This case study shows the reduction of depression, anxiety, and post-traumatic stress disorder measurement items using confirmatory factorial analysis and structural equation modeling. The researcher described the creation of an important scale of measuring only meaning in women with obstetric fistula. The analyses will show you how to reduce and manage latent variables for future research endeavors. The researcher’s original 33 items independently analyzed (9 depressions, 7 anxieties, and 17 post-traumatic stress disorder items) the mental health status of women with obstetric fistula to determine which items would be the most important at assessing meaning. The student will learn about confirmatory factorial analysis and determining structural equation modeling and why statistical procedure is essential for researchers who are interested in items reduction and alteration. The case study reviews the basic concepts and application of confirmatory analysis and structural question modeling. This study is an extension of articles published in BMC Psychiatry.