Figure 4

Causal and mutual relationships with FAMS emotional well-being score. The standardized total effect of EDSS on FAMS emotional well-being score is -.32, which consists of a standardized direct effect of -.16 and a standardized indirect effect of -.15. EDSS scores negatively affect the FAMS emotional well-being scores directly, while changes in personal income score positively affect this score directly. Changes in employment status and EDSS scores negatively influence NAS-J anxiety/depression, self-esteem, acceptance, and attitude scores as well as the number of sources of disease information score, and the knowledge of disease information score positively influences the NAS-J anxiety/depression, self-esteem, acceptance, and attitude scores. Changes in employment status, number of sources of disease information, and knowledge of disease information scores indirectly affect FAMS emotional well-being score through the NAS-J anxiety/depression, self-esteem, acceptance, and attitude scores. EDSS scores affect the FAMS emotional well-being score directly and indirectly through the NAS-J anxiety/depression, self-esteem, acceptance, and attitude scores. d1, e1, e2, e3, e4, and e5 in the figure are error terms. Numbers are standardized path coefficients, and asterisks (*) indicate statistical significance (p < 0.05).