Background: Depression and anxiety is well established as a prevalent mental health problem in end-stage renal disease patients treated with hemodialysis. However these problem remains difficult to assess and is undertreated. Aims & Objective: To assess the demographic and psychological factors associated with depression among hemodialysis patients and elucidated the relationships between depression, anxiety, fatigue, poor health-related quality of life, and increased suicide risk. Method: This cross-sectional study enrolled 150 end-stage renal disease patients age >18 years on hemodialysis. Psychological characteristics were assessed with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the short-form Health-Related Quality of Life Scale, and Chalder Fatigue Scale, and structural equation modeling was used to analyze the models and the strength of relationships between variables and suicidal ideation. Results: Of the 150 patients, 70 (46.6%) had depression symptoms, and 43 (28.6%) had suicidal ideation in the previous month. Depression was significantly correlated with a low body mass index (BMI) and the number of co morbid physical illnesses. Depressed patients had greater levels of fatigue and anxiety, more common suicidal ideation, and poorer quality of life than nondepressed patients. Results revealed a significant direct effect for depression and anxiety on suicidal ideation. Conclusion: Among hemodialysis patients, depression was associated with a low BMI and an increased number of comorbid physical illnesses. Depression and anxiety were robust indicators of suicidal ideation. A prospective study would prove helpful in determining whether early detection and early intervention of comorbid depression and anxiety among hemodialysis patients would reduce suicide risk.