Perception of Telepsychiatry in Saudi Adults with Major Depressive Disorder and Validation of the Telehealth Satisfaction Scale: A Cross-Sectional Study

<b>Background:</b> Telepsychiatry expanded rapidly during the COVID-19 pandemic, yet patient experience data from mixed urban and rural areas in Saudi Arabia remain scarce. <b>Objective:</b> We aimed to quantify the perception of telepsychiatry among adults with major depressive disorder [MDD] in Madinah City, the KSA, and to identify associated demographic and clinical factors. <b>Methods:</b> A cross-sectional survey was conducted at Madinah Mental Health Hospital between December 2024 and March 2025. Eligible participants were Arabic-speaking adults [≥18 years] with a clinician-confirmed diagnosis of major depressive disorder [MDD] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], following a scheduled video- or audio-based telepsychiatry consultation. Perception of telepsychiatry was assessed using the validated 10-item Arabic version of the Telehealth Satisfaction Scale [TeSS], which evaluates audiovisual quality, communication, and support. Variables associated with perception at <i>p</i> < 0.20 in the bivariable analyses were entered into a multiple linear regression model to identify independent predictors. <b>Results:</b> Of the 218 eligible patients, 207 participated [response rate = 95%], with similarly high participation rates being reported in comparable telepsychiatry surveys [e.g., 90-91%]. The majority were male [59%], with a mean [SD] age of 38.4 [11.2] years. The mean satisfaction score was 32.3 ± 6.3, and 36% of participants were classified as highly satisfied. In the multivariable analysis, higher satisfaction was independently associated with male gender [B = 3.0, 95% CI: 1.3-4.7], intermediate versus elementary education [B = 4.3, 95% CI: 1.1-7.6], and the presence of a chronic illness [B = 2.1, 95% CI: 0.3-3.8]. <b>Conclusions:</b> Telepsychiatry is generally well-accepted among adults with depression in Madinah. However, women and individuals with lower educational attainment report lower satisfaction. Targeted interventions such as improving privacy, offering digital literacy support, and tailoring communication may help improve the telepsychiatry experience for underserved groups.