ORIGINAL RESEARCH article
Front. Psychol.
Sec. Personality and Social Psychology
Paranoia affected COVID-19 vaccine refusal by increasing beliefs in conspiracy theories and mistrust of science
Provisionally accepted
Luca Simione1,2*
Monia Vagni3,4
Tiziana Maiorano3
Valeria Giostra3
Daniela Maria Pajardi3*
Jan-Willem Van Prooijen5- 1UNINT - Università degli studi Internazionali di Roma, Roma, Italy
- 2Istituto di Scienze e Tecnologie della Cognizione Consiglio Nazionale delle Ricerche, Rome, Italy
- 3Universita degli Studi di Urbino Carlo Bo Dipartimento di Studi Umanistici, Urbino, Italy
- 4Universita degli Studi di Perugia Dipartimento di Filosofia Scienze Sociali Umane e della Formazione, Perugia, Italy
- 5Vrije Universiteit Amsterdam Afdeling Experimentele en Toegepaste Psychologie, Amsterdam, Netherlands
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Psychological determinants of COVID-19 vaccination have been widely studied since the onset of the pandemic, yet little is known about how these factors evolved once vaccines became available. This study addresses this gap by examining psychological predictors of vaccination attitudes and behavior during Italy's third wave (spring 2021), a phase marked by widespread vaccine access and persistent public uncertainty. A total of 375 adults completed standardized measures of anxiety, depression, death anxiety, paranoia, mistrust in science, mistrust in scientific communication, and conspiracy beliefs. Vaccine intentions were assessed through perceived usefulness and safety, and by actual uptake. Using structural equation modeling with Huber-White robust estimation and bias-corrected bootstrapping, we tested a mediation model linking psychological factors to vaccine evaluation and behavior. Results showed that paranoia exerted a significant indirect effect on both vaccine evaluation and uptake, mediated by mistrust in science and conspiracy beliefs. Death anxiety displayed a small but direct positive association with vaccination behavior. These findings indicate that while contextual factors such as vaccine availability shape overall attitudes, paranoia and related distrust remain stable psychological barriers to vaccine acceptance. The study extends prior research by clarifying how enduring cognitive biases interact with situational context to influence vaccination decisions, with implications for public health communication strategies.
Keywords: Vaccination hesitancy, paranoia, COVID-19 vaccines, Mistrust, psychologicalfactors
Received: 04 Oct 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Simione, Vagni, Maiorano, Giostra, Pajardi and Van Prooijen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Luca Simione, luca.simione@gmail.com
Daniela Maria Pajardi, daniela.pajardi@uniurb.it
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.