SYSTEMATIC REVIEW article
Front. Public Health
Sec. Public Health Education and Promotion
A Systematic Review on the Psychological Factors Behind Vaccine Hesitancy in the COVID-19 Era
Provisionally accepted
Francesco Panico*
Rosalia De Biase
Laura Catalano
Isa Zappullo
FRANCESCA D'OLIMPIO
Luigi Trojano
Laura Sagliano- University of Campania Luigi Vanvitelli, Caserta, Italy
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ABSTRACT Background. Vaccine hesitancy may represent a global threat because of its inherent consequences for health, social and economic systems. Understanding the factors associated with vaccine hesitancy is fundamental to developing effective healthcare policies. While previous studies have mainly focused on sociological and cultural variables and transient illness-specific fears and beliefs, the present systematic review focuses on the psychological factors (such as emotional dispositions, cognitive functioning and expectations, and stable personality traits) associated with vaccine hesitancy during the COVID-19 era. Methods. A systematic review using a systematic search of PubMed, PsychINFO and Web of Science databases was performed with a time frame ranging between 1 January 2020 to 31 January 2025 focusing on psychological factors and vaccine hesitancy. Studies targeting the general population and employing validated instruments to assess emotional, cognitive and personality factors and vaccine hesitancy were selected, while investigations on context-specific, psycho-social, cultural and political factors were excluded. Quality and risk of bias in the selected studies was assessed using an adapted version of the Newcastle-Ottawa Scale, and main studies' characteristics, variables and outcomes were synthesised using a narrative approach and table. Results. Fourteen studies were finally included in the qualitative synthesis. The results showed that some variables such as depressive and anxiety levels, as well as emotion regulation strategies may affect vaccination behaviour, although some cultural and generational differences were also observed. Differences in cognitive flexibility, decision-making, and personal expectations may influence vaccine hesitancy. Notably, some personality factors, like extraversion, openness, conscientiousness and dark personality traits, may influence hesitancy to vaccinate. Conclusions. This review highlights emotional, cognitive, and personality factors associated with vaccine hesitancy, providing evidence for personalised, evidence-based interventions aimed at promoting adherence to national vaccination policies.
Keywords: Vaccine hesitancy, emotion, Cognition, Personality, COVID-19, Health, intervention
Received: 23 Sep 2025; Accepted: 24 Oct 2025.
Copyright: © 2025 Panico, De Biase, Catalano, Zappullo, D'OLIMPIO, Trojano and Sagliano. 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: Francesco Panico, francesco.panico@unicampania.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.