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Saudi Electronic University
Health Sciences Collage
Master of Healthcare Administration
HCM 600 Research Project
Examining The Long-Term Interventions Effects of Telepsychiatry on Chronic Mental
Health Conditions in Saudi Arabia: Systematic Review
A Research Project
Submitted in Partial Fulfillment of the Requirements for the Degree
(MSc of Healthcare Administration)
Presented by:
Rehab Nawaf Alharbi
ID: ………………………
Supervisor:
Dr. Danyah A Aldailami
Date: 25/10/2024

Declaration
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.

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.

Table of Contents
Declaration

Acknowledgement

iii

Table of Content

ivii

List of Abbreviations

List of Tables

List of Figures

Chapter 1: Introduction

Chapter 2: Literature Review

Chapter 3: Objectives

Chapter 4: Materials and Methods

Chapter 5: Results

Chapter 6: Discussion

Conclusion

Recommendations

References

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

IRB

Institutional Review Board

DSM-5

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

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.
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.
Recommendations: Enhancing clinicians’ knowledge and familiarity with telepsychiatry is
crucial for effective service delivery and addressing identified knowledge gaps. Investing in
technological infrastructure and support is essential for providing a seamless and satisfactory patient
experience in telepsychiatry.
Keywords: Telepsychiatry, Chronic Mental Health, Saudi Arabia, Long-term Interventions

Chapter 1: Introduction

Introduction
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, Win, & Vlahu-Gjorgievska, 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 (American Psychiatric Association, 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).
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).
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
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).
While short-term telepsychiatry interventions have demonstrated benefits such as increased
accessibility, treatment adherence, and patient satisfaction, the long-term impacts of these
interventions on chronic mental health conditions remain underexplored, particularly within the
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.
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.

Objectives
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?

Chapter 2: Literature Review

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).
2.1. 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)

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).
Factors impact (Impact of Telepsychiatry on Healthcare Systems in Saudi Arabia)
Barrires and the challenges advange and disadvange

2.2. Consolidated Thematic Analysis of Telepsychiatry’s Impact on Chronic Mental Health
Conditions
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.
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.
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.
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.
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.
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 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.
Future Directions and Hybrid Models
Given the complementary strengths of telepsychiatry and in-person 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).
Conclusion
Telepsychiatry has emerged as a transformative tool in addressing chronic mental health
conditions, offering improved accessibility, patient satisfaction, and adherence to treatment.
However, to maximize its potential in regions like Saudi Arabia, cultural considerations,
technological infrastructure, and regulatory frameworks must be prioritized. A hybrid care model
that integrates the strengths of both telepsychiatry and in-person treatment may pave the way for
comprehensive and inclusive mental health services.

2.5. Systematic Review of 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 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
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).

Chapter 3: Objectives

Objectives
General Objective
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 Objectives
4) To assess the effectiveness of telepsychiatry interventions in improving clinical outcomes
for individuals with chronic mental health conditions in Saudi Arabia.
5) To identify and analyze the barriers and facilitators affecting the implementation and
acceptance of telepsychiatry among patients and healthcare providers in the Saudi Arabia.
6) 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
4) What are the long-term clinical effects of telepsychiatry on chronic mental health
conditions in Saudi Arabia?
5) How do patient satisfaction levels with telepsychiatry compare to those of traditional inperson psychiatric care in Saudi Arabia?
6) What are the key barriers and facilitators affecting the implementation of telepsychiatry for
chronic mental health conditions in Saudi Arabia?

Chapter 4: Materials and Methods

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.

Table (1): Database Sources:
No.

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 peerreviewed 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
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.

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.
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:

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

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

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.

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.

Chapter 5: Results

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

Details

Research Title

Telepsychiatry: knowledge, effectiveness, and willingness; assessments of
psychiatrists in Saudi Arabia

Objective

Assess psychiatrists’ knowledge and perceptions of telepsychiatry and their
willingness to adopt it in Saudi Arabia.

Study Design

Cross-sectional study

Study Period

November 2020 – May 2021

Participants
Age Range

328 psychiatrists in Saudi Arabia
Predominantly 25–35 years (48.8%)

Nationality

Majority Saudis (83.5%)

Gender

Male (70.4%) and Female (29.6%)

Key Variables

Knowledge, perception, willingness, barriers, and effectiveness of
telepsychiatry

Data Collection
Data Analysis

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

Category

Details

Knowledge Level

Poor: 51.8%, Good: 48.2%

Perception Level

Good: 80.8%, Poor: 19.2%

Key Influences

Higher knowledge among older psychiatrists, consultants, those with 11–15
years of experience, and frequent online patient interactions

Conclusion

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)

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

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.

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%

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.

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.

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

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)

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.

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.

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.

Chapter 6: Discussion

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
follow-up, 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

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.

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.

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

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.

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

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.

Chapter 7: Conclusion and Recommendations

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,
making it more effective and consistent.
2. Investments in telepsychiatry infrastructure are crucial, including improving internet
connectivity, digital platforms, and technological support to ensure a seamless patient
experience. Technical support tailored for younger and urban users should also be
prioritized to maximize satisfaction and service usage.
3. Financial constraints were noted as a major barrier to telepsychiatry implementation.
Policymakers should consider establishing

reimbursement models specific to

telepsychiatry, alongside regulatory guidelines that address data security, patient privacy,
and provider accountability.

4. Public awareness initiatives can help normalize telepsychiatry and mitigate any lingering
concerns about virtual care. Increasing awareness of telepsychiatry’s benefits may boost
acceptance among both patients and healthcare providers.
5. To sustain satisfaction and optimize outcomes, telepsychiatry services should be adaptable,
offering both video and audio consultation options. Reducing wait times and tailoring
support based on patient demographics, including age and geographic location, can further
enhance service delivery.
6. Further studies are needed to assess the long-term impact of telepsychiatry on clinical
outcomes, quality of life, and therapeutic rapport. Comparative studies between
telepsychiatry and traditional in-person care could provide a clearer understanding of areas
where telepsychiatry excels or requires adaptation.

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