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A Strategic Double-Loop Learning Method for Organisational Decision-Making toward Servitisation

In recent years, manufacturing industries have been expected to achieve servitisation—namely, a shift from product sales to product-service systems—in order to achieve sustainable production and consumption patterns. In order to achieve servitisation, manufacturing firms should grasp the business environment and encourage organisational learning to develop the knowledge for servitisation in their environment. The existing knowledge management studies enable the empirical acquisition and reuse of knowledge from past case studies and make efforts to support organisational learning. However, they do not cover the guiding of firms engaged in servitisation to learn appropriately for their business environment. The learning required for manufacturing firms engaged in servitisation is learning that focuses on questioning and modifying existing product-oriented premises—double-loop learning. This paper proposes a method to support strategic double-loop learning within manufacturing companies engaged in servitisation. This method evaluates the compatibility between the implicit premises that manufacturers refer to as the rationale for their decision toward servitisation and the external environment and enables to formulate a practical strategy for double-loop learning. The proposed method was applied to the case of a cassette tape music player to demonstrate its usefulness. This study suggests theoretical foundations for future research into knowledge management for traditional manufacturing companies’ decisions concerning servitisation, and suggests that these should be carried out dynamically according to the business environment.

Web Application for Emotion-based Music Player

Abstract: Human expressions play an important role in the extraction of an individual's emotional state. It helps in determining the current state and mood of an individual, extracting and understanding the emotion that an individual has based on various features of the face such as eyes, cheeks, forehead, or even through the curve of the smile. A survey confirmed that people use Music as a form of expression. They often relate to a particular piece of music according to their emotions. Considering these aspects of how music impacts a part of the human brain and body, our project will deal with extracting the user’s facial expressions and features to determine the current mood of the user. Once the emotion is detected, a playlist of songs suitable to the mood of the user will be presented to the user. This can be a big help to alleviate the mood or simply calm the individual and can also get quicker song according to the mood, saving time from looking up different songs and parallel developing a software that can be used anywhere with the help of providing the functionality of playing music according to the emotion detected. Keywords: Music, Emotion recognition, Categorization, Recommendations, Computer vision, Camera

Affective Music Player for Multiple Emotion Recognition Using Facial Expressions with SVM

Sound immission levels and listening characteristics in music player users, machine learning based cloud music application with facial recognition using android studio (musync).

This paper output is a music player application but when it comes to its features it will be way more than a simple music player. It is developed on Android Studio and other tools like: Firebase is used as database, Android phone camera, Music library of Android Phone are used in the development of application. When user changes his phone or reset his phone then all of his data is lost or user has to put all the data in his computer and then back to his mobile phone except data that is backed up online. Message data, photos and contacts are that things that users backed up online. But music files normally don’t get backed up and user troubles in re downloading the files or moving files in computer and back to phone. In this purposed work the targeted problem is resolved as MUSYNC application is be able to automatically backup all the mp3 data from the phone and user will get all of his data by just signing in the application in his new phone. The purposed application has a feature of sync music. Users can sync music with another one and that person will able to listen to same music instantly. Application also provides a unique feature of mood detection using digital image processing DIP. This feature is able to check your face emotion and play music according to it. User just has to take a picture and that is it, this music player plays the music according to your mood. This feature is useful when user having tough time what to listen.

Passive RFID-based Music Player Textile

Music player based on human emotions, espotify (an emotion based music player).

Human emotion plays an essential role in social relationships. Emotions are reflected from verbalization, hand gestures of a body, through outward appearances and facial expressions. Music is an art form that soothes and calms the human brain and body. To analyze the mood of an individual, we first need to examine its emotions. If we detect an individual's emotions, then we can also detect an individual's mood. Taking the above two aspects and blending them, our system deals with detecting the emotion of a person through facial expression and playing music according to the emotion detected that will alleviate the mood or calm the individual and can also get quicker songs according to the emotion, saving time from looking up different songs. Different expressions of the face could be angry, happy, sad, and neutral. Facial emotions can be captured and detected through an inbuilt camera or a webcam. In our project, the Fisherface Algorithm is used for the detection of human emotions. After detecting an individual's emotion, our system will play the music automatically based on the emotion of an individual.

Gesture Controlled Music Player

A music player is a computer program for playing audio files or songs encoded in MP3 format. This application will reside in the user's computer, such as iTunes, Windows Media Player and RealPlayer that are used to organize a music collection and play audio files. Our player provides an easy-to-use graphical user interface with symbols provided on the buttons to enable varied types of users to use the player efficiently. Along with the basic functionalities of a music player like playing, pausing, stopping and playing next or previous song, we have provided some interesting features which make our player intelligent. Hence, we have rightly named it ‘Brain Waves Music Player’. It has the ability to judge our sentiments and play the suitable songs accordingly. Also, the player can be controlled using gestures.

A Review on Life Cycle Assessment of Solar PV Panel

Humans tend to connect the music they hear, to the emotion they are feeling. The song playlists though are, at periods too large to sort out automatically. It would be accommodating if the music player was “smart enough” to sort out the music based on the current state of emotion the individual is feeling. The main idea of this project is to automatically play songs based upon the emotions of the adherent. Based on the emotion, the music will be played from the predefined playlist. It aims to deliver user-preferred music with emotional attentiveness. In the existing system user want to manually select the songs, randomly played songs may not accede to the feel of the adherent, user has to classify the songs into various emotions and for playing the songs user has to manually choose a particular emotion. These difficulties can be avoided by using our project. This is a novel way that helps the handler to automatically play songs based on the emotions of the handler. It recognizes the facial emotions of the adherent and plays the songs based on their emotion. The emotions are recognized using a machine learning method Support Vector Machine (SVM) algorithm. The human twist is an important organ of an individual's body and it especially plays an important role in the heritage of an individual's behaviours and emotional appearance.

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  • Published: 30 August 2019

The effects of playing music on mental health outcomes

  • Laura W. Wesseldijk 1 , 2 ,
  • Fredrik Ullén 1   na1 &
  • Miriam A. Mosing 1 , 3   na1  

Scientific Reports volume  9 , Article number:  12606 ( 2019 ) Cite this article

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  • Behavioural genetics
  • Psychiatric disorders
  • Risk factors

The association between active musical engagement (as leisure activity or professionally) and mental health is still unclear, with earlier studies reporting contrasting findings. Here we tested whether musical engagement predicts (1) a diagnosis of depression, anxiety, schizophrenia, bipolar or stress-related disorders based on nationwide patient registers or (2) self-reported depressive, burnout and schizotypal symptoms in 10,776 Swedish twins. Information was available on the years individuals played an instrument, including their start and stop date if applicable, and their level of achievement. Survival analyses were used to test the effect of musical engagement on the incidence of psychiatric disorders. Regression analyses were applied for self-reported psychiatric symptoms. Additionally, we conducted co-twin control analyses to further explore the association while controlling for genetic and shared environmental confounding. Results showed that overall individuals playing a musical instrument (independent of their musical achievement) may have a somewhat increased risk for mental health problems, though only significant for self-reported mental health measures. When controlling for familial liability associations diminished, suggesting that the association is likely not due to a causal negative effect of playing music, but rather to shared underlying environmental or genetic factors influencing both musicianship and mental health problems.


The high suicide rate among famous musicians over the last few years, e.g. Soundgarden’s Chris Cornell, Linkin Park’s Chester Bennington, Avicii and the Prodigy’s Keith Flint, has received a lot of media attention and raised the question about a possible relationship between mental health problems and musicianship. In line with that, a recent survey among 2,211 British self-identified professional musicians found musicians to be up to three times more likely to report depressive problems than individuals in the general population 1 . Furthermore, several famous people engaged in creative professions other than musicianship were also known for their psychiatric illnesses, like Vincent van Gogh, Ernest Hemingway or John Nash. It has been shown that unaffected relatives of individuals with bipolar disorder or schizophrenia have higher levels of creativity 2 , 3 , 4 , 5 . Overall, such findings suggest that creativity and musicianship are risk factors for mental health problems.

On the other hand, there are many studies that report positive relationships between musical engagement and indicators of mental health, thus suggesting the opposite, namely that engagement in music could be protective against psychiatric problems. Although epidemiological studies investigating the association between music and the risk of mental health problems are rare – for a review, see 6 – the few existing ones all tend to suggest a positive effect of music 7 . For example, singing or playing music has been reported to be have a positive influence on various subjective health outcomes, including anxiety and depression 8 . Singing in a choir is related to higher self-rated quality of life and satisfaction with health 9 , and playing an instrument, and singing or performing in theater, tend to be associated with increased self-rated health in women, but decreased all-cause mortality in men and not vice versa 10 . Hours of music practice has been shown to be associated with lower alexithymia (i.e., a dysfunction in emotional awareness, social attachment, and interpersonal relating) 11 . Finally, in 50,797 Norwegian males, but not in females, it was found that active participation in music, singing or theater predicted significantly lower depressive symptoms 12 . It is important to note that the measures of health outcomes in these studies are retrospective self-reports. Therefore, the outcomes could partly reflect characteristics of the rater and may be subject to a recall bias.

Furthermore, there are numerous reviews on the effect of music interventions, both active (e.g. performing) and passive (e.g. listening), on individuals in clinical settings, e.g. during medical procedures or in mental health clinics (for reviews in children, see 13 , 14 , 15 , 16 , 17 ; for reviews in adults, see 18 , 19 , 20 ). The majority of reviews conclude that music interventions have a positive effect on pain, mood, and anxious or depressive symptoms in both children and adults in clinical settings. This suggests not only a positive association in line with the epidemiological research, but also potentially a causal relationship. It is important to note that most of the music interventions described in these studies have been tailored to address individually assessed needs of a client by a music therapist, which differs significantly from self-initiated musical engagement in daily life. Furthermore, as pointed out in most of these reviews, it is difficult to draw firm conclusions about protective effect of music due to the mixed quality of many of the conducted studies, i.e., studies had small samples, suffered from bias due to methodological issues, and there was great variability among the results of the studies.

In sum, the direction of the association between musical engagement and mental health is still unclear with powerful population based research still failing to establish a relation unequivocally. Furthermore, it seems that differentiating between active amateur and professional musicians might explain the discrepancy between, on the one hand research reporting beneficial effects of music in everyday life on mental health, and on the other hand the high rate of depression and suicides among professional musicians. This view is in line with findings from the recent study of Bonde, et al . 21 in which active professional musicians reported more health problems than active amateur musicians, while active amateur musicians reported significantly better self-reported health than non-musicians. Possibly, the strain and pressure experienced by professional musicians may override a possible overall positive effect of musical engagement. Furthermore, an association between engagement in music and mental health problems on a population level does not necessarily reflect causal effects; it could also reflect reverse causation or underlying shared genetic or shared environmental factors that influence both the choice to engage in music and the development of psychiatric problems. It is well known that genetic factors play a role both in mental health problems 22 and in individual variation in music-related abilities 23 . In line with that, there is evidence that the association between creativity and psychiatric disorders is largely driven by underlying shared genetic factors 24 . Studying twins can reduce genetic and shared environmental confounding and strengthen causal inferences.

