Publication date: Dec 01, 2025

This study aims to examine the parents’ COVID-19 vaccine hesitancy after the end of the zero-COVID-19 policy in South China, and to identify the pathway of psychological distress affecting vaccine hesitancy based on the “3C” model (confidence, complacency, and convenience). A city-wide cross-sectional survey was conducted among parents of children in primary and junior middle schools from five districts of Shenzhen City, China. Information about demographic characteristics, health conditions for the children, parents’ psychological distress, and COVID-19 vaccine hesitancy was collected. Multi-variable logistic and linear regression models were applied to detect potential associations. Overall, 3127 parents were included (average age: 38. 331 +/- 5. 757 years). Among their in-school children, the uptake rate of the COVID-19 vaccine for ≥1 dose, ≥2 doses, and ≥3 doses were 98. 2%, 94. 9%, and 11. 0%, respectively by April 2023. The overall rate of parents’ vaccine hesitancy was 43. 6%. Parents with anxiety (OR: 1. 685, 95%CI: 1. 250 ~ 2. 272), depression (OR: 1. 507, 95%CI: 1. 105 ~ 2. 054), and a high-stress level (OR: 1. 162, 95%CI: 1. 000 ~ 1. 350) were more likely to report vaccine hesitancy. For parents’ COVID-19 vaccine hesitancy, stress affected all “3C” dimensions (confidence: β = 0. 099, complacency: β = 0. 138, and convenience: β = 0. 117, all P < .001), while depression affected two dimensions (complacency: β = 0. 068, P < .001, convenience: β = 0. 042, P = . 021) and anxiety only affected one dimension (complacency: β = 0. 074, P < .001). This study identifies a significant proportion of Chinese parents reporting COVID-19 vaccine hesitancy for their in-school children after the end of zero-COVID-19 policy. Immediate mental healthcare services and tailored health education based on the "3C" model should be provided to parents with psychological distress.

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