arabia
Prospective cross-sectional study with convenience sampling
conducted from November 2023 to January 2024, using a Telehealth
Usability Questionnaire
916 participants, recruited from general adult population across Saudi
Arabia
– Female participants: 53.7%
– Mean age: 47.2 years
– Primary care and hospital specialties
– 50% telephone consultations
– 33% video calls on hospital platforms
– Over 90% preferred virtual appointments over in-person visits
– >90% rated telehealth as useful, convenient, effective, and reliable
– 97.4% satisfied with overall telehealth experience despite technical
interruptions
Lower satisfaction was seen in younger participants, urban residents,
specialty clinic attendees, those consulting psychologists, and those
who preferred in-person visits or had telephone consultations
High satisfaction and usability of virtual consultations in Saudi
Arabia, with strong preference for video calls; suggests expansion of
telehealth services alongside patient education efforts.

46

Chapter 6: Discussion

47

Discussion
Theme (1): The Effectiveness of Telepsychiatry Interventions in Improving Clinical
Outcomes for Individuals with Chronic Mental Health Conditions in Saudi Arabia
This theme centers on understanding how telepsychiatry, as a long-term intervention, impacts
clinical outcomes for chronic mental health patients in Saudi Arabia. Recent studies highlight the
nuanced success of telepsychiatry in improving these outcomes, though barriers remain.
6.1.1. Effectiveness and Patient Outcomes
The studies by Alghamdi et al. (2022), Khalil et al. (2023), and Wafia et al. (2022) underscore
telepsychiatry’s positive role in Saudi Arabia’s healthcare landscape, particularly for chronic
mental health conditions. In the study by Wafia et al., a high satisfaction rate among patients
(86.8% effectiveness) reflects telepsychiatry’s success in addressing accessibility and quality
concerns. Given that Saudi Arabia’s healthcare system has faced increasing demand for mental
health services, telepsychiatry offers a practical alternative to conventional in-person visits. For
patients with chronic conditions, whose needs often include sustained therapy and regular followup, telepsychiatry’s ability to streamline access is significant in maintaining continuity of care,
potentially reducing symptom severity and improving stability in mental health status.
The observational study by Khalil et al. highlights the logistical advantages telepsychiatry
affords, with over 75% of respondents recognizing its potential to improve access and save time
for both providers and patients. This logistical efficiency is especially valuable for chronic mental
health conditions, where frequent, uninterrupted care is essential. Despite these benefits, only
around 50% of participants viewed telepsychiatry as highly effective and reliable. This mixed
sentiment suggests that while telepsychiatry has made strides in improving outcomes for chronic
mental health care, further work is required to optimize service delivery, address technical
reliability issues, and enhance the depth of care that can be provided virtually.
6.1.2. Knowledge and Perception of Telepsychiatry among Psychiatrists
The study by Alghamdi et al. (2022) highlights a significant knowledge gap among
psychiatrists in Saudi Arabia regarding telepsychiatry, with 51.8% showing limited understanding
of its applications. This knowledge deficiency could impact clinical outcomes, as clinicians with
limited telepsychiatry experience may face challenges in delivering high-quality care via virtual

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means. Although 80.8% of the surveyed psychiatrists had a positive perception of telepsychiatry,
their knowledge gaps suggest the need for targeted educational programs to ensure that
psychiatrists feel fully equipped to use these platforms. This initiative could bolster the confidence
of practitioners, potentially leading to better patient engagement, adherence to treatment plans, and
overall clinical outcomes.
Alghamdi’s study also identified correlations between practitioners’ knowledge levels and
factors such as age, professional experience, and frequency of online interactions with patients.
This finding is especially relevant for chronic mental health care, where establishing rapport,
building trust, and maintaining regular communication are critical. By addressing these knowledge
gaps and promoting training, Saudi Arabia could optimize the efficacy of telepsychiatry in treating
chronic conditions, making telepsychiatry not only an adjunct but an integral part of long-term
mental health care.
6.1.3. Patient Satisfaction and Quality of Life
Wafia et al.’s (2022) study on patient satisfaction highlights an essential outcome measure: the
overall quality of life. Satisfaction with factors such as accessibility (56.6%) and safety (91.2%)
reveals that patients with chronic mental health conditions find telepsychiatry valuable for its
convenience and perceived safety. These satisfaction metrics suggest a favorable patient
experience, indicating that telepsychiatry contributes positively to patients’ quality of life by
reducing the stress associated with travel, wait times, and in-person visits. This is particularly
beneficial for patients with chronic conditions such as depression and anxiety, who may find travel
and prolonged waiting times exacerbating to their mental health symptoms. This emphasis on
satisfaction as an indicator of quality of life highlights the potential long-term benefits
telepsychiatry can provide for chronic conditions in a Saudi Arabian context. However,
satisfaction does not equate directly to clinical effectiveness, as the Khalil study suggests;
therefore, monitoring patient outcomes alongside satisfaction may be essential for holistic
evaluation.