Here, using a large genetically informative sample of Swedish twins, we aim to investigate whether there is an association between active musical engagement defined by whether an individual plays an instrument, on an amateur and professional level, and mental health and if so, whether the relationship is consistent with a causal hypothesis, i.e., that musical engagement truly affects mental health. We use data from the Swedish nationwide in-patient and outpatient registers for psychiatric diagnoses (i.e., diagnosis of depression, anxiety disorder, schizophrenia, bipolar, stress disorder) as well as self-reports on mental health problems (depressive, burnout and schizotypal symptoms). As the association between playing sport and mental health is already well established, we conducted sensitivity analyses investigating a protective effect of sport against psychiatric problems in this sample.


Data for the present study was collected as part of “the Study of Twin Adults: Genes and Environment” (STAGE), a sub-study in a cohort of approximately 32,000 adult twins registered with the Swedish Twin Register (STR). The STAGE study sent out a web survey in 2012–2013 inquiring about, musical engagement and musical achievement and other potentially music related traits. The 11,543 responders were aged between 27 and 54 years and data were available for 10,776 individuals on musical engagement and for 6,833 on musical achievement.

The National Patient Register (NPR) records the use of the health care system in Sweden, which has nationwide coverage ensuring equal access to health care for all residents, using a 10-digit personal identification number assigned to all Swedish residents 25 . The NPR includes an in-patient register (IPR) and out-patient register (OPR). The IPR contains information about hospitalizations since 1964 (with full national coverage since 1977), while the OPR covers outpatient visits since 2001 26 . The Cause of Death Register (CDR) contains information from death records since 1961 27 . The Swedish twins from the STAGE study were linked to records from the IPR, OPR and CDR.

Informed consent was obtained from all participants. The study was approved by the Regional Ethics Review Board in Stockholm (Dnr 2011/570-31/5, 2012/1107-32, 2018/866-32). All research methods were performed in accordance with relevant guidelines and regulations.

Musical engagement

Participants were asked whether they ever played an instrument. Those who responded positively were asked at what age they started to play, whether they still played an instrument and, if not, at what age they stopped playing. From these questions, a music status variable was created (0: does not play, 1: used to play, 2: plays).

Sport engagement

Participants reported on whether they ever actively trained a sport (excluding exercise training or physical activity in general). Information on age they started training a sport, whether they still played and at what age they stopped playing resulted in a sport status variable with 0 ‘does not play’, 1 ‘used to play’ and 2 ‘plays sport’.

Musical achievement

Musical achievement was measured with a Swedish version of the Creative Achievement Questionnaire (CAQ) that assesses different domains of creativity, including music 28 , 29 . Individuals were asked to rate their musical achievement on a seven-point scale: 1 ‘I am not engaged in music at all’, 2’I have played or sang privately, but I have never played, sang or showed my music to others’, 3’I have taken music lessons, but I have never played, sang or showed my music to others’, 4 ‘I have played or sung, or my music has been played in public concerts in my home town, but I have not been paid for this’, 5 ‘I have played or sung, or my music has been played in public concerts in my home town, and I have been paid for this’, 6 ‘I am professionally active as a musician’ and 7 ‘I am professionally active as a musician and have been reviewed/featured in national or international media and/or have received an award for my musical activities’. To differentiate between amateur and professional musicians, we converted the scale to three groups: 1 ‘no engagement in music’, 2–4 ‘making music on an amateur level’, and 5–7 ‘professionally active in music’.

Registry-based mental health outcomes

For each individual we derived information (diagnosis and date of first diagnosis) on incidence of depression, anxiety disorder, schizophrenia, bipolar disorder, or stress disorder based on clinical diagnoses after any inpatient or outpatient visit, or underlying cause of death registered in the national registers according to the International Classification of Diseases (ICD) codes as reported in Table  1 . We created an ‘any psychiatric diagnosis’ variable indicating whether the participant has ever been diagnosed with any of the five categories of clinical diagnoses above. For this variable, we selected the earliest date of diagnosis in case of comorbidity.

Questionnaire-based self-reported mental health

In addition, self-reports on mental health outcomes (i.e., depressive, burnout and schizotypal symptoms) obtained in the web survey were analyzed. Depressive symptoms were measured with the depression scale of the Hopkins Symptom Checklist 30 . This scale contains of six items all ranging from 0 to 4 (0 ‘not at all’ to 4 ‘extremely’), measuring depressive symptoms in a work-related context, with higher scores indicating more depressive symptoms. Burn-out symptoms related to work were measured with the Emotional exhaustion subscale of the Maslach Burnout Inventory-General Survey 31 . This scale consists of five items that range from 1 (every day) to 6 (a few times per year or less/never). Therefore, as higher scores reflect less burnout symptoms, we reversed this scale so that higher scores indicate more burnout symptoms in line with the other mental health outcomes. Schizotypal symptoms were measured with the “Positive Dimension Frequency Scale” of the Community Assessment of Psychic Experiences (CAPE) questionnaire 32 . The score is based on 20 positive symptom items that can be answered with four different symptom frequency levels, from 1 ‘never’ to 4 ‘almost always’. Higher scores indicate more schizotypal symptoms. The Cronbach alpha reliability in present study was 0.89 for the depressive symptom scale, 0.87 for the burnout symptom scale and 0.79 for the schizotypal symptom scale.

Level of education

Educational achievement was dichotomized into ‘low and intermediate’ (1 to 7; unfinished primary school to bachelor education) and ‘high’ (8 to 10; master education to PhD).

Statistical analyses

All analyses were conducted in STATA 15.

Survival analyses , i.e., Cox proportional hazard regression, were conducted to explore the effect of musical engagement and musical achievement on the risk to receive a registry-based diagnosis of a psychiatric disorder 33 . Survival analysis is a method to analyze data where the outcome variable is the time until an event happens. The time (years) from the age of twelve to either the date of first receiving a psychiatric diagnosis or to the date of censoring (i.e., date of death or end of follow-up at January 1, 2015) were used as the time scale (i.e., the survival time). For the analyses on the effect of musical engagement , we had to take into account that some individuals had not yet started playing an instrument at the age of twelve (i.e., would start at a later age), or stopped playing at some stage. Therefore, years were split on whether the individual did not play, stopped or started playing, or currently played a musical instrument using the stsplit statement to differentiate between the three levels of musical engagement. We used Cox proportional hazard regressions, a method that assumes the effect upon survival to be constant over time, to calculate hazard ratios (HRs) with 95% confidence intervals. The HRs represent the effects of 1) playing an instrument versus never having played an instrument or 2) having played an instrument (but stopped before diagnosis) versus never having played an instrument on the baseline risk for a mental health diagnosis (independent of playing status) during the follow-up period. A HR value greater than one indicates an increased risk, while a value below one indicates a protective effect. Additionally, we conducted the survival analyses to estimate the effect of musical achievement in a lifetime on the risk of a mental health diagnosis, in which the HRs represent 1) the effect of having performed music as an amateur versus not being involved in music, or 2) the effect of having performed music professionally versus not being involved in music. As we analyzed the three level musical achievement in a lifetime, we did not split years on age (assuming that individuals have been on a lifelong ‘achievement’ trajectory). To correct for relatedness in the twin sample, the robust standard error estimator for clustered observations was used 34 . We fitted separate survival models for each of the five psychiatric disorder diagnoses as well as for the ‘any psychiatric diagnosis’ variable. Thus, first, we in total fitted six models for the effect of musical engagement and another six models for musical achievement. All models included sex as a covariate. Additionally, we fitted all models corrected for level of education, resulting in a small loss of data due to missing information for some individuals, therefore reducing the power. For each model, the proportional hazards assumption was tested using Schoenfeld residuals. No evidence for deviation from the proportional hazards assumption was found for any of the models (all p values > 0.01). As a sensitivity analysis, the above-described models for musical engagement (in which we used the stsplit statement) were repeated with sport engagement as the exposure variable instead, to estimate the effect of playing sport on registry-based psychiatric disorder diagnoses.

Self-reported mental health outcomes

Linear regression analyses were performed to explore the effect of musical engagement and musical achievement on the self-rated continuous measures of depressive symptoms, burnout symptoms and schizotypal symptoms. To correct for relatedness in the twin sample, we used the robust standard error estimator for clustered observations. We included sex as a covariate. Additionally, we ran the analyses corrected for level of education. As a sensitivity analysis, we estimated the effect of sport engagement on depressive, burnout and schizotypal symptoms using linear regression analyses.

Co-twin control analyses (within-pair analyses)

Within-pair analyses in identical twins were conducted to further explore the association between musical engagement and receiving a mental health diagnosis when controlling for genetic and shared environmental factors. As monozygotic (MZ) twins are genetically identical and share their family environment, studying identical twins excludes confounding in case a genetic predisposition or shared environmental influence affects both outcome (mental health problems), and exposure (music engagement). Therefore, if music engagement truly causes a lower/higher risk for receiving a mental health diagnosis, we would expect the MZ twin that plays music to have a lower/higher risk of psychiatric problems than his or her co-twin that does not play music. Conditional Cox regression models, with the strata statement to stratify by pair identifier, were fitted for the mental health diagnoses to estimate HRs with 95% confidence intervals. Notably, only complete identical twin pairs discordant for exposure (i.e., music engagement) and outcome (i.e., the psychiatric disorder diagnosis) contribute to the within-pair analyses. The conditional logistic regression estimates the effect of the difference between the two observations in the strata. Twins are regarded as discordant for the outcome when the time of the psychiatric diagnosis differs. Due to the low prevalence of schizophrenia and bipolar disorder in the complete twin pairs, these phenotypes were excluded from the within-pair analyses.

Additionally, to explore further the effect of music engagement on the self-rated continuous measures of depressive symptoms, burnout symptoms and schizotypal symptoms, we conducted within-pair linear regression analyses using the xtreg fe statement to stratify by twin pair. In within-pair analyses in identical twins correcting for sex is not required as each twin is matched to his or her co-twin. To increase power, we also included data from same-sex dizygotic (DZ) twins (who share on average 50% of their genetic makeup and 100% of their family environment).


Information on mental health outcomes and musical engagement was available for 9,816 individuals [2,212 complete twin pairs (1,055 MZ, 661 dizygotic same-sex (DZ), 496 dizygotic opposite-sex (DOS) twins) and 5,392 individual twins]. Among these individuals, data on musical achievement were available for 6,295 individuals [1,208 complete twin pairs (627 MZ, 342 DZ, 239 DOS) and 3,879 individual twins]. Characteristics of the participants are reported in Table  2 .

Women were more likely to initiate playing an instrument than men (37.7% of men versus 20.5% of women), while roughly the same amount of men and women remained actively involved in music in adulthood (23.3% of men and 21.9% of women). More men (8.5%) than women (5%) played music professionally.

