Introduction

Adolescence, between 10 and 19 years old (^{WHO, 1986}), represents a special moment in human development that occurs when individuals go from childhood protected by parents to start the process of social independence. This transition tends to be facilitated by major psychosocial, hormonal and neuronal changes, which allow adolescents to gain the experiences and skills they need to navigate the adult world (^{Fatori et al., 2018}).

However, this plasticity also burdens adolescents with greater vulnerability to mental health problems. Regulatory growth and increased vulnerability are driven in part by an increase in exploratory and risk behavior (^{Teixeira, Couto & Delgado, 2017}).

Due to this increase in exploratory behavior, broader socio-environmental influences, such as the neighborhood, may have stronger effects on adolescents than in children (^{Evans et al., 2020}).

The economic and demographic benefits of health promotion practice for adolescents are evident, increasing school productivity, reducing health costs and ensuring a future with more health for young people (^{WHO, 2017}).

Health promotion programs focused on the school environment have the possibility of offering a large number of actions, from care inherent to primary health care, needs for interventions in acute problems to mental health, sexual health, counseling on substance use, and health promotion (^{Kitchen, 2017}).

In this respect, school health services have the potential to offer easy access to adolescents in their daily environment, and school health nurses are important providers of health services for children and adolescents (^{Kivimäki et al., 2019}; ^{Anttila et al., 2021}).

In this context, schools constitute environments where mental health can be promoted with the aim of improving well-being and where mental health care can be offered (^{Bjørnsen et al., 2018}). In particular, because about 10 to 20% of young people aged 10 to 24 years suffer from mental health problems, and 63-86% of all mental health problems requiring a diagnosis are generally not detected (^{Kieling et al., 2011}; ^{Evans-Lacko et al., 2018}).

Thus, mental health interventions for adolescents can be developed in a school environment, because each adolescent tends to spend the vast majority of their time in this place, where schools can still be considered as facilitating environments of contact with young people (^{Richter, 2022}).

Health promotion activities in the school environment are part of the scope of primary health care assignments, where the promotion of mental health in school adolescents is gaining an increasingly relevant role in which the use of mental health promotion strategies offered in the school environment has been increasingly necessary (^{Appleton et al., 2022}; ^{Richter, 2022}).

Study conducted by ^{Souza et al. (2021}) identified a gap in the literature regarding adolescent health promotion productions in Latin America. It also found the absence of proposals that take into account local demands and the participation of different actors, including adolescents, in the definition of the proposed strategies.

Considering the increased prevalence of psychological distress among adolescents (^{WHO, 2017}), it is necessary to develop studies and build strategies for promoting the mental health of this population. The objective of this research was to characterize the emotional demands of adolescents from a public school in the city of Niterói, referred to the Family Health Strategy and to describe the knowledge about protective factors of mental health among adolescents.

Materials and methods

It is a qualitative research, of participatory approach, from the Sociopoetic perspective - a research method developed in the 90's by the French pedagogue and philosopher Jacques Gauthier - having as principles that all knowledge is equal in law and that it is possible to make research an event of creation; the importance of the body in the construction of the imaginary; the importance of dominated cultures, their categories and the concepts produced by them; the role of artistic creativity in the construction of knowledge; the importance of the subjects as co-responsible for the knowledge produced; and the importance of the spiritual, human and political sense, forms and contents of knowledge (^{Tavares, 2016}).

A survey of mental health demands was conducted in a public school in the city of Niterói, Rio de Janeiro-Brazil, with a view to developing strategies to promote mental health.

The estimated population of the municipality was 516,981,000 inhabitants in 2021, and in 2020 there were 19,631 enrolled in high school in 95 schools (^{IBGE, 2021}). It should also be noted that the total coverage of primary health care units that could offer support with health promotion activities of schoolchildren in December 2020 was about 80 establishments (^{Brazil, 2022}).

The research was based on the perspective that adolescents are creative, critical and powerful to find ways to resolve their conflicts and that for this they only need support. Thus, this research valued the adolescent's knowledge, their processes of creation and interest for the construction of knowledge in view of the effectiveness of artistic interventions to reduce the stigmas related to problems that affect their mental health and promotion measures based on widely validated scientific evidence (^{Gaiha et al., 2021}).

