Telepsychiatry faces challenges in the Arab world because of regulatory aspects and cultural perspectives of Telemedicine. This study aims to evaluate outpatient mental health service utilization trends in United Arab Emirates (UAE) during and after the COVID-19 pandemic, focusing on modality preferences between remote (e-clinic) and in-person visits. The authors analyzed demographic and diagnostic factors influencing appointment choices, as well as no-show rates, to better understand patient engagement and inform future hybrid mental health-care models.
A retrospective observational analysis was conducted using data from Al Amal Psychiatric Hospital in Dubai, UAE, between January 2020 and December 2022. Outpatient visits were categorized as remote (e-clinic) or in-person. Variables included age, gender, nationality, education and primary psychiatric diagnosis. Diagnoses were coded using ICD-10. For patients with multiple diagnoses, the primary presenting complaint was used for analysis. No-show rates were compared across modalities. Statistical analysis included chi-square tests and descriptive statistics.
The authors analyzed 34,929 outpatient appointments between January 2020 and December 2022. During the pandemic, remote (e-clinic) appointments became the dominant modality, but this trend partially reversed after pandemic with increased in-person attendance. Overall, in-person visits had significantly lower no-show rates compared to remote appointments (p < 0.001). Female patients exhibited higher no-show rates for in-person visits, while male patients had higher no-show rates for remote visits. Older adults had lower no-show rates across both modalities. Patients diagnosed with schizophrenia and substance use disorder predominantly used in-person services, whereas patients with anxiety disorders showed higher uptake of remote care.
This study has several limitations. This study is a single-institution, retrospective analysis, which may limit generalizability. Clinical outcomes and patient satisfaction were not assessed, restricting conclusions about telepsychiatry effectiveness or acceptability. Potential confounders such as socioeconomic status, digital literacy and distance from health-care facilities were not captured. Appointment modality was partly determined by patient preference and clinician judgment, introducing possible selection bias. Additionally, no correction for multiple statistical comparisons was performed, increasing the risk of Type I error. Differences in wait times between remote and in-person appointments were not systematically recorded or analyzed.
This study provides actionable insights for health-care policymakers and providers in the UAE and similar contexts. The findings of this study support the integration of hybrid care models that combine remote and in-person psychiatric services, allowing flexible, patient-centered care delivery. Tailoring appointment modalities to patient demographics and diagnoses can optimize resource allocation, improve access and reduce no-show rates. Health systems should invest in telepsychiatry infrastructure, clinician training and digital literacy support for patients to sustain virtual services beyond the pandemic. Additionally, monitoring appointment modality trends can inform service planning and help address barriers to equitable mental health-care delivery.
The expansion of telepsychiatry has significant social implications, particularly in reducing stigma and improving mental health-care accessibility. Virtual services offer privacy and convenience making psychiatric care more acceptable to populations that may otherwise avoid treatment because of cultural or social barriers. This study highlights disparities in service use by age gender and education suggesting a need for targeted interventions to ensure equitable access. Promoting digital inclusivity and addressing the digital divide are essential to prevent exacerbating health-care inequalities. Broad adoption of hybrid models could reshape societal perceptions of mental health fostering a more open and inclusive care environment.
To the best of the authors’ knowledge, this study is the first large-scale analysis of mental health outpatient service utilization trends in UAE after COVID-19, focusing on remote versus in-person care modalities. This study provides novel insights into patient preferences, demographic and diagnostic influences on service uptake and no-show patterns across different visit types. By integrating conceptual frameworks such as the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology, this study adds theoretical value to the understanding of telepsychiatry adoption in the Gulf region. The findings offer practical guidance for developing hybrid mental health services in underrepresented health-care settings.