Although overall, there was an overall trend towards a somewhat elevated risk for psychiatric disease in those engaged with music, neither playing music nor having played music in the past (Fig.  1 ), nor professional musicianship (Fig.  2 ) was significantly associated with the risk for any of the psychiatric disorders. The analyses adjusted for level of education showed similar results (see Table  S1 for musical engagement and Table  S2 for musical achievement, in the supplementary material), with the exception that individuals who played an instrument had a significantly higher risk (39%) of being diagnosed with an anxiety disorder (HR 1.39, CI 1.01–1.92) compared to those who never played an instrument. In terms of covariates, we found females to have a higher risk for depression (92%), anxiety disorder (92%), and stress-related disorders (58%) (Table  S1 ). Additionally, individuals with higher levels of education had a significantly lower risk for psychiatric disorders, depression, anxiety disorder, schizophrenia or bipolar disorder (Table  S1 ).

figure 1

Music engagement and registry-based mental health outcomes. Sex is included as covariate.

figure 2

Music achievement and registry-based mental health outcomes. Sex is included as a covariate.

Self-reported mental health

Results of the regression analyses with self-reported mental health symptoms indicated that playing an instrument was significantly associated with more schizotypal symptoms and depressive and burnout symptoms in a work context (see left part of Table  3 ). Having played an instrument in the past did not significantly influence any of the self-rated mental health outcomes. Furthermore, even though professional and amateur musicians report more burnout and schizotypal symptoms than non-players, individuals who played music professionally did not experience significantly more depressive, burnout or schizotypal symptoms than individuals who play music on an amateur level (see right part of Table  3 ). When analyses were repeated adjusting for level of education (results not shown) all results remained the same.

Sensitivity sport analyses

Results of the sensitivity analyses on the registry-based mental health outcomes showed that individuals who actively played sports were less likely to develop any psychiatric disorder, as well as depression, anxiety, and bipolar disorder (see Fig.  S1 ). There was no sustained beneficial effect of past sports engagement after stopping with exercise. The analyses adjusted for level of education showed the same results.

Regression analyses on the self-reported mental health outcomes showed that individuals who actively play sports were significantly less likely to report depressive symptoms (β = −0.23, p < 0.001) and burnout symptoms (β = −0.20, p < 0.001), but not schizotypal symptoms (β = 0.00, p = 0.96). Past sport activities were unrelated to the self-reported mental health outcomes (p values range between 0.08 and 0.20). Including level of education in the analyses did not affect the results.

Co-twin control analyses

Results of the co-twin control analyses for both the registry-based and self-reported mental health measures are shown in Table  4 . None of the within-pair estimates were significant. However, overall, the effect sizes (HR or beta) moved closer to zero with increased controlling of shared liability.

We aimed to investigate the association between musical engagement in everyday life and mental health in a large cohort of Swedish twins. Although the findings were somewhat mixed, overall results suggest that individuals who actively play a musical instrument (but not necessarily professionally) may have a somewhat increased risk for mental health problems. However, when controlling for familial liability these associations became weaker and non-significant suggesting that the association is likely explained by underlying shared factors influencing both musicianship and mental health problems.

While analyses using registry-based mental health diagnoses showed no significant association between music playing or professional musical engagement and psychiatric diagnoses, the direction of the effect was trending towards a somewhat increased risk for psychiatric diagnoses for those actively engaged with music. Results from the self-reported mental health outcomes further supported this; individuals playing an instrument report more depressive, burnout and schizotypal symptoms. This is in contrast with previous epidemiological and clinical studies reporting positive effects of musical engagement on anxious and depressive symptoms 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 . Further, a recent study by Fancourt and Steptoe 35 found cultural engagement to decrease the development of depression in older ages. However, it appears likely that it is important to distinguish between general cultural engagement, i.e., visits to the theatre, concerts or opera, the cinema or an art gallery, exhibition or museum) and active playing of a musical instrument, which is the focus of the present study. Playing a musical instrument is much more narrowly defined behavior and involves many (cognitive and physical) processes different from engaging in cultural musical activities or listening to music. On the other hand, our findings are in line with results from the survey among British professional musicians 1 and with previous findings of associations between creativity and mental health problems, i.e., that people engaging in creative activities tend to experience more psychiatric problems 4 . It is important to note that the previous epidemiological studies on mental health, the British musicians study, but also our continuous mental health outcomes, were based on self-report. An explanation could be that results of self-report reflect a different attitude towards mental health among more creative individuals, with higher acceptance and awareness of mental health problems, possibly resulting in over-reporting in the field.

Further, there is evidence that the association between creativity and psychiatric disorders can be largely attributed to underlying shared genetic factors 24 , 36 . This is in line with present results of our co-twin control analyses, which showed that the association between musicianship and mental health was attenuated when controlling for genetic and shared environmental confounding (although all analyses were non-significant). This suggests that the observed associations would partly be explained by a shared underlying etiology, (i.e., genetic or family environmental factors which affect both, individuals differences in music playing and mental health) and not by a causal effect of playing music. The within-pair results, however, should be interpreted with caution as only discordant twin pairs contribute to the co-twin control analyses, which reduced the power to find significant associations.

We found significant differences between professional or amateur musicians and non-players in self-rated health outcomes, which are in line with our findings on playing music in general. However, in neither self-rated nor registry-based data, we observed any significant differences in mental health problems between professional musicians compared to amateur musicians. This is in contrast to findings from the study of Bonde, et al . 21 in which active professional musicians reported higher numbers of overall health problems than active amateur musicians, while active amateur musicians reported significantly better self-reported health than non-musicians did. Whilst this was also a large population-based sample, this study analyzed general health instead of mental health, which likely contributes to the difference in findings.

The discrepancy in findings between registry-based mental health diagnoses and self-reported mental health could be due to an influence of rater and recall biases captured in the self-reported mental health outcomes, as discussed above. However, another explanation could be less power in the analyses with the registry-based mental health diagnoses to detect an existing effect. The power of a method to analyze survival time data depends partly on the number of psychiatric diagnoses rather than on the total sample size. In the present sample, observed post-hoc power for the survival analyses to detect a HR of 0.8 for music engagement is 88% for the incidence of a psychiatric disorder, 67% for depression, 61% for anxiety, 7% for schizophrenia, 18% for bipolar and 45% for stress disorder, reflecting the different incident rates of the disorders. As the self-reported mental health problems were measured on a continuous scale, these analyses have higher power (i.e., no cut-off score needs to be reached to obtain a full diagnosis). Nevertheless, our sensitivity analyses in the registry-based outcomes on the effect of sport did show a significant protective effect of sport against the risk of receiving a diagnosis of a psychiatric disorder, depression, anxiety and bipolar disorder in this sample, suggesting that an association can be found with the present distribution of the data if existent. Therefore, we conclude that a lack of power is not a likely explanation for our null findings in the registry-based health outcomes, and that if there truly were an effect, it would be very small.

There are some limitations of this study in addition to the ones we already touched upon. We analyzed data on psychiatric diagnoses obtained from the Swedish nationwide in-patient and outpatient registers. However, the outpatient register only reached full coverage in 2001 and it is therefore possible that some individuals were not classified with a psychiatric disorder, although they did experience mental health problems before 2001. The same holds for individuals with mental health problems who did not visit a doctor. In addition, the dichotomous rather than dimensional nature of psychiatric diagnoses excludes large parts of the continuous variation among individuals in psychiatric problems. The continuous symptom scales increase the power to detect an effect of engagement in music or sports, but may be somewhat biased. Furthermore, our study explored potential effects of active musical engagement (i.e., making music) in everyday life and therefore our findings do not allow for any conclusions about the potential effect of (personalized) musical interventions on mental health problems. Lastly, as mentioned earlier, the sample of discordant twin pairs contributing to the co-twin control analyses was small, resulting in low power to detect effects.

To our knowledge, the present population-based study is the only genetically informative large-scale study to investigate associations between active engagement in music (both as a leisure activity and professionally) and registry-based as well as self-reported mental health outcomes. Rather than a protective effect of music engagement in everyday life as often suggested, our findings suggest that individuals actively engaged in music playing, but not only professional musicians, may have a somewhat elevated risk for mental health problems. This association may at least partly be due to shared underlying etiology and it is unlikely that it reflects a causal effect of playing music.

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The present work was supported by the Marcus and Amalia Wallenberg Foundation (MAW 2018.0017), and the Bank of Sweden Tercentenary Foundation (M11-0451:1). We acknowledge The Swedish Twin Registry for access to data. The Swedish Twin Registry is managed by the Karolinska Institutet and receives funding through the Swedish Research Council under the grant no 2017-00641. Open access funding provided by Karolinska Institute.

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Fredrik Ullén and Miriam A. Mosing jointly supervised this work.

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Department of Neuroscience, Karolinska Institutet, Solnavägen 9, SE-171 77, Stockholm, Sweden

Laura W. Wesseldijk, Fredrik Ullén & Miriam A. Mosing

Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands

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Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels v 12A, 171 77, Stockholm, Sweden

  • Miriam A. Mosing

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F.U., M.M. and L.W. developed the study design. L.W. performed the data analysis and interpretation under the supervision of F.U., M.M. L.W. and M.M. drafted the manuscript, and F.U. provided critical revisions. All authors approved the final version of the manuscript for submission.

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Wesseldijk, L.W., Ullén, F. & Mosing, M.A. The effects of playing music on mental health outcomes. Sci Rep 9 , 12606 (2019).

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Recommender Systems for Medicine and Music pp 107–118 Cite as

Music Recommendation Systems: A Survey

  • Mariusz Kleć   ORCID: 5 &
  • Alicja Wieczorkowska   ORCID: 5  
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Part of the Studies in Computational Intelligence book series (SCI,volume 946)

This introductory chapter presents an overview of music recommendation systems, supported by a comprehensive list of references. We pay special attention to user-centric systems which personalize their output by tracking the context of the user, including the user’s emotions and personality. Besides, we emphasize the importance of social media, the usability of user interfaces and the application of deep learning techniques in the recent developments in music recommendation systems. We also outline inspirations for the future research in the field.

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Zbigniew W. Ras

Department of Multimedia, Polish-Japanese Academy of Information Technology, Warsaw, Poland

Alicja Wieczorkowska

Department of Medical Informatics, Faculty of Medicine, Shimane University, Izumo, Japan

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Kleć, M., Wieczorkowska, A. (2021). Music Recommendation Systems: A Survey. In: Ras, Z.W., Wieczorkowska, A., Tsumoto, S. (eds) Recommender Systems for Medicine and Music. Studies in Computational Intelligence, vol 946. Springer, Cham.

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Editorial: the impact of music on human development and well-being.

\nGraham F. Welch

  • 1 Department of Culture, Communication and Media, University College London, London, United Kingdom
  • 2 Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
  • 3 School of Humanities and Communication Arts, Western Sydney University, Penrith, NSW, Australia
  • 4 Melbourne Conservatorium of Music, University of Melbourne, Melbourne, VIC, Australia

Editorial on the Research Topic The Impact of Music on Human Development and Well-Being

Music is one of the most universal ways of expression and communication for humankind and is present in the everyday lives of people of all ages and from all cultures around the world ( Mehr et al., 2019 ). Hence, it seems more appropriate to talk about musics (plural) rather than in the singular ( Goble, 2015 ). Furthermore, research by anthropologists as well as ethnomusicologists suggests that music has been a characteristic of the human condition for millennia (cf. Blacking, 1976 ; Brown, 1999 ; Mithen, 2005 ; Dissanayake, 2012 ; Higham et al., 2012 ; Cross, 2016 ). Nevertheless, whilst the potential for musical behavior is a characteristic of all human beings, its realization is shaped by the environment and the experiences of individuals, often within groups ( North and Hargreaves, 2008 ; Welch and McPherson, 2018 ). Listening to music, singing, playing (informally, formally), creating (exploring, composing, improvising), whether individually and collectively, are common activities for the vast majority of people. Music represents an enjoyable activity in and of itself, but its influence goes beyond simple amusement.