This study had as theoretical support the Deleuzian aesthetics. It is a theoretical perspective that assumes that models and strategies of health promotion understand health as positivity, power-intensity, as a way of thinking that unfolds about “works” and takes them as testimonies of an issue that refers to the sensitive dimension and the power of thought (^{Rancière, 2000}). In this study, this study also finds its epistemological parameters in the field of Institutional Analysis, in the studies on “The Three Ecologies” (^{Guattari, 2007}) and in the cartographic method (^{Deleuze & Guattari, 1997}), indicating the relevance of an ethical-aesthetic paradigm in which the body is a cross-sectional-directing vector.

The inclusion criteria for the study were: being a school student in adolescence, being enrolled in high school at a public school in the city of Niterói-RJ, which was part of the coverage area of primary health care. Thus, the AT school was defined as the locus of the study. Exclusion criteria were: being over 19 years of age; refusal to participate in the research; inability to communicate verbally in Portuguese.

The data were produced in 2021 through a semi-structured interview in a single meeting planned in advance, in which the workshop through group activity had the participation of 30 adolescent students, aged between 13 and 16 years, invited from two classes of students, who wished to participate by free choice during the period of school activity, in a small court of the school itself where the emotional demands of adolescents were approached through a workshop by a group activity created by the researchers themselves, called the “Olympics of Emotions”, considering that in 2021, the same year of data production, the 32^nd edition of the Olympic Games was held. The dynamics were applied in three stages and lasted three hours.

Initially, the students were welcomed, in a court with chairs arranged in circles. Some students have made themselves available to help organize the environment. Some tables were placed with creative materials, snacks and flowers. We distributed some posters on the walls, implementing an “environment” of Olympiad with scores and orientations of the activities.

In the first stage of the group activity, the participants were offered the composition of three teams with 10 participants each. They split in space forming 3 circles. Each group was asked to choose a name for their team. Then offered a card to write the name of each team and then we pasted them on a poster made by us - “Olympic Scoreboard”. Team I, with 10 participants, chose the name “Fire Fox”, team II, formed by nine students, was called “Cead Group”, and team III, composed of 11 participants - “Inside Out”.

In the second stage, blank post sticks are distributed to each participant, asking them to ask questions related to the doubts they have about their emotions and mental health. The questions were placed in a box, later some were drawn and discussed with the adolescents. The answering groups earned points in the game to allow a situational diagnosis regarding questions of interest about emotions and mental health.

In the third stage, we present to the group a set of five themes, initially proposed by two adolescents taken as research consultants. The groups were instructed to choose three of the proposed themes, since time would not allow all issues to be addressed. The following themes were suggested: a) female empowerment; b) family conflict and toxic relationships; c) suicide prevention; d) bullying; e) control of stress and anxiety. The themes chosen were in order of priority: e, b, c. For each theme, an activity was proposed. For “e” activity - music, performance and dance; “b” - theater; “c”- poster and cut-out collage.

Regarding the production of the data, participants were asked to express their ideas about emotions and mental health from the proposed playful activities.

Ethical aspects, the research is approved in the Ethics Committee, opinion CAAE 42569921.5.0000.5243. Participation was authorized by those responsible for education. At the beginning of the activity we explained the objectives of the workshop to the participants and authorization was requested to perform records through image, video and sound (guaranteeing the right to anonymity). None of the participants objected.

Results

The presentation of the results was performed based on the systematization of the results found in each of the stages of the Olympics of Emotions.

In the first stage of the activity, the school adolescents were welcomed where arrangements were made for the organization and the appropriate explanations, where the participants were proposed the composition of 3 teams forming 3 circles, choosing a name for their team.

The second stage sought to make a situational diagnosis regarding the identification of topics of interest to adolescents about mental health and emotions.

To facilitate its execution, the third stage was divided into three phases:

Discussion

The school environment has represented, through its mechanisms of operation, a device of social participation and development of citizenship processes. Understood as a space that is a health promoter due to its potential to arouse healthier and more creative forms of existence in the world and sociability. Because they are more accessible and natural than health services, the school provides adolescents with interventions that are less stigmatizing (^{Vieira et al., 2020}).

^{Denny et al. (2019}) corroborates this argument, stating that the development of actions in contexts that adolescents are already and attend can facilitate the development of actions directed to them, including those of mental health promotion.

Understanding the doubts of school adolescents about mental health issues can serve as support to health professionals, especially those of primary care, to identify potential needs of this public. From the analysis of questions of interest about adolescents’ emotions and mental health (table 1), it is possible to identify anxiety as the main topic of interest related to mental health.

Adolescence is a phase associated with high reactivity and emotional instability. Depressive and anxiety symptoms are quite frequent in our society, also focusing on adolescence. Anxiety in adolescence is usually associated with the development of other psychopathologies in adulthood, such as depression, anxiety disorders, substance use and school or social maladjustment (^{Grolli, Wagner & Dalbosco, 2017}).

