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The mental health of patients and clinicians during the COVID-19 pandemic

Oct. 20, 2020
Amber Auger, MPH, RDH, reflects on her own mental health journey through the COVID-19 crisis. She also looks at how to cope with the combination of pandemic stress and the coming wintertime.
October is not only National Dental Hygiene Month; it is also Mental Health Awareness Month. This year has challenged all of us in many ways, and a global pandemic has the potential to have multiple negative effects on one’s emotional and physical health. The CDC reports that anxiety was three times higher than normal in June 2020, while depression was four times higher.1

There are so many unknowns in our world, it becomes overwhelming if you do not have the right coping strategies. As the winter months approach and communities continue to further restrictions, we must understand the warning signs for depression and mental health illness—not only for patients but for ourselves and our community.

Depression is a complex condition that can be experienced during serious medical illness, can be episodic, and be chronic due to genetics. Depression can leave one feeling down from time to time, or can cause deep feelings of hopelessness and despair. Depression is more than just sadness in response to a hard day or a setback. Depression changes how one thinks, feels, and functions daily.

When women experience depression, it tends to manifest in feelings of guilt, excessive sleeping, overeating, and weight gain. When men experience depression, it tends to manifest in fatigue, difficulty sleeping, and loss of interest in work and hobbies.2 Depression in men can also manifest in substance abuse, anger, aggression, and reckless behavior.2

Other signs of depression include but are not limited to weight changes, sleep changes, irritability or anger, feeling of helplessness or hopelessness, loss of interest in daily activities, loss of energy, self-loathing, difficulty concentrating, and unexplained aches and pains.2

Dealing with depression

I am someone who has struggled with moderate anxiety and seasonal depression for years. Living in New England, the shorter dark days can easily push me into mild depression. The anxiety and depression have never gone away for me. I simply learn how to best manage it. I take one day at a time and focus on what I can control.

Therefore, the structure is key. I will make sure that I have a fun event, which I call a “funtivity,” planned at least once a week. Thankfully, Margo, my adorable dog, is as much of an extrovert as I am so our walks tend to involve multiple stops to check in on our neighbors. I purchased my first home last year, a townhouse that is one of 35 units. During quarantine, all of my travel stopped, and I was furloughed from my clinical position. There were a few dark days, and honestly, sometimes you simply need a day to acknowledge sadness and disappointment. I would not let myself stay there and my friends would not either. It is so easy to focus on the bad things if you do not have accountability.

Throughout the pandemic Margo and I would go on three- to four-hour adventures, and even though some days were chilly, we both bundled up. During this time, we met so many of our neighbors. One by one, they would come out and walk with my dog and me as we stayed six feet apart. We learned about one another and then followed up to support each other. Now, Margo has five houses that she always stops at to see if her friends are coming out. My neighbors became my family. I have bought groceries for my neighbors, driven them to doctor’s appointments, and shared meals with them. It is a unique network that I could not have dreamt of. 

What helps most is scheduling time with friends and getting outside during the day as much as possible. Scheduling outings is extremely helpful to decrease and prevent depression. The important part is keeping the commitment that was made; often when struggling with depression you may not want to feel like being around others, even on a Zoom call. Having social interaction is key to feeling supported. Research demonstrates that caring for others, caring for a pet, surrounding yourself with people who make you feel valued and heard, and seeking professional guidance can help to reduce depression. 

Mental health and the pandemic 

The Centers for Disease Control and Prevention surveyed 5,470 adults from June 24 to June 30th, 2020, and the results demonstrated that 31% of people had signs of anxiety and depression. At least one adverse mental or behavioral health symptom was reported by more than one-half of respondents who were aged 18–24 years (74.9%) and 25–44 years (51.9%), of Hispanic ethnicity (52.1%), and who held less than a high school diploma (66.2%), as well as those who were essential workers (54.0%), unpaid caregivers for adults (66.6%), and who reported treatment for diagnosed anxiety (72.7%), depression (68.8%), or PTSD (88.0%) at the time of the survey.1 Of those surveyed, 11% stated they seriously considered suicide, and research demonstrated that males are more prone to suicide.1 Every 40 seconds, someone dies from suicide and it is the 10th leading cause of death in the United States.3 Nationally, there has been a rise in suicides since the pandemic began.

Coping strategies 

The more you can move, the better. Exercise will increase endorphins and if you can be outside for it you will have double the benefits. Watching a funny TV show or movie can help to improve morale, and talking with friends or family, taking a long hot bath, and focusing on small tasks to achieve every day can help to decrease the feelings of depression.

Sleep is important for mental health and one should strive for eight hours daily; too much or too little sleep can negatively impact mood. Diets high in carbohydrates and sugar can increase anxiety, therefore implementing a well-balanced diet is critical. Both vitamin B and D have been shown to significantly improve mood and energy, therefore should be considered.

Mindfulness is an important factor, as our tendency to amplify the bad can easily increase when we are depressed. Mindfulness will help to identify negative thinking patterns and holding ourselves accountable to our thought life can significantly change our lives. Ask yourself questions like, “What would I tell a friend who had this thought?” to get perspective on the situation.2

As the second wave of the pandemic hits many communities, it is important to ensure that we can identify practical approaches to cope with the challenges of the ongoing pandemic. Many organizations can be of assistance to those struggling with mental health issues. Mental Health America is one of them. To determine resources closest to you, call 1-800-273-8255, a 24-hour crisis center. You can also call 1-800-985-5990 or text “TalkWithUs” to 66746 at the SAMHSA Disaster Distress Helpline. Trained crisis workers will listen to you and direct you to the resources you need. Don’t be afraid to reach out with a supportive hand to someone in your community, as you could save a life.


  1. Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1
  2. Smith M, Robinson L, Segal J. Coping with Depression. HelpGuide. Updated September 2020. https://www.helpguide.org/articles/depression/coping-with-depression.htm
  3. Robinson. Grappling with the rise of work-related suicide during the pandemic: How to support yourself and fellow coworkers. Forbes. September 5, 2020. https://www.forbes.com/sites/bryanrobinson/2020/09/05/grappling-with-the-rise-of-work-related-suicide-during-the-pandemic-how-to-support-yourself-and-fellow-coworkers/#1b6cda1548d2

Amber Auger, MPH, RDH, is a practicing dental hygienist and clinical innovations implementation specialist. With 14 years of experience in the dental industry, Auger works with practices to provide customized protocols, to refocus on the patient experience, and to utilize systemic approaches to periodontal therapy. She is a regular contributor to RDH magazine, a featured author for DentistryIQ, and host of #AskAmberRDH. Auger also provides preventive services abroad yearly and is always willing to have dental professionals join her team. She can be reached at [email protected].