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Theme (2): Barriers and Facilitators Affecting the Implementation and Acceptance of
Telepsychiatry among Patients and Healthcare Providers in Saudi Arabia
The implementation and acceptance of telepsychiatry in Saudi Arabia have been shaped by a
mix of significant barriers and facilitators. While there is a strong interest in telepsychiatry among
healthcare providers, as indicated in the studies reviewed, there remain various structural,
financial, and cultural challenges that hinder the widespread adoption of telepsychiatry services.
6.2.1. Key Barriers to Implementation and Acceptance
1. Lack of Awareness and Perceived Need for Telepsychiatry
The study by Al-Thebiti et al. (2017) found that although 59% of healthcare providers
demonstrated an interest in telepsychiatry, a significant 90% lacked awareness of its
potential benefits. This lack of awareness can be attributed to limited exposure to
telepsychiatry within healthcare settings and insufficient professional development
opportunities to increase familiarity with these systems. Additionally, 40% of respondents
did not perceive a strong need for telepsychiatry compared to traditional face-to-face visits,
which may stem from an established preference for conventional care models. This
perception highlights a cultural and institutional hesitancy that could be a significant barrier
in promoting telepsychiatry as an acceptable and effective long-term care model in Saudi
Arabia.
2. Infrastructure and Financial Constraints
The study by Alaboudi et al. (2016) identified several structural barriers, including
inadequate technological infrastructure and limited financial support for telepsychiatry
services. In Saudi Arabia, robust internet and technology infrastructure are not uniformly
available, particularly in rural and remote areas. This limitation restricts accessibility to
telepsychiatry services, reducing its efficacy for underserved populations. Furthermore,
financial constraints, including the cost of implementation and the need for sustainable
funding models, are pressing concerns. Telepsychiatry systems require substantial initial
investment and ongoing financial support, which can be challenging for healthcare
facilities with limited budgets or competing priorities.

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3. Regulatory and Cultural Barriers
According to Aldeghaither et al. (2022) and Alghamdi et al. (2022), regulatory
challenges and cultural considerations further complicate telepsychiatry implementation.
Regulations around patient privacy, data security, and licensure across jurisdictions are
critical to maintaining the integrity of telepsychiatry systems. However, these regulatory
frameworks in Saudi Arabia are still evolving and can vary widely, creating uncertainty
among providers and limiting the reach of telepsychiatry services. Culturally, there may
also be hesitancy among patients and providers to fully engage with telepsychiatry due to
concerns about the impersonality of virtual consultations and the potential lack of
therapeutic rapport, which is often emphasized in traditional in-person mental health
settings.
6.2.2. Facilitators Supporting Implementation and Acceptance
1. Positive Provider Attitudes and Willingness to Adopt
Despite barriers, findings from Al-Thebiti et al. (2017) indicate a promising level of
acceptance and willingness among providers to implement telepsychiatry (84%). This
openness suggests that providers recognize the potential benefits of telepsychiatry,
especially for increasing access to care in rural and underserved areas. The willingness
among younger healthcare providers, in particular, signals an opportunity to target
education and training efforts that will further enhance telepsychiatry knowledge and skills.
By building on this interest, healthcare facilities can foster a more supportive environment
for telepsychiatry, encouraging adoption and long-term integration into mental health
services.
2. Alignment with Saudi Vision 2030
The research by Aldeghaither et al. (2022) highlights that the Saudi Vision 2030
initiative has created a strong impetus for telepsychiatry adoption. Vision 2030’s focus on
digital transformation and improving healthcare accessibility aligns closely with the goals
of telepsychiatry. During the COVID-19 pandemic, for instance, there was rapid adoption
of telehealth services, which demonstrated the feasibility and effectiveness of
telepsychiatry in meeting mental health needs under pressing conditions. This alignment

51

with national priorities can serve as a powerful facilitator, as it encourages policy makers
to address financial and regulatory barriers and to promote telepsychiatry as part of broader
healthcare reforms.
3. Increased Accessibility and Resource Optimization
The potential of telepsychiatry to enhance healthcare accessibility is particularly
pertinent for individuals in remote or underserved regions where specialized mental health
services may be limited. Khalil et al. (2023) noted that over 75% of providers
acknowledged telepsychiatry’s role in improving access and saving time. This suggests
that telepsychiatry can effectively address geographic disparities in healthcare access,
reducing travel costs and improving the timeliness of care for patients with chronic mental
health conditions. In turn, the efficient use of resources facilitated by telepsychiatry could
help the Saudi healthcare system manage its resources more sustainably, especially in light
of the anticipated growth in mental health service demand.

