Are psychological status and trust in information related to vaccine hesitancy during COVID-19 pandemic? A latent class and mediation analyses in Italy.

Despite the recognized benefits of the COVID-19 vaccination, vaccine hesitancy (VH) remains one of the biggest challenges of the mass vaccination campaign. Most studies investigating VH determinants focused on socio-demographics and direct relationships. In this study, we aimed at: 1) identifying subgroups of people differently affected by the pandemic, in terms of psychological status; 2) investigating the role of psychological status and trust in information as possible mediators of the relationship between individual characteristics and VH. To this purpose, a latent class analysis (LCA) followed by a mediation analysis were carried out on data from a survey conducted in January 2021 on 1011 Italian citizens. LCA identified four different subgroups characterized by a differential psychological impact of the pandemic: the extremely affected (21.1%), the highly affected (49.1%), the moderately affected (21.8%) and the slightly affected (8%). We found that VH decreased with the increase of psychological impact (from 59.3% to 23.9%). In the mediation analysis, past vaccination refusal, age 45-54 years and lower-than-average income, were all indirectly related to higher VH through mistrust in COVID-19 information. Differently, the psychological impact counteracted the greater VH in females, the negative effect of social media among youngest (<35 years) and the negative effect of mistrust in the lower-than-average-income subgroup. Knowledge of psychological profile of hesitant individuals, their level of trust and the sources of information they access, together with their sociodemographic characteristics provides a more comprehensive picture of VH determinants that can be used by public health stakeholders to effectively design and adapt communication campaigns.