Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 3 2026 06 17 282 290 Alaa Neamah Pediatric Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. Qasim Kadhim Ashour Kadhim Ashour Pediatric Nursing Department, College of Nursing, University of Kerbala, Kerbala, Iraq. Enas Ahmed Abdel Karim Pediatric Nursing Department, College of Nursing, University of Al-Qadisiyah, Al-Diwaniyah, Iraq. Al-Musawi Matsher Pediatric Nursing Department, College of Nursing, University of Baghdad, Baghdad, Iraq. 2026 05 11 2026 06 08 Objective: To assess levels of self-esteem, social anxiety, and affective lability among pediatric nursing students; to examine their associations with academic achievement; and to test whether social anxiety and affective lability mediate the self-esteem–achievement relationship. Method: A descriptive cross-sectional study was conducted among 370 nursing students aged 17-24 years using purposive sampling. Instruments included the Coopersmith Self-Esteem Scale (self-esteem), the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), the Affective Lability Scale (ALS-18), and academic achievement records from the pediatric nursing course. Sociodemographic variables were also collected. Data were analyzed using Pearson correlations and mediation analysis with Hayes PROCESS Model 4. Results: Students demonstrated moderate self-esteem, mild-to-moderate social anxiety, and clinically notable affective lability (mean ALS-18 = 42.3 ± 11.7; scores > 40 indicate clinically notable emotional dysregulation). Self-esteem showed a significant positive correlation with academic achievement (r = 0.42, P < 0.01). Social anxiety (r = -0.38, P < 0.01) and affective lability (r = -0.36, P < 0.01) were each negatively correlated with both self-esteem and academic achievement. Mediation analysis revealed that social anxiety and affective lability partially mediated the relationship between self-esteem and academic achievement (indirect effect = 0.19, 95% CI: 0.08 to 0.33), accounting for 41% of the total association between self-esteem and academic achievement (proportion mediated = 0.41). No significant associations were found between sociodemographic variables and self-esteem. Conclusion: Self-esteem is positively associated with academic achievement among pediatric nursing students. Cross-sectional mediation analysis indicates that this association is statistically consistent with a model in which social anxiety and affective lability together account for 41% of the total association. However, causal interpretation requires longitudinal replication. Psychiatric screening for emotional dysregulation and social anxiety using validated tools such as the ALS-18 and LSAS may help identify at-risk students, but experimental studies are needed to test whether interventions targeting these constructs improve academic outcomes. https://ijps.tums.ac.ir/index.php/ijps/article/view/4614 https://ijps.tums.ac.ir/index.php/ijps/article/download/4614/1343