These activities not only allow the expression of personal inner states and feelings, but also can bring about many positive effects in those who engage in them. There is an increasing body of empirical and experimental studies concerning the wider benefits of musical activity, and research in the sciences associated with music suggests that there are many dimensions of human life—including physical, social, educational, psychological (cognitive and emotional)—which can be affected positively by successful engagement in music ( Biasutti and Concina, 2013 ). Learning in and through music is something that can happen formally (such as part of structured lessons in school), as well as in other-than-formal situations, such as in the home with family and friends, often non-sequentially and not necessarily intentional, and where participation in music learning is voluntary, rather than mandated, such as in a community setting (cf. Green, 2002 ; Folkestad, 2006 ; Saether, 2016 ; Welch and McPherson, 2018 ).

Such benefits are evidenced across the lifespan, including early childhood ( Gerry et al., 2012 ; Williams et al., 2015 ; Linnavalli et al., 2018 ), adolescence ( McFerran et al., 2018 ), and older adulthood ( Lindblad and de Boise, 2020 ). Within these lifespan perspectives, research into music's contribution to health and well-being provides evidence of physical and psychological impacts ( MacDonald et al., 2013 ; Fancourt and Finn, 2019 ; van den Elzen et al., 2019 ). Benefits are also reported in terms of young people's educational outcomes ( Guhn et al., 2019 ), and successful musical activity can enhance an individual's sense of social inclusion ( Welch et al., 2014 ) and social cohesion ( Elvers et al., 2017 ).

This special issue provides a collection of 21, new research articles that deepen and develop our understanding of the ways and means that music can impact positively on human development and well-being. The collection draws on the work of 88 researchers from 17 different countries across the world, with each article offering an illustration of how music can relate to other important aspects of human functioning. In addition, the articles collectively illustrate a wide range of contemporary research approaches. These provide evidence of how different research aims concerning the wider benefits of music require sensitive and appropriate methodologies.

In terms of childhood and adolescence, for example, Putkinen et al. demonstrate how musical training is likely to foster enhanced sound encoding in 9 to 15-year-olds and thus be related to reading skills. A separate Finnish study by Saarikallio et al. provides evidence of how musical listening influences adolescents' perceived sense of agency and emotional well-being, whilst demonstrating how this impact is particularly nuanced by context and individuality. Aspects of mental health are the focus for an Australian study by Stewart et al. of young people with tendencies to depression. The article explores how, despite existing literature on the positive use of music for mood regulation, music listening can be double-edged and could actually sustain or intensify a negative mood.

A Portuguese study by Martins et al. shifts the center of attention from mental to physical benefits in their study of how learning music can support children's coordination. They provide empirical data on how a sustained, 24-week programme of Orff-based music education, which included the playing of simple tuned percussion instruments, significantly enhanced the manual dexterity and bimanual coordination in participant 8-year-olds compared to their active control (sports) and passive control peers. A related study by Loui et al. in the USA offers insights into the neurological impact of sustained musical instrument practice. Eight-year-old children who play one or more musical instruments for at least 0.5 h per week had higher scores on verbal ability and intellectual ability, and these correlated with greater measurable connections between particular regions of the brain related to both auditory-motor and bi-hemispheric connectivity.

Younger, pre-school children can also benefit from musical activities, with associations being reported between informal musical experiences in the home and specific aspects of language development. A UK-led study by Politimou et al. found that rhythm perception and production were the best predictors of young children's phonological awareness, whilst melody perception was the best predictor of grammar acquisition, a novel association not previously observed in developmental research. In another pre-school study, Barrett et al. explored the beliefs and values held by Australian early childhood and care practitioners concerning the value of music in young children's learning. Despite having limited formal qualifications and experience of personal music learning, practitioners tended overall to have positive attitudes to music, although this was biased toward music as a recreational and fun activity, with limited support for the notion of how music might be used to support wider aspects of children's learning and development.

Engaging in music to support a positive sense of personal agency is an integral feature of several articles in the collection. In addition to the Saarikallio team's research mentioned above, Moors et al. provide a novel example of how engaging in collective beatboxing can be life-enhancing for throat cancer patients in the UK who have undergone laryngectomy, both in terms of supporting their voice rehabilitation and alaryngeal phonation, as well as patients' sense of social inclusion and emotional well-being.

One potential reason for these positive findings is examined in an Australian study by Krause et al. . They apply the lens of self-determination theory to examine musical participation and well-being in a large group of 17 to 85-year-olds. Respondents to an online questionnaire signaled the importance of active music making in their lives in meeting three basic psychological needs embracing a sense of competency, relatedness and autonomy.

The use of public performance in music therapy is the subject of a US study by Vaudreuil et al. concerning the social transformation and reintegration of US military service members. Two example case studies are reported of service members who received music therapy as part of their treatment for post-traumatic stress disorder, traumatic brain injury, and other psychological health concerns. The participants wrote, learned, and refined songs over multiple music therapy sessions and created song introductions to share with audiences. Subsequent interviews provide positive evidence of the beneficial psychological effects of this programme of audience-focused musical activity.

Relatedly, McFerran et al. in Australia examined the ways in which music and trauma have been reported in selected music therapy literature from the past 10 years. The team's critical interpretive synthesis of 36 related articles led them to identify four different ways in which music has been used beneficially to support those who have experienced trauma. These approaches embrace the use of music for stabilizing (the modulation of physiological processes) and entrainment (the synchronization of music and movement), as well as for expressive and performative purposes—the fostering of emotional and social well-being.

The therapeutic potential of music is also explored in a detailed case study by Fachner et al. . Their research focuses on the nature of critical moments in a guided imagery and music session between a music therapist and a client, and evidences how these moments relate to underlying neurological function in the mechanics of music therapy.

At the other end of the age span, and also related to therapy, an Australian study by Brancatisano et al. reports on a new Music, Mind, and Movement programme for people in their eighties with mild to moderate dementia. Participants involved in the programme tended to show an improvement in aspects of cognition, particularly verbal fluency and attention. Similarly, Wilson and MacDonald report on a 10-week group music programme for young Scottish adults with learning difficulties. The research data suggest that participants enjoyed the programme and tended to sustain participation, with benefits evidenced in increased social engagement, interaction and communication.

The role of technology in facilitating access to music and supporting a sense of agency in older people is the focus for a major literature review by Creech , now based in Canada. Although this is a relatively under-researched field, the available evidence suggests that that older people, even those with complex needs, are capable of engaging with and using technology in a variety of ways that support their musical perception, learning and participation and wider quality of life.

Related to the particular needs of the young, children's general behavior can also improve through music, as exampled in an innovative, school-based, intensive 3-month orchestral programme in Italy with 8 to 10-year-olds. Fasano et al. report that the programme was particularly beneficial in reducing hyperactivity, inattention and impulsivity, whilst enhancing inhibitory control. These benefits are in line with research findings concerning successful music education with specific cases of young people with ADHD whose behavior is characterized by these same disruptive symptoms (hyperactivity, inattention, and impulsivity).

Extra-musical benefits are also reported in a study of college students (Bachelors and Masters) and amateur musicians in a joint Swiss-UK study. Antonini Philippe et al. suggest that, whilst music making can offer some health protective effects, there is a need for greater health awareness and promotion among advanced music students. Compared to the amateur musicians, the college music students evaluated their overall quality of life and general and physical health more negatively, as did females in terms of their psychological health. Somewhat paradoxically, the college students who had taken part in judged performances reported higher psychological health ratings. This may have been because this sub-group were slightly older and more experienced musicians.

Music appears to be a common accompaniment to exercise, whether in the gym, park or street. Nikol et al. in South East Asia explore the potential physical benefits of synchronous exercise to music, especially in hot and humid conditions. Their randomized cross-over study (2019) reports that “time-to-exhaustion” under the synchronous music condition was 2/3 longer compared to the no-music condition for the same participants. In addition, perceived exertion was significantly lower, by an average of 22% during the synchronous condition.

Comparisons between music and sport are often evidenced in the body of existing Frontiers research literature related to performance and group behaviors. Our new collection contains a contribution to this literature in a study by Habe et al. . The authors investigated elite musicians and top athletes in Slovenia in terms of their perceptions of flow in performance and satisfaction with life. The questionnaire data analyses suggest that the experience of flow appears to influence satisfaction with life in these high-functioning individuals, albeit with some variations related to discipline, participant sex and whether considering team or individual performance.

A more formal link between music and movement is the focus of an exploratory case study by Cirelli and Trehub . They investigated a 19-month-old infant's dance-like, motorically-complex responses to familiar and unfamiliar songs, presented at different speeds. Movements were faster for the more familiar items at their original tempo. The child had been observed previously as moving to music at the age of 6 months.

Finally, a novel UK-based study by Waddington-Jones et al. evaluated the impact of two professional composers who were tasked, individually, to lead a 4-month programme of group composing in two separate and diverse community settings—one with a choral group and the other in a residential home, both funded as part of a music programme for the Hull City of Culture in 2017. In addition to the two composers, the participants were older adults, with the residential group being joined by schoolchildren from a local Primary school to collaborate in a final performance. Qualitative data analyses provide evidence of multi-dimensional psychological benefits arising from the successful, group-focused music-making activities.

In summary, these studies demonstrate that engaging in musical activity can have a positive impact on health and well-being in a variety of ways and in a diverse range of contexts across the lifespan. Musical activities, whether focused on listening, being creative or re-creative, individual or collective, are infused with the potential to be therapeutic, developmental, enriching, and educational, with the caveat provided that such musical experiences are perceived to be engaging, meaningful and successful by those who participate.

Collectively, these studies also celebrate the multiplicity of ways in which music can be experienced. Reading across the articles might raise a question as to whether or not any particular type of musical experience is seen to be more beneficial compared with another. The answer, at least in part, is that the empirical evidence suggests that musical engagement comes in myriad forms along a continuum of more or less overt activity, embracing learning, performing, composing and improvising, as well as listening and appreciating. Furthermore, given the multidimensional neurological processing of musical experience, it seems reasonable to hypothesize that it is perhaps the level of emotional engagement in the activity that drives its degree of health and well-being efficacy as much as the activity's overt musical features. And therein are opportunities for further research!

Author Contributions

The editorial was drafted by GW and approved by the topic Co-editors. All authors listed have made a substantial, direct and intellectual contribution to the Edited Collection, and have approved this editorial for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We are very grateful to all the contributing authors and their participants for their positive engagement with this Frontiers Research Topic, and also for the Frontiers staff for their commitment and support in bringing this topic to press.

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Keywords: music, wider benefits, lifespan, health, well-being

Citation: Welch GF, Biasutti M, MacRitchie J, McPherson GE and Himonides E (2020) Editorial: The Impact of Music on Human Development and Well-Being. Front. Psychol. 11:1246. doi: 10.3389/fpsyg.2020.01246

Received: 12 January 2020; Accepted: 13 May 2020; Published: 17 June 2020.

