Identifying the effective factors on depression in patients with multiple sclerosis using structural equation modeling approach: The role of stress, self-esteem, and mindfulness

 The purpose of this study was to identify the effective factors that are related to depression in people with multiple sclerosis (MS).  This study utilized a cross-sectional, descriptive, and correlational design. Statistical population of this research included all patients with MS in Mazandaran Province, Iran, in 2016. The sample consisted of 147 patients who were selected via the available sampling method. For data collection, the Depression, Anxiety, and Stress Scale-21 items (DASS-21), Rosenberg Self-Esteem Scale (RSES), and Freiburg Mindfulness Inventory-Short Form (FMI-SF) were administered for all patients. Then the data was analyzed via SPSS and AMOS software using confirmatory factor analysis (CFA) and structural equation modeling (SEM).  The results of the CFA to review the construct validity of the questionnaires indicated that the model was consistent with the data. SEM indicated that self-esteem served as a mediator between both stress and depression. Also, mindfulness had the role of mediator variable in the relationship between self-esteem and depression.  This study adds to the existing literature by providing SEM for depression in patients with MS. Theoretical and practical implications of presented results and model are also discussed.