By identifying the needs of information/knowledge of adolescents’ mental health, it is possible to design potential health education actions and socioemotional learning programs at school and in health units, which can improve the adolescent’s understanding of their emotions and sufferings. In this regard, it is increasingly necessary that primary health care professionals guide adolescents about the causes of the development of anxiety disorders, and that these may involve complex interactions between biological, environmental and individual factors, as well as individual characteristics, such as genetic influence and temperament (^{Fusar‐Poli et al., 2021}; ^{Rentala et al., 2019}).

It is also worth noting the relevance of PHC professionals to bring school adolescents knowledge about how selective physical exercises can reduce the incidence of anxiety disorders. Furthermore, that universal psychological/psychoeducational interventions can improve anxiety symptoms, but do not prevent depressive/anxiety disorders, while universal physical exercise can reduce the incidence of anxiety disorders (^{Huang et al., 2021}; ^{Campos et al., 2019}).

Regarding the discussions about dealing with stress and anxiety, it was possible to identify the music as the main means used by school adolescents to deal with these situations and at the moment they were instructed to choose a song to sing together, both Group I and Group III, choose the same song, which is from the musical genre “Funk”. The music of group II was of the musical genre “Música Popular Brasileira”.

The songs chosen represent the soundtrack of the journey of adolescents to adulthood. By identifying with a specific body of music, as well as with the creators of these songs and other fans, teenagers define and fine-tune their ideas about who they are, who they want to be and who they want to socialize with. In adolescence, musical preferences “show who you are” and are referred to as a “badge”, and are also related as a factor of mental well-being for this audience (^{Bogt, Hale & Becht, 2021}).

The perception of adequate social or emotional support can be an important factor for protecting mental health in adolescents. Protective factors encompass personal, family and environmental factors. By fostering them, we strengthen the promotion of the adolescent’s mental health, reducing the impact of an emotional disturbance in his/her life. Personal factors include: the promotion of self-esteem, self-concept and self-efficacy, autonomy, responsibility, conflict resolution, social skills and assertiveness development. Regarding family factors: good communication and family affection, cohesion among its members, development of healthy habits, education in values and setting limits while favoring autonomy. Socio-environmental factors are support networks, friends, healthy models, identification and strategies for controlling environmental pressure for unhealthy conducts and integration and school success (^{Hildebrand et al., 2019}).

As a potential scenario for health promotion, especially mental health, the school environment has several benefits. Thus, health promotion activities, following the approach of life skills, including stress prevention and mental health promotion, should be present in schools where interventions (predominantly face-to-face) tend to be promising (^{Eschenbeck et al., 2019}).

It is also necessary that school adolescents be accompanied by PHC professionals and be aware of the importance of selective screening and that psychological/psychoeducational interventions in vulnerable subgroups can improve anxiety/depression symptoms, but their effectiveness in reducing the incidence of psychotic/bipolar/common mental disorders is not proven (^{Davide, 2022}; ^{Rosa, Loureiro & Sequeira, 2019}).

When a reflection is made on the resolution of conflicts and problems faced among adolescents, according to table 4 of this study, which brings the scenes and reports of the dramatizations presented by the students, and the reports resulting from the discussion around the fundamental issue “How do you feel when your mother won’t let you leave home or do something?”, and also considering the data presented in table 5 - it is possible to show that the main problems and conflicts experienced by adolescents occur in the intrafamily environment, substantially in the relationships between parents and children.

The theatricalization of the lived allowed the students to outsource a latent cruelty in family relationships. Confirming what ^{Artaud teaches us (2006}, p. 24) about the power of theater - it is a formidable call for forces that lead the spirit, by example, to the origin of their conflicts... explaining conflicts, releases forces, triggers possibilities... the theater exists to leak abscesses collectively.

Intrafamilial violence against children and adolescents is a world reality that consists of any violent act committed by any family member against another member under 18 years of age. This phenomenon is manifested through physical, sexual, psychological and neglect forms (WHO, 2014).

The prevention of the phenomenon of violence and the development of measures to care for adolescents is fundamental for them to enjoy a healthier life (^{Hugh-Jones et al., 2022}).

Study conducted by ^{Magalhães et al. (2020}) revealed that adolescents with a history of intrafamily violence have impaired school performance and are vulnerable to the onset of depressive symptoms - manifested by deep sadness, self-injury behavior, as well as suicidal ideation.