Reviewed by:

Copyright © 2020 Welch, Biasutti, MacRitchie, McPherson and Himonides. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Graham F. Welch, ; Michele Biasutti,

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Reviewing the Effectiveness of Music Interventions in Treating Depression

Associated data.

Depression is a very common mood disorder, resulting in a loss of social function, reduced quality of life and increased mortality. Music interventions have been shown to be a potential alternative for depression therapy but the number of up-to-date research literature is quite limited. We present a review of original research trials which utilize music or music therapy as intervention to treat participants with depressive symptoms. Our goal was to differentiate the impact of certain therapeutic uses of music used in the various experiments. Randomized controlled study designs were preferred but also longitudinal studies were chosen to be included. 28 studies with a total number of 1,810 participants met our inclusion criteria and were finally selected. We distinguished between passive listening to music (record from a CD or live music) (79%), and active singing, playing, or improvising with instruments (46%). Within certain boundaries of variance an analysis of similar studies was attempted. Critical parameters were for example length of trial, number of sessions, participants' age, kind of music, active or passive participation and single- or group setting. In 26 studies, a statistically significant reduction in depression levels was found over time in the experimental (music intervention) group compared to a control ( n = 25) or comparison group ( n = 2). In particular, elderly participants showed impressive improvements when they listened to music or participated in music therapy projects. Researchers used group settings more often than individual sessions and our results indicated a slightly better outcome for those cases. Additional questionnaires about participants confidence, self-esteem or motivation, confirmed further improvements after music treatment. Consequently, the present review offers an extensive set of comparable data, observations about the range of treatment options these papers addressed, and thus might represent a valuable aid for future projects for the use of music-based interventions to improve symptoms of depression.


“If I were not a physicist, I would probably be a musician. I often think in music. I live my daydreams in music. I see my life in terms of music.” −Einstein, 1929 .

Depression is one of the most serious and frequent mental disorders worldwide. International studies predict that approximately 322 million (WHO, 2017 ) of the world's population suffer from a clinical depression. This disorder can occur from infancy to old age, with women being affected more often than men (WHO, 2017 ). Thus, depression is one of the most common chronic diseases. Depressive suffering is associated with psychological, physical, emotional, and social impairments. This can influence the whole human being in a fundamental way. Without clinical treatment, it has the tendency to recur or to take a chronic course that can lead to loneliness (Alpass and Neville, 2003 ) and an increasing social isolation (Teo, 2012 ). Depression can have many causes that range from genetic, over psychological factors (negative self-concept, pessimism, anxiety and compulsive states, etc.) to psychological trauma. In addition, substance abuse (Neighbors et al., 1992 ) or chronic diseases (Moussavi et al., 2007 ) can also trigger depression. The colloquial use of the term “depressed” has nothing to do with the depression in the clinical sense. The ICD-10 (WHO, 1992 ) and the DSM-V (APA, 2013 ) provide a classification based on symptoms, considering the patient's history and its severity, duration, course and frequency. Within the last two decades, research on the use of music medicine or music therapy to treat depression, showed a growing popularity and several publications have appeared that documented this movement (e.g., Lee, 2000 ; Loewy, 2004 ; Esfandiari and Mansouri, 2014 ; Verrusio et al., 2014 ; Chen et al., 2016 ; Fancourt et al., 2016 ). However, most researchers used a very specific experimental setup (Hillecke et al., 2005 ) and thus, for example, focused only on one music genre (i.e., classical, modern; instrumental, vocal), used a predefined experimental setup (group or individual) (e.g., Kim et al., 2006 ; Chen et al., 2016 ), or specified precisely the age range (i.e., adolescents, elderly) of participants (e.g., Koelsch et al., 2010 ; Verrusio et al., 2014 ). A recent meta-analysis (Hole et al., 2015 ) reviewed 72 randomized controlled trials and concluded that music was a notable aid for reducing postoperative symptoms of anxiety and pain.

Dementia patients showed significant cognitive and emotional benefits when they sang, or listened to familiar songs (Särkämö et al., 2008 , 2014 ). Beneficial effects were also described for CNMP (Chronic Non-Malignant Pain) patients with depression (Siedliecki and Good, 2006 ) 1 . Cardiology is an area where music interventions are commonly used for intervention purposes. Various explanations were postulated and the broad range of effects on the cardiovascular system was investigated (Trappe, 2010 ; Hanser, 2014 ). Music as a therapeutic approach was evaluated (Gold et al., 2004 ), and found to have positive effects before heart surgery (Twiss et al., 2006 ), used to increase relaxation during angiography (Bally et al., 2003 ), or decrease anxiety (Doğan and Senturan, 2012 ; Yinger and Gooding, 2015 ). A systematic review (Jespersen et al., 2015 ) concluded that music improved subjective sleep quality in adults with insomnia, verbal memory in children (Chan et al., 1998 ; Ho et al., 2003 ), and episodic long-term memory (Eschrich et al., 2008 ). Music conveyed a certain mood or atmosphere (Husain et al., 2002 ), allowed composers to trigger emotions (Bodner et al., 2007 ; Droit-Volet et al., 2013 ), based on the cultural background (Balkwill and Thompson, 1999 ), or ethnic group (Werner et al., 2009 ) someone belonged to. In contrast, the emotional state itself plays a role (Al'tman et al., 2004 ) on how music is interpreted (Al'tman et al., 2000 ), and durations are evaluated (Schäfer et al., 2013 ). Subjective impressions embedded in a composition caused physiological body reactions (Grewe et al., 2007 ; Jäncke, 2008 ) and even strengthened the immune system (McCraty et al., 1996 ; Bittman et al., 2001 ). The pace of (background) music (Oakes, 2003 ), has also been used as an essential element of many marketing concepts (North and Hargreaves, 1999 ), to create a relaxed atmosphere. An in-depth, detailed illustration described the wide variety of conscious, as well as subconscious influences music can have (Panksepp and Bernatzky, 2002 ), and endorsed future research on this subject.

Distinction between the terms “Music Therapy [MT]” and “Music Medicine [MM]”

Most of us know what kind of music or song “can cheer us up.” To treat someone else is something completely different though. Therefore, evidence-based procedures were created for a more pragmatic approach. It is important to differentiate between music therapy and the therapeutic use of music. Music used for patient treatment can be divided into two major categories, namely [MT] and [MM], although the distinction is not always that clear.

Music therapy [MT]

Term used primarily for a setting, where sessions are provided by a board-certified music therapist. Music therapy [MT] (Maratos et al., 2008 ; Bradt et al., 2015 ) stands for the “… clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program ” (AMTA) 2 . Many different fields of practice, mostly in the health care system, show an increasing amount of interest in [MT]. Mandatory is a systematic constructed therapy process that was created by a board-certified music therapist and requires an individual-specific music selection that is developed uniquely for and together with the patient in one or more sessions. Therapy settings are not limited to listening, but may also include playing, composing, or interacting with music. Presentations can be pre-recorded or live. In other cases (basic) instruments are built together. The process to create these tailor-made selections requires specific knowledge on how to select, then construct and combine the most suitable stimuli or hardware. It must also be noted that music therapy is offered as a profession-qualifying course of study.

Music medicine [MM] (i.e., functional music, music in medicine)

Carried out independently by professionals, who are not qualified music therapists, like relaxation therapists, physicians or (natural) scientists. A previous consultation, or collaboration, with a certified music therapist can be helpful (Register, 2002 ). In recent years, significant progress has been made in both the research and clinical application of music as a form of treatment. It has valuable therapeutic properties, suitable for the treatment of several diseases. The term “music medicine” is used as a term for the therapeutic use of music in medicine (Bradt et al., 2015 , 2016 ), to be able to differentiate it from “music therapy.” [MM] stands for a medical, physiological and physical evaluation of the use of music. If someone listens to his or her favorite music, this is sometimes also considered as a form of music medicine. [MM] deliberately differs from music therapy as part of psychiatric care or psychotherapy. It is important to stress out that the term “Music Therapy [MT]” should not be used for any kind of treatment involving music, although there is without doubt a relationship between [MT] and [MM]. What all of them have in common is the focus on a scientifically, artistically or clinically based approach to music.

“Seamless Transitions” between music therapy [MT] and music medicine [MM]

Activity used for treatment is ambiguous or not clearly labeled as “Music Therapy” or “Music Medicine.” It should not be forgotten that the definition of “Music Therapy” is not always clearly distinguishable from “Music Medicine.” One possible scenario would be a physician (i.e., “non-professional”), who is not officially certified by the AMTA (or comparable institutions), but still acts according to the mandatory rules. In addition, depending on one's home country, uniform standards or eligibility requirements might be substantially different. We think that every effort should be recognized and therefore postulate one definition that can describe the main principle of [MT], [MM], and everything in between, in one sentence: “ Implementation of acoustic stimuli (“music”) as a medium for the purpose of improving symptoms in a defined group of participants (patients) suffering from depression.”

Materials and methods

Literature search.

Search strategy and selection process was performed according to the recommended guidelines of the Cochrane Centre on systematic literature search (Higgins and Green, 2008 ). Our approach ( Figure 2 ) was according to their scientific relevance, supplemented by the analysis of relevant journals, conferences and workshops of recent years. We obtained 60,795 articles from various search engines as initial result. Retrieved data was collected and processed on an existing personal computer with the latest Windows operating system.

Search, collection, selection, and review strategies

We used a combination of words defining three search-categories (Music-, Treatment-, and Depression associated) as well as several words (e.g., Sound, Unhappy, and Treatment) assigned to each category as described in the collection process.below. If synonyms of those keywords were identified, they were added as well. Theme-categories 3 were created next, then related keywords identified and added into a table. “Boolean Operators 4 ” were used as logical connectives to broaden and/or narrow our search results within many databases (mostly search engines as described below).

This way the systematic variation of keyword-based queries and search terms could be performed with much more efficiency. To find the most relevant literature on the subject, keywords were entered into various scientific search engines, namely PubMed, MEDLINE, and Google Scholar. After the collection process, several different steps were used to reduce the number of retrieved results. Selection out of the collected material included to narrow down search results to a limited period of time. We decided to choose a period between 1990 and 2016 (i.e., not exceeding 26 years), because within these years several very interesting works of research were published, but often not mentioned explicitly, discussed in detail, or the main target of a comparative review. After several papers were excluded, a systematic key phrases search was conducted once more to retrieve results, limited to original research articles 5 . We also removed search results that quoted book chapters, as well as reports from international congresses and conferences. Research papers that remained were distinguished from duplicates (or miss-matches not dismissed yet). Based on our predefined criteria for in- and ex-clusion, relevant publications were then selected for an intensified review process. Our plan was to apply the following inclusion criteria: Original research article, published at time of selection, music and/or instruments were used intentionally to improve the emotional status of participants (i.e., intended or officially confirmed as music therapy). The following exclusion criteria were used: No original research, article was not published (e.g., project phase, in review), unverified data or literature was used, participants did neither receive nor interact with music. Not relevant for in- or exclusion was the kind of questionnaire used to measure depression, additional diagnostic measures for pathologies other than depression, spatial and temporal implementation of treatment, demographics (i.e., number, age, and gender) participants had, or distinctive features (like setting, duration, speakers, live version, and recorded) of stimuli. After the initial number of results, the remaining articles were manually checked for completeness and accuracy of information. Our final selection of articles included 28 research papers.

