Psychological Determinants of Academic Success in Anatomy: The Interplay of Anxiety, Depression, and Self-Esteem on Anatomy Examination Scores among Second-Year Medical Students

Objective: This study was conducted to determine the prevalence, inter-relationships, and determinants of self-esteem, anxiety and depression, and their impact on academic performance in Anatomy among second-year medical undergraduates of Rajarata University of Sri Lanka (RUSL). 
Methods: An analytical cross-sectional study was conducted among 184 second-year students selected based on total population sampling strategy. Data collection was done using a self-administered questionnaire containing GAD-7, Beck’s Depression Inventory (BDI) and Rosenberg Self-esteem Scale, along with questions to gather demographic information, Anatomy modular assessment grades and students’ perceptions. Data were analyzed using Pearson correlation, t-test and ANOVA.  
Results: Among 184 participants, majority (65.8%) were females. Anatomy final score ranged from 26.69 to 76.34 with a mean of 55.56 (±8.48). Female students performed significantly better than male students (p<0.05). Mean scores for self-esteem, anxiety and depression were 28.14 ±3.47 (scale 10-40), 6.33 ±4.07 (scale 0-21), and 9.66 ±7.46 (scale 0-63), respectively, with no significant gender differences. Self-esteem correlated negatively with anxiety (r=−.336, p<0.001) and depression (r=−.355, p<0.001), and positively with Anatomy final score (r=.245, p=0.001). Anxiety correlated positively with depression (r=.570, p<0.001). Significant association of depression was noted with the economic status and English language proficiency. Majority (71.7%) reported frequent module-based exams affected mental health. Peer support (83.7%) and faculty/staff support (95.1%) were perceived positively. 
Conclusion: High self-esteem correlated with better performance in Anatomy and lower levels of anxiety and depression. Though severe psychological distress is uncommon, perceived pressure from frequent module-based exams and socioeconomic factors call for institutional review and targeted mental health support.