Implicit versus explicit ambivalence: differential association with depressive and anxiety symptoms and guilt in family caregivers of people with dementia

OBJECTIVES: Family caregivers of people with dementia often experience ambivalent feelings toward their relative, which have been linked to higher depressive and anxiety symptoms, guilt, and greater reports of behavioral and psychological symptoms of dementia (BPSD). Most previous studies have relied on explicit reports, which may not fully capture conflicted emotions. This study assessed caregivers' implicit ambivalence using an evaluative priming task and examined its associations with explicit ambivalence, depressive and anxiety symptoms, guilt, and BPSD. METHOD: Ninety-four family caregivers completed an evaluative priming task in which the name of their relative with dementia preceded positive and negative target words. The task yielded an implicit ambivalence index and allowed classification of caregivers as implicitly ambivalent, implicitly negative, implicitly positive, or undifferentiated. RESULTS: Explicit and implicit ambivalence were both associated with depressive and anxiety symptoms, although they were not intercorrelated. Implicitly ambivalent caregivers reported higher depressive and anxiety symptoms and greater reactivity to memory-related BPSD than the other groups, whereas guilt was exclusively related to explicit ambivalence. CONCLUSION: Both explicit and implicit ambivalence are linked to caregivers' emotional distress; however, only explicit ambivalence appears to evoke guilt by challenging caregivers' perceptions of meeting moral or social standards.