General information — (Figure ​ (Figure1 1 )

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“Road-Map” Outline of the following results section (idea, concept and creation of this Figure by Leubner).

Evaluating the methodological quality of our meta-review

During the review process, we used a very strict self-monitoring procedure to ensure that the quality of scientific research was met to the best of our knowledge and stood in accordance with the standards of good scientific practice. Every effort has been made to provide the accuracy of contents as well as completeness of data published within our meta-review. Inspired by another author's meta-review (Kamioka et al., 2014 ), we evaluated our work by the AMSTAR checklist (Shea et al., 2007 ) 6 and found no reasons for objection regarding our selection of reviews. AMSTAR (acronym for “Assessment of Multiple SysTemAtic Reviews”), a questionnaire for assessing systemic reviews, is based on a rating scale with 11 items (i.e., questions). AMSTAR allows authors to determine and graduate the methodological quality of their systematic review.

Effect size

We investigated a wide variety of scholarly papers within our review. There were many different approaches and several procedures. As far as intervention approaches and procedures were concerned, we found (very) similar trends in several papers. To ensure that those different tendencies were not only based on our pure assumption as well as biased interpretation, we also calculated the effect-size correlation by using the mean scores as well as standard deviations for each of the treatment and control groups, if this setup was used by the respective researcher. Most trials showed a small difference in between the experimental and control group at baseline, what almost always turned into a large effect size regarding post-measurement.

Depression score improvement (DSI) — approach to compare questionnaires

As mentioned above, we selected 28 scholarly articles that used different questionnaires to measure symptoms of depression for experimental and control groups. According to common statistical standards we used a formula to evaluate and compare the relative standing of each mean to every other mean. To avoid confusion, we decided to refer to it as “Depression Score Improvement (DSI).” Mathematically speaking it stands for the mean difference between the pre-test and post-test results (i.e., score changes) in percent. (DSI Ind ) stands for an individual and (DSI{ Gr ) for a group setting. Please refer to the Supplementary Materials (Table: “Complete Display of Statistical Data”) 7 for additional information.

The results will review the works in terms of demographics, treatment implementation, and diagnostic measures.

Literature search results — (Figure ​ (Figure2 2 )

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Overview of our Collection, Selection, and Review Process (idea, concept and creation of this Figure by Leubner). Initially, the total number of retrieved results was 118,000 as far as google-scholar was concerned. Analysis was complicated by the disproportionately high number of results from google-scholar. Therefore, we decided to narrow down this initial search query to a period from 1990 up to 2016, and reduced the results from google-scholar to 60,000 this way. Compared to the other two search engines, this process was done two steps ahead. At google-scholar we excluded patents as well as citations in the initial window for our search results. Unfortunately search options are very limited, and though we retrieved at first this overwhelming number of 118,000 results!. Some keywords (e.g., anxiety, pain, fear, violence) were deliberately excluded right from the beginning. This was done right at the start of our selection/search process, to prevent a systematic distortion of retrieved results.

Collection process – results

A large list of keywords, based on several questions we had, was created initially. They were combined into search-terms and finally put into search-categories as category-dependent keywords. In addition, we discussed several parameters and agreed on three categories (associated to music, treatment, and depression). By querying scientific databases, using the above-mentioned category-dependent keywords as input criteria, we retrieved a very large number of results. We then searched for a combination of the following words and/or phrases (e.g., “ music AND therapy AND depression”; “acoustic AND intervention AND unhappy” ), narrowed down the retrieved results according to a combination of several keywords (e.g., “ music therapy”; “acoustic intervention” ), and sorted this data according to relevance.

Selection process – results

In step two we applied the above-mentioned approach and narrowed down our search query to a limited period of time, then systematically searched for key phrases, and excluded duplicates as well as previously overlooked miss-matches. Our inclusion criteria can be summarized as follows: Original research article, already published at time of selection, music and/or instruments were used intentionally to improve the emotional status of participants. Our exclusion criteria were: No original research, article was not published (e.g., project phase, in review), unverified data or literature was used, participants did neither receive nor interact with music.

Review process – results

Based on our predefined criteria for inclusion and exclusion, relevant publications were then selected and used for our intensified review process. After reducing the initial number of results, we obtained the remaining articles, conducted a hand-search in selected scientific journals, and manually checked for completeness as well as accuracy of the contained information. The final selection of articles, according to our selection criteria, included 28 papers.

Demographics 8

To begin with, the number of participants as well as age and gender related basic demographics were analyzed.

Participants – results

Our final selection of 28 studies included 1,810 participants, with group sizes between five and 236 persons (n av = 64.64; SD = 56.13). For experimental groups, we counted 954 individuals ( n min = 5; n max = 116; n av = 34.07; SD = 27.78), and 856 ( n min = 10; n max = 120; n av = 30.57; SD = 29.10) for the control respectively. Although three authors (Ashida, 2000 ; Guétin et al., 2009b ; Schwantes and Mckinney, 2010 ) did not use a control sample, those articles were nevertheless considered for calculating accurate and up-to-date data. Depending on each review, sample groups differed profoundly in number of participants. The smallest one had five participants (Schwantes and Mckinney, 2010 ), followed by three authors (Hendricks et al., 1999 ; Ashida, 2000 ; Guétin et al., 2009b ) who used between 10 and 20 individuals in their clinical trials. Medium sized groups of up to 100 participants were found in six articles (Gupta and Gupta, 2005 ; Castillo-Pérez et al., 2010 ; Erkkilä et al., 2011 ; Wang et al., 2011 ; Lu et al., 2013 ). Large groups with more than 100 (Koelsch et al., 2010 ; Silverman, 2011 ), or 200 (Chen et al., 2016 ) participants were the exception, and 236 participants (Chang et al., 2008 ) presented the upper end in our selection.

Age groups – results

Within our selected articles, the youngest participant was 14 (Hendricks et al., 1999 ), and the oldest 95 years of age (Guétin et al., 2009a ). We then separated relevant groups, according to their age, into three categories, namely “young,” “medium,” and “elderly.”

Participants were defined as “young,” if their mean age was below or equal to 30 years (≤30). Young individuals did show minimal better (i.e., higher) depression score improvements (DSI) (mean difference between the pre-test and post-test results was calculated in percent), if they attended group (mean DSI Gr = 53.83%) 9 , rather than individual (DSI Ind = 40.47%) music intervention sessions. These results may be due to the beneficial consequences of social interactions within groups, and thus confirm previous study results (Garber et al., 2009 ; Tartakovsky, 2015 ).

We used the term “medium” for groups of participants, whose mean ages ranged between 31 (>30) and 59 years (<60). Medium-aged participants presented much better results (i.e., higher depression score improvements), if they attended a group (mean DSI Gr = 48.37%), rather than an individual (mean DSI Ind = 24.79%) intervention setting. However, it should be stressed that our findings only show a positive trend and thus should not be evidence.

The third and final group was defined by us as “elderly” and included participants with a mean age of 60 years or above (≥60). Noticeable results were found for the age group we defined as elderly, as participants showed slightly better (i.e., higher) score improvements (mean DSI Ind = 48.96%), if they attended an individual setting. Considering the music selection that had been used for elderly participants, a strong tendency toward classical compositions was found (e.g., Chan et al., 2010 ; Han et al., 2011 ). Because a relevant number of participants came from Asian countries (e.g., China, Korea), elderly people from those research articles received, in addition to classical music, quite often Asian oriented compositions as well. Despite our extensive investigations, the influence this combination had on results, remained uncertain. Positive tendencies within those groups might be due to “traditional” and/or “culture related” factors. It is, however, also conceivable that combining Western classical with traditional Asian music is notably suited to produce better results. Concerning this matter, future research on western depression patients treated with a combination of classical Western, and traditional Asian music might be a promising concept to be further explored.

Gender – results

As far as gender was concerned, we subdivided each sample group in its female and male participants. Women and men were found in 20 study designs. This was the most frequently used constellation. Within this selection, we did not find any significant differences, and so no further analysis was done. Only women took part in two studies (Chang et al., 2008 ; Esfandiari and Mansouri, 2014 ) 10 . Interestingly the same stimuli setup was used in both cases. It consisted of instrumental music without vocals, stored on a digital record, and was presented via loudspeakers from a CD (Chang et al., 2008 ) or MP3 player (Esfandiari and Mansouri, 2014 ). Only men were seen in four research papers (Gupta and Gupta, 2005 ; Schwantes and Mckinney, 2010 ; Albornoz, 2011 ; Chen et al., 2016 ). A significant improvement of depression scores was reported for every experimental group, and once (Albornoz, 2011 ) for a corresponding control setting (received only standard and no alternative treatment). Three articles (Schwantes and Mckinney, 2010 ; Albornoz, 2011 ; Chen et al., 2016 ) shared several similarities, as percussion instruments (e.g., drums, tambourines) were part of each genre selection, all participants received music interventions in a group setting, and stimuli were actively produced within a live performance. In addition, the BDI questionnaire has also been used in three cases (Gupta and Gupta, 2005 ; Albornoz, 2011 ; Chen et al., 2016 ), and thus we were able to perform a search for similarities or tendencies. The average duration for one music intervention was 80 ( SD = 45) min and the total number of sessions was 17 ( SD = 5) in average. Two publications (Hsu and Lai, 2004 ; Wang et al., 2011 ) did not offer any information about gender related distribution of participants.

Music therapy [MT] vs. music medicine [MM] — study results

Music-therapy [mt].

Within our selection of 28 articles, six explicitly mentioned a certified music therapist (Hanser and Thompson, 1994 ; Choi et al., 2008 ; Schwantes and Mckinney, 2010 ; Erkkilä et al., 2011 ; Han et al., 2011 ; Silverman, 2011 ) 11 . For five articles with available data, a combined average depression score improvement (DSI) of 40.87% ( SD = 7.70%) was calculated for the experimental groups. As far as the relevant control groups were concerned, only twice depression scores decreased at all (Choi et al., 2008 ; Erkkilä et al., 2011 ; Table ​ Table1 1 ).

Music-Therapy interventions—music types and results.