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Theme (3): The Long-Term Impacts of Telepsychiatry on Patient Experience, Satisfaction,
and Overall Quality of Life in Individuals with Chronic Mental Health Conditions
The impact of telepsychiatry on patient experience, satisfaction, and overall quality of life for
chronic mental health patients in Saudi Arabia reveals an encouraging yet complex picture. As
demonstrated in recent studies, telepsychiatry has proven to be highly satisfactory and accessible,
with positive implications for the quality of life of patients who require regular psychiatric care.
However, there remain factors that influence satisfaction levels, such as technical stability and
individual preferences for in-person versus virtual consultations.
6.3.1. Patient Satisfaction and Experience with Telepsychiatry
Studies conducted at King Khalid University Hospital (Almalky & Alhaidar, 2021) and
through the Ministry of Health’s telemedicine services (Alfaleh et al., 2021) demonstrate high
patient satisfaction rates with telepsychiatry in Saudi Arabia. Almalky & Alhaidar’s study reported
that 94.3% of telepsychiatry patients expressed overall satisfaction, appreciating the ease of access,
comfort, privacy, and perceived competence of clinicians. These findings are significant, as
convenience and accessibility are particularly crucial for individuals with chronic mental health
conditions who require consistent, long-term care. Additionally, the increased sense of privacy in
telepsychiatry may have helped mitigate stigma, a common concern for mental health patients,
enhancing the overall experience and encouraging continued use of telepsychiatry.
Similarly, the study by Alfaleh et al. (2021), which surveyed users of telemedicine services
like the 937 Call Center and the Sehha Application, found high levels of satisfaction across aspects
such as communication and listening skills. The lower satisfaction with wait times (67.87%)
highlights a specific area where telepsychiatry services could be improved. Addressing wait times
through increased provider availability could further enhance satisfaction, making telepsychiatry
an even more reliable and appealing option for chronic mental health care in Saudi Arabia.
6.3.2. Preference for Virtual Consultations and Implications for Quality of Life
Al-Shareef & AlWabel’s (2024) nationwide study provides insights into patient preferences
and satisfaction across telehealth platforms, revealing a strong preference (over 90%) for virtual
consultations. This preference suggests that telepsychiatry may positively influence the quality of
life for patients by reducing the burdens associated with travel, waiting rooms, and time constraints

53

of in-person visits. Patients who are otherwise homebound, live in rural areas, or experience social
anxiety may particularly benefit from the flexibility and accessibility of telepsychiatry.
Moreover, the study found that although technical issues were occasionally reported, an
impressive 97.4% of participants were satisfied with their overall telehealth experience. This
indicates that telepsychiatry’s convenience and accessibility may outweigh technical challenges
for many users, especially for those in regular need of mental health support. However, the lower
satisfaction reported among younger participants, urban residents, specialty clinic patients, and
those consulting with psychologists suggests that these groups may require more tailored
telepsychiatry approaches to optimize their experience. These insights suggest that while
telepsychiatry is generally well-received, its long-term success may depend on addressing specific
subgroup needs, such as offering more reliable technical support or adjusting service delivery
methods.
6.3.3. Impact on Long-Term Quality of Life
For chronic mental health patients, continuity of care is essential to symptom management and
quality of life. The high satisfaction rates and positive user experiences reported across studies
imply that telepsychiatry is instrumental in maintaining consistent psychiatric support, which is
critical for managing chronic conditions. The results of Almalky & Alhaidar (2021) and Alfaleh
et al. (2021) suggest that telepsychiatry provides consistent access to care without the need for
frequent, potentially stressful in-person visits. Additionally, the findings of AlShareef & AlWabel
(2024) indicate that virtual consultations are not only convenient but are also viewed as effective
by most users, implying that patients experience tangible benefits from telepsychiatry that may
improve their overall quality of life.
However, it is also important to consider the effects of telepsychiatry on therapeutic rapport
and patient-clinician relationships. Chronic mental health patients may need to form a stable,
trusting connection with their clinicians to achieve long-term benefits from telepsychiatry. While
some patients report satisfaction with virtual interaction, others may find that the lack of physical
presence limits their ability to fully engage. Addressing this limitation may involve offering both
video and audio consultation options to suit individual preferences, ensuring that patients feel
comfortable with their mode of engagement, which in turn can foster better therapeutic alliances
and long-term benefits.

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Chapter 7: Conclusion and Recommendations

55

Conclusion and Recommendations
Conclusion:
The findings of this systematic review suggest that telepsychiatry holds substantial promise in
improving clinical outcomes, enhancing patient satisfaction, and providing accessible mental
health care for individuals with chronic conditions in Saudi Arabia. Evidence highlights
telepsychiatry’s ability to overcome logistical barriers, reduce wait times, and increase treatment
accessibility for underserved populations, thereby aligning with the objectives of Saudi Vision
2030. Telepsychiatry has demonstrated effectiveness in maintaining patient engagement and
delivering high-quality care remotely, which is crucial for individuals requiring ongoing support
for chronic mental health conditions.
However, the effectiveness of telepsychiatry remains uneven across several areas. While
patient satisfaction and general acceptance are high, challenges such as limited clinician
knowledge, technical issues, and infrastructural limitations affect its reliability. Financial
constraints, inadequate policy frameworks, and provider-related barriers further hinder widespread
adoption. Addressing these gaps is necessary for telepsychiatry to fully realize its potential as a
sustainable, long-term solution within Saudi Arabia’s mental healthcare system.
Recommendations:
1. Focused training programs should be developed to improve clinicians’ knowledge and
familiarity with telepsychiatry, addressing the knowledge gaps identified in this review.
Continuous education on telepsychiatry best practices will help enhance service delivery,
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