In addition to explicit physical and psychological violence, students complain about the invasion of their privacy, lack of trust and dialogue with parents.

It is important to highlight the suffering caused by the aggressions experienced by adolescents inside their home, where it should be a space of protection, expressed in the speech of one of the students - “To deal with this has to breathe!” This phrase, although subtle and mature, expresses well the impact of violence on the lives of adolescents.

They comment on the impact of machismo on violence against girls who end up experiencing more restrictions, more hostilities and more exposure to violence. In addition to the violence they suffer in the street space and the community in which they live, a fact that can be proven by other research (^{Palacio et al., 2021}; ^{Miliauskas & Faus, 2020}).

In addition to the problems already reported by adolescents, the condition of poverty and scarcity of resources affects a large part of the population and produces and reproduces even more violence within the family itself. Thus, it is necessary to consider the very adverse socioeconomic conditions that afflict families, making adolescents more likely to present emotional problems (^{Reiss et al., 2019}).

The intervention on the socio-emotional and environmental risk factors that influence the adolescent’s mental health goes beyond the health area, and should be faced intersectorally, involving the areas of health, education, social assistance and economic, with generation of employment and income for families, environmental infrastructure and leisure (^{Marques-Feixa et al., 2021}).

Based on the theatrical activity performed with the students, ^{Baremblitt (2002}) said about the power of this resource for experimentation and re-creation of themselves, allowing the group to deal with a set of events that take place in time and space through an attitude of openness to the new, to the different, to the unknown, to the flows and potentialities of chance, the needs and demands of the participating group.

Through the reports extracted from the activity “poster and cut-collage”, contained in table 6 of this study - referring to the themes and reports presented by the students from the discussions around the sentence “A poster for suicide prevention”, we identified the centrality in the experiences experienced in the form of advice, with motivational phrases, in order to trigger attitudes of modification of daily habits as a way to develop protective factors of mental health of school adolescents.

The students’ interest in the theme of suicide may be related to the fact that this is the second leading cause of death among adolescents aged 10 to 24 years worldwide. In countries such as the United States, suicide accounts for 17.7% of all deaths among 15- to 24-year-olds (^{Murphy et al., 2017}).

Therefore, it is recommended that PHC professionals provide school adolescents with information about the protective factors of their mental health and prevention of potential mental health problems. In particular, it is necessary to consider, the risk factors for suicide of adolescents - individual internal factors and external environmental factors. While individual internal factors include sex, sleep deprivation, previous suicidal behaviors, genetic factors, history of mental illness, and physical disorders; external environmental factors include relationships with colleagues, family relationships, school bullying, and stressful life events. (^{Lee, Lee & Kim, 2021}; ^{Vieira et al., 2020}).

We realized that the development of cooperative and solidarity activities among young people as a strategy of health education allowed to expand sensitivity and inventive capacity, empowering them to want to meet a better future sharing dreams and utopias, taking care of themselves, the other and the environment, as pointed out in ^{Guattari’s aesthetic perspective (2007}).

The methodology of health education applied with students demonstrates that programs carried out in schools can influence and promote mental health, reducing risk factors and emotional and conduct problems through socioemotional learning (^{Lawrence et al., 2021}). And that adolescents seem to benefit from suicide prevention narratives with personal stories from colleagues about how to deal with suicidal ideation and the search for help (^{Exner-Cortens et al., 2021}).

Conclusion

The data show that the cultural knowledge of adolescents, considered by many as superficial and secondary, proved to be potent in this study. In addition, the students showed great interest in topics related to mental health, demanding discussion of specific topics such as anxiety, depression, stress, guilt, grief, isolation, among others.

The students showed joy and curiosity when participating in mental health promotion activities at school on a recreational and creative basis, showing that this is a good way to promote the mental health of the school.

The proposed dynamic contributed to promote the empowerment of adolescents, bringing elements for reflection of school agents, PHC professionals and the students themselves, because even those who did not participate in the activity were achieved by the unfolding of the experience within the school.

Thus, we can affirm that health promotion - being related to a set of values such as democracy, participation, partnership, development, social justice and citizenship - is a perspective that evokes intersectoral action to face the problems experienced by adolescents.

The partnership between PHC and school proved to be a field to be explored with the development of creative actions to promote the mental health of adolescents, in view of their healthy and sustainable development, reaffirming the social commitment to the health of vulnerable populations.

Contributions of the study: the themes of interest pointed out by the adolescents themselves can guide health education proposals at school participating in the research. This study created a methodology for promoting mental health with adolescents that, upon validation, can be replicated with other groups of students and educational and health institutions.