Regarding the kind of music provided by a board-certified music therapist, we found some similarities that stood out and appeared more frequently, when compared to music medicine interventions. Percussion music (mainly drumming) was used by four researchers (Choi et al., 2008 ; Schwantes and Mckinney, 2010 ; Erkkilä et al., 2011 ; Han et al., 2011 ). One author (Choi et al., 2008 ) used music based on instruments that were selected according to participant's preferences. Included were, for example, egg shakes, base-, ocean-, and paddle-drums. Participants actively played and passively listened to instruments or sounds, complemented by singing together. Another researcher (Erkkilä et al., 2011 ) preferred the African Djembe 12 drum as well as a selection of several percussion sounds created digitally by an external MIDI ( Musical Instrument Digital Interface ) synthesizer. Percussion-oriented improvisation that included rhythmic drumming and vocal patterns was another approach one scholar (Han et al., 2011 ) used for his stimuli selection. Congas, Cabassas, Ago-Gos, and Claves was the percussion-based selection (in addition a guitar and a Piano was also available) in the fourth music-therapy article (Schwantes and Mckinney, 2010 ). Twice, music without the use of percussion instruments or drums in general, was selected for the intervention. Once (Hanser and Thompson, 1994 ) relaxing, slow and rhythmic harp-samples, played from a cassette-player, were used. In addition, each of the participants was invited to bring some samples of her or his favored music titles. The second one (Silverman, 2011 ) decided to play a “12-bar Blues” (i.e., “blues changes”) 13 progression as an introduction, followed by a Blues songwriting session. The last-mentioned music-therapy project was the only article out of six, where participants within their respective music intervention group did not present a significant reduction of depression. A very interesting “fund” was that none of the music-therapy articles neither concentrated their main music selection on classical, nor on Jazz music. When we looked for other distinctive features it turned out that stimuli were actively produced within a live performance in five articles. There was only one exception (Hanser and Thompson, 1994 ), where a passive presentation of recorded stimuli was preferred by the scholar.

Music-medicine [MM]

The remaining 22 research articles did not explicitly mention a certified music therapist. In those cases, some variant of music medicine was used for intervention. Often the expression music therapy was used, although a more detailed description or specific information was neither published nor available upon our request. With one exception (Castillo-Pérez et al., 2010 ), we could calculate the (DSI) 9 for 25 articles that used some variant of music-medicine [MM].

When we investigated the kind of music that was used, a broader selection of genres was found. Percussion based tracks and drumming appeared in five scholarly papers (Ashida, 2000 ; Albornoz, 2011 ; Lu et al., 2013 ; Chen et al., 2016 ; Fancourt et al., 2016 ). Researchers that used drums reported a significant depression score improvement for every experimental group and we calculated an average of 53.71% for those five articles. Regarding the kind of genre used in our selection of music-medicine articles, a wider range of genres was found. One of the biggest differences was that only music-medicine articles used, in addition to percussion stimuli, also classical and Jazz music for their intervention. Please note that for reasons of confusion, we do not mention the Seamless Transitions between Music Therapy [MT] and Music Medicine [MM] from the “Materials and Methods Section.”

Music genres (selection of music titles) – results

Regarding the kind of music used in our selection of research articles, a wide range of genres was found. Mainly three styles, classical 14 (9x), percussion 15 (9x), and Jazz (5x) music were used more frequently for music intervention. The evaluation took place when specific compositions showed significantly greater improvements in depression compared to other research attempts. Utilizing our comprehensive data analysis, music titles were categorized according to genre or style (e.g., classical music, Jazz), narrowed down (e.g., Jazz), sorted by magnitude of depression score improvements (DSI) 9 , and finally examined for distinctive features (like setting, duration, speakers, live version, recorded). Similarities that stood out and appeared more frequently among one selected music genre were compared with the 28 scholarly articles we selected for our meta-review.

Classical music – results

In nine articles, classical music (Classical or Baroque period) 22 was used. Several well-known composers such as W.A. Mozart (Castillo-Pérez et al., 2010 ), L. v. Beethoven (Chang et al., 2008 ; Chan et al., 2009 ) and J. S. Bach (Castillo-Pérez et al., 2010 ; Koelsch et al., 2010 ) have been among the selected samples. If classical music was used as intervention, our calculations revealed that four studies out of eight 16 were among those with depression score improvements (DSI) 31 that were above the average 17 of 39.98% ( SD = 12). When we looked for similarities between these, three of the four studies (Harmat et al., 2008 ; Chan et al., 2009 ; Guétin et al., 2009a ) used individual sessions, rather than a group setting (Koelsch et al., 2010 ). For all four articles mentioned above, we calculated an average of 11 ( SD = 10) for the total number of sessions that included classical music. The remaining five articles on the other hand, presenting results not as good as the aforementioned, showed an average of 30 ( SD = 21) music interventions. One plausible hypothesis might be “saturation effect” caused by too many interventions in total. Too little variety within the selection of music titles has probably played an important role as well. A general tendency that less intervention sessions in total would lead to better results for every case where classical compositions were included could not be confirmed for our selection.

Percussion (drumming-based) music – results

Percussion music (mainly drumming) was used by nine 18 researchers, and among those, two ways of integration were found. On the one hand, rhythmic percussion compositions were included as part of the music title selection used for intervention. On the other hand, and this was the case in nine articles, various forms of drums had been offered to those who joined the experimental groups, allowing them to “produce their own” music. Sometimes participants were accompanied by a music therapist (e.g., Albornoz, 2011 ) or professional artist (Fancourt et al., 2016 ), who gave instructions on how to use and play these instruments. When we looked for trends or distinctive features percussion music (in particular drumming) had, it turned out that, except one article (Erkkilä et al., 2011 ), all were carried out within a group, rather than an individual setting. A further search for additional similarities, leading to better outcome scores, did not deliver any new findings as far as improvement of depression was concerned. Participants in altogether 7 out of 9 percussion groups were medium aged, two authors (Ashida, 2000 ; Han et al., 2011 ) described elderly participants, whereas none of the percussion groups included young participants.

A wide and even distribution of reduced depression scores across all outcome levels became apparent, when participants received percussion (or drumming) interventions. We calculated an average depression score improvement (DSI) of 47.80% ( SD = 14). Above-average results regarding depression score improvement (DSI), were achieved in four experiments that had an average percussion session duration of 63 ( SD = 19) min. In comparison, we calculated for the remaining five articles an average of 93 ( SD = 26) min. Although a difference of 30 min showed a clear tendency, it was not enough of a difference to draw any definitive conclusions.

Jazz music – results

Finally, five 19 researchers used primarily Jazz 20 as music genre for their intervention. Featured performers (artists) were Vernon Duke (“April in Paris”) (Chan et al., 2009 ), M. Greger (“Up to Date”), and Louis Armstrong (“St. Louis Blues”) (Koelsch et al., 2010 ). Unfortunately, available data was quite limited, mainly since most authors did not disclose relevant information and a detailed description was rarely seen. Some interesting points were also found for research articles that used Jazz as a treatment option. All five of them were among those with good outcome scores, as far as depression reduction was concerned. Test scores ranged between a significance level of p < 0.01 (Guétin et al., 2009a ; Verrusio et al., 2014 ; Chen et al., 2016 ) and sometimes even better than p < 0.001 (e.g., Koelsch et al., 2010 ; Fancourt et al., 2016 ). Depression score improvement (DSI) had an average of 43.41% ( SD = 6). However, there was no clear trend leading toward Jazz as a more effective intervention option, when compared to other music genres. This was assumed because the two studies that showed the best 21 reduction in depression [Chan et al., 2010 (DSI = 48.78%); Koelsch et al., 2010 (DSI = 4 6.58%)] used both classical music in addition to Jazz as an intervention. Experimental groups received two types of intervention (i.e., classical music and Jazz) which eventually blurred outcome scores or prevented more accurate results. Since it was not possible to differentiate to what extent either classical music or Jazz was responsible for the positive trend in reducing symptoms of depression, further research in this field is needed.

Additional music genres – results

Numerous other music styles were used in the experiments, ranging from Indian ragas 22 played on a flute (Gupta and Gupta, 2005 ; Deshmukh et al., 2009 ), nature sound compositions (Ashida, 2000 ; Chang et al., 2008 ), meditative (Chan et al., 2010 ), or slow rhythm music (Chan et al., 2012 ), to lullabies (Chang et al., 2008 ), pop or rock (Kim et al., 2006 ; Erkkilä et al., 2011 ), Irish folk, Salsa, and Reggae (Koelsch et al., 2010 ), only to name a few. As far as we were concerned all those genres mentioned above would present interesting approaches for future research. Due to a relatively small number and simultaneously wide-ranging variety, more thorough investigations are needed, though. These should be examined independently. As far as the above-mentioned music genres, other than classical, percussion, or Jazz were concerned, no indication for a preferable combination was observed.

Experimental vs. control groups – results

Non-significant results for experimental groups ( p > 0.05).

In two (Deshmukh et al., 2009 ; Silverman, 2011 ) out of 28 studies within our selection of research papers, no significant reduction in depression scores was reported, after participants participated in music interventions. Within those two cases all relevant statistical observations differed without any obvious similarities indicating reasons for non-significant results. Although the results did not meet statistical significance for symptom improvement, both authors explicitly pointed out that positive changes in the severity of depression became obvious for the respective experimental groups. We declared one article (Guétin et al., 2009b ) as significant, although it was marked as non-significant in our complete table. This was due to the overall results of this specific research paper, with significant [HADS-D] test scores for weeks 5, 10, and 15. Only week 20 did not follow this positive trend of improvement. It is also important to mention that after music treatment every one of the additional tests [HADS-A for Anxiety; Face(-Scale) to measure mood] showed significant improvements for the experimental group.

Alternative treatment for corresponding control groups

Control groups, who received an alternative (i.e., non-music) intervention, were found in nine research articles (e.g., Guétin et al., 2009a ; Castillo-Pérez et al., 2010 ) 23 . We investigated whether there were particularly noticeable differences in outcome scores, when relevant control groups, who received an alternative treatment, were compared to those who received no additional intervention at all (or only the usual treatment) 24 . As far as these nine articles were concerned, a significant reduction ( p < 0.05) in depression scores was found in every experimental but only one control setting (Hendricks et al., 1999 ). In this case, an entirely different result became apparent, when control participants received a Cognitive-Behavioral Therapy [CBT] and a significant reduction ( p < 0.05) in depression scores was measured compared to the respective baseline score, although music still lead to better results. Another scholar (Chan et al., 2012 ) 25 , instructed participants in the control group to take a resting period, while simultaneously the experimental attendees joined their music intervention session. This alternative approach did not reduce the [GDS-15] depression score, but even increased it. Interestingly, the same author previously published (Chan et al., 2009 ) a significant ( p = 0.007) increase (i.e., worsening of depression) for the relevant control setting. To be complete, a resting period was also conducted in another case (Hsu and Lai, 2004 ), but results showed also no significant reduction in depression scores. Other attempts to provide an alternative intervention for the control group have been monomorphic tones (Koelsch et al., 2010 ) that corresponded to the experimental music samples (in pitch-, BPM-, and duration), verbal treatment sessions (Silverman, 2011 ), antidepressant drugs (Verrusio et al., 2014 ) 26 , reading sessions (Guétin et al., 2009a ) or a “conductive-behavioral” psychotherapy (Castillo-Pérez et al., 2010 ).

Significant results for control groups ( p < 0.05):

Significant reduction of depression ( p < 0.05) in corresponding control (“non-music treatment”) groups was reported twice (Hendricks et al., 1999 ; Albornoz, 2011 ) within our selection of scholarly articles. In one instance (Albornoz, 2011 ) the relevant participants received only standard care, but in the other case (Hendricks et al., 1999 ) an already above mentioned alternative treatment (i.e., “Cognitive-Behavioral Activities”) was reported.

Spatial and temporal implementation of treatment

Individual vs. group intervention – results.

