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Background Parental attitudes towards the vaccines play a key role in the success of the herd immunity for the COVID-19. Psychological health seemed to be a controversial determinant of vaccine hesitancy and remained to be investigated. This study attempted to measure parental psychological distress, attitudes towards the COVID-19 vaccine, and to explore the potential associations. Methods An online survey using convenience sampling method was conducted among parents within the school public health network of Shenzhen. Demographic information and attitudes towards COVID-19 vaccination were collected. The Patient Health Questionnaire (PHQ-4) was applied to measure psychological distress. Results Overall, 4,748 parents were included (average age: 40.28, standard deviation: 5.08). More than one fifth of them demonstrated psychological distress, in which only 3.3% were moderate to severe symptom. The proportions of COVID-19 vaccine hesitancy for themselves, their spouses, and their children were 25.2%, 26.1%, and 27.3%, respectively. Parents with psychological distress were more likely to suffer vaccine hesitancy for themselves (OR: 1.277, 95%CI: 1.091∼1.494), for their spouses (OR:1.276, 95%CI: 1.088∼1.496) and children (OR:1.274, 95%CI: 1.092∼1.486). These associations tended to be more significant among parents with mild or severe psychological distress. Limitation Non-random sampling limited the generalization of our findings to all parents. Conclusion Parents had a low level of psychological distress but relatively high willingness of COVID-19 vaccination when there was no local epidemic but persistent risk of imported cases. Targeted health education and intervention strategies should be provided to people with vaccine hesitancy, especially for those who were susceptible to psychological distress.

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