Background and Objectives: The evaluation and accurate recognition of all the needs and problems of patients, including spiritual needs, are inevitable to increase the quality of nursing care. This study aimed to evaluate the spiritual needs and their association with anxiety and depression in the elderly with chronic diseases. Methods: This cross-sectional analytical study was conducted on 100 patients with chronic diseases above 60 years of age. The subjects were selected through convenience sampling in the two hospitals of Qom, Iran, in 2017. Data collection tools were demographic characteristics questionnaire, as well as the questionnaire of spiritual needs and hospital anxiety and depression scale. Results: In this study, the mean age of the subjects was 65.4±5.2 years. All the patients were reported with at least a spiritual need. The highest score related to the item of "requesting help from God" was 2.31±0.76, whereas the lowest score related to the item of "talking with others about the life after death" was 0.66±0.98. The results of regression analysis demonstrated that among the variables entered into the univariate model, the two variables of depression and disease duration had a significant relation with spiritual needs. Conclusion: Unmet spiritual needs were reported high in the elderly with chronic diseases, and depression, as well as disease duration, were the effective factors in the spiritual needs of the elderly with chronic diseases. Therefore, the spiritual needs of patients with chronic diseases should be considered in clinical care in order to identify potential therapeutic ways to support and stabilize their emotional state.