As postulated by previous literature (Wheeler et al., 2003 ; Maratos et al., 2008 ), we differentiated mainly two scenarios based on the number of participants who attended music intervention sessions and referred to them as “group” or “individual.” Group sessions can awaken participants' social interactions and individual sessions often provides motivation (Wheeler et al., 2003 ). Here, a “group” scenario was specified, if two or more persons ( n ≥ 2) were treated simultaneously, whereas “individual” determined experimental settings where only one single person received music interventions individually ( n = 1). Among our article selection we could find a well-balanced distribution of 15 trials with participants who received music interventions in a group, while 13 researchers used an individual setting. First, the impact of individual compared to group treatment was evaluated. Here an almost equivalent outcome (for the significance-level of results) across all 13 individual, compared to 15 group settings was found, without any advantage to one over the other. Non-significant improvements were seen once for a group (Silverman, 2011 ) and once 27 for an individual (Deshmukh et al., 2009 ) intervention.

Single-session duration – results

The question whether groups showed different (i.e., more or less) improvements, if the duration of one single session was altered, we decided to use the intervention length as a key metric (Figure ​ (Figure3). 3 ). Except for two instances (Hendricks et al., 1999 ; Wang et al., 2011 ), 26 research papers reported the duration one single treatment had. Among those 20 min (Guétin et al., 2009a ) was the shortest, and 120 min (Albornoz, 2011 ; Han et al., 2011 ) the longest duration for one session. The average for all 26 articles was 55 min, 70 min for 13 28 group settings, and 40 min as far as the 13 individual intervention setups were concerned.

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Session- and research duration–vs.–[DSI] results in dependence of treatment setting.

Entire research (=) intervention program duration – results

Continuing our review process, some interesting diversity was found for the scheduled (i.e., total) treatment duration (Figure ​ (Figure3). 3 ). It ranged from 1 day in two cases (Koelsch et al., 2010 ; Silverman, 2011 ) up to 20 (Guétin et al., 2009b ), or even 24 weeks (Verrusio et al., 2014 ). Out of 26 trials an average duration of 7 weeks was found. In two cases, the data was missing (Wang et al., 2011 ; Esfandiari and Mansouri, 2014 ). The scheduled (i.e., total) treatment duration was determined by a variety of factors. Our investigation, whether there was any relationship between the entire duration of experimental projects and relevant outcome scores, delivered the following results. For an individual (Ind) therapy setting, we isolated eight 29 research papers with above average 30 results in depression score improvement (DSI Ind > 36.50%). We then calculated for the entire project an average duration of almost 7 weeks. For the remaining five 31 articles that also used an individual approach, but had below average depression score improvements, an average duration of 6 weeks was found. A different picture became apparent when we selected those four 32 articles that presented better than average (DSI Gr > 49.09%) results in depression score improvement, after participants received music intervention in a group (Gr). Percussion music (mainly drumming) was used by three researchers (Ashida, 2000 ; Lu et al., 2013 ; Chen et al., 2016 ). In comparison, the fourth author (Hendricks et al., 1999 ) used a selection of relaxing music for treatment. For this setup, a combined duration of six ( SD = 4) weeks was calculated for the entire project length. On the other hand, a mean close to 10 ( SD = 7) weeks was found for the remaining 7 33 group intervention projects that were less successful (i.e., below average), as far as depression score reduction was concerned. Based on these results, we concluded that the length for the entire music intervention procedure might be a crucial element for successful results, and seems to be associated with the intervention type. These findings were not enough to draw further conclusions for every project though, but as far as our selection was concerned, a slightly longer intervention duration of 7 weeks led to better results if participants were treated individually. In comparison, for a group setting our calculations revealed a different picture, when we calculated the average entire duration for all relevant research projects. Here it was 6 weeks that produced the most beneficial results within groups. Drums were used for three out of the four projects that presented above average results. Once (Ashida, 2000 ) a small African drum was used for “drumming activity” at the start of every session. Each time a different participant was asked to perform with this instrument, although nobody in the experimental group was neither a professional drummer nor a musician. African drums were also used by another researcher (Chen et al., 2016 ). In addition, equipment also included one stereo, one electronic piano, two guitars, one set of hand glockenspiel, and other percussion instruments such as cymbals, tambourines, and xylophones. Finally, percussion instruments used in the third study (Lu et al., 2013 ) included hand bells, snare drums, a castanet, a tambourine, some claves, a triangle and wood blocks.

Total number of sessions – results

Continuing the analysis, we evaluated the total number of music intervention sessions. Apparently, this metric was dependent on the duration as well as frequency (“session frequency”) each intervention had. With one exception (Wang et al., 2011 ), where relevant data was missing, the number of sessions varied considerably. Only a single treatment session was used by three authors (Chan et al., 2010 ; Koelsch et al., 2010 ; Silverman, 2011 ), whereas 56 sessions (Castillo-Pérez et al., 2010 ) marked the opposite end of the scale. For 27 articles with available data, a combined average of 15 sessions was found. As far as the total number of sessions in an individual type of setting was concerned, above average results had a combined number of 13 ( SD = 5) sessions, whereas the remaining six research works had 18 ( SD = 8) interventions. The best results in a group setting showed an average of 17 sessions ( SD = 15) and they were found in 7 scholarly publications. In comparison, we calculated 14 sessions in total for the remaining 7 articles.

Session frequency (i.e., sessions per week) – results

As described previously (Wheeler et al., 2003 ), the number of sessions can produce different results. Researchers, within our selection of 28 articles, used various approaches for their experiment, as far as the “session frequency” (i.e., number of sessions within a defined duration) was concerned. Pre-defined intervals ranged from once a week up to one time a day. Once (Choi et al., 2008 ), the article did mention the total number of sessions ( n = 15) with a “frequency” of one to two times a week and a total intervention duration of 12 weeks. To be able to present an appropriate comparison of statistical data, a mean of 1.25 sessions per week was calculated. Besides two cases (Wang et al., 2011 ; Esfandiari and Mansouri, 2014 ) where no information was provided, the combined average session frequency for the remaining 26 articles was 2.89 ( SD = 2.50) interventions per week. Usually sessions were held once a week.

Session- and research duration – vs. – [DSI] results in dependence of treatment setting

We further investigated if there was an association between therapy setting (individual or group), the length of a single session, and trial duration with regard to symptom improvement. Groups (Figure ​ (Figure3) 3 ) showed better (i.e., above average) improvements in depression, if each session had an average duration of 60 min, and the mean length of treatment was 4–8 weeks.

In comparison, the two variables, session length and trial duration, had different effects for individual treatment approaches (Figure ​ (Figure3). 3 ). Above average results were found for sessions lasting 30 min combined with a treatment duration between 4 and 8 weeks.

Diagnostic measures – results of selected questionnaires

We discovered some distinctive features as well as certain similarities in our selection of 28 articles. They might be a guidance for future research projects and as such are presented in more detail in the subsections below.

Beck depression inventory [BDI]

There are three versions of the BDI. The original [BDI] (Beck et al., 1961 ), followed by its first [BDI-I/-1A] (Beck et al., 1988 ) and second [BDI-II] revision (Beck et al., 1996 ). Beck used a novel approach to develop his inventory by writing down the verbal symptom description of his patients with depression and later sorted his notes according to intensity or severity.

Beck depression inventory [BDI] – results

The BDI 34 (Beck et al., 1961 , 1996 ) was the most widely used screening tool in our scholarly selection. It was used in eight trials, but we only selected 7 35 studies for evaluating pre-post BDI scores. Once (Harmat et al., 2008 ), results were only provided for the experimental group, although an experimental control setting was described by the author. Twice (Harmat et al., 2008 ; Esfandiari and Mansouri, 2014 ) two experimental groups and one control group were reported. In one case (Esfandiari and Mansouri, 2014 ) two different music genres were used (“Light Pop & Heavy Rock”), and in another incident (Harmat et al., 2008 ) the second experimental group listened to an audiobook (“Music & Audiobook”). BDI baseline scores, that indicated a minimal 36 to mild 37 depression, were found in two articles (Gupta and Gupta, 2005 ; Harmat et al., 2008 ). Both authors reported for their experimental group a significant improvement of (BDI) depression scores. We calculated an overall average reduction of 2.72 ( SD = 0.03). Moderate 38 signs of depression, with BDI baseline scores that ranged from 18.66 (Albornoz, 2011 ) to 24.72 (Chen et al., 2016 ), were found twice. Music intervention improved BDI scores significantly, with an overall average reduction of 10.65 ( SD = 3.63) for both articles mentioned above. For the respective control groups one author (Chen et al., 2016 ) reported non-significant pre-post changes, whereas the other researcher (Albornoz, 2011 ) described a significant 39 reduction in the standard treatment group as well. The remaining three scholarly papers (Hendricks et al., 1999 ; Choi et al., 2008 ; Esfandiari and Mansouri, 2014 ) described participants with a severe 40 depression, as confirmed by the initial (baseline) BDI results. One article (Esfandiari and Mansouri, 2014 ), of the three mentioned above, used one control and two experimental groups, who were treated with either “light” or “heavy” music. To be able to compare this work with the other studies one single baseline (31.75), post treatment (12.50), and pre-post difference score of 19.25 ( SD = 2.47) 41 was calculated (according to common statistical standards) for both experimental settings. Interestingly, the corresponding control sample showed a three-point increased BDI score ( p > 0.05) and no decrease at any time. Continuing with the remaining articles, even bigger initial baseline BDI scores of 39.00 ( SD = n/a) (Hendricks et al., 1999 ) and 49.30 ( SD = 3.10) (Choi et al., 2008 ) were found. In addition, both authors reported a significant pre-post BDI score reduction 42 for their experimental groups. Based on the published data it became evident that BDI scores improved significantly in each of the cases and this time an overall average reduction of 26.90 ( SD = 9.59) was calculated. Once (Hendricks et al., 1999 ) a significantly reduced BDI pre-post score was also reported for the control setting, where participants received a cognitive-behavioral activities program as an alternative (non-music) intervention.

We compared all research projects that used the BDI questionnaire (Table ​ (Table2). 2 ). Higher baseline scores almost always led to comparatively bigger score reductions in those experimental groups, who received music intervention. Except for two articles (Hendricks et al., 1999 ; Albornoz, 2011 ), no significant improvements were found for control samples. For one of the above-mentioned exceptions (Hendricks et al., 1999 ) an alternative treatment (“ Cognitive-Behavioral” activities ) was provided, which might be a plausible explanation why those relatively young participants (all 14 or 15 years old) showed such reductions in BDI values. Nevertheless, it is also important to mention that the relevant experimental group improved to a greater extent (BDI PRE − BDI POST = 37.66) after treatment. As far as the other case (Albornoz, 2011 ) was concerned, no alternatives (i.e., other than basic or usual care) were offered, and thus no explanation had been established as to how the results could be explained.

Comparison of BDI results.

Geriatric depression scale [GDS-15/-30]

The original Geriatric Depression Scale [GDS-30] (Yesavage et al., 1983 ) includes 30 questions (Hanser and Thompson, 1994 ; Chan et al., 2009 ; Guétin et al., 2009a ) and its shorter equivalent [GDS-15] (Yesavage and Sheikh, 1986 ) contains 15 items (Chan et al., 2010 , 2012 ; Verrusio et al., 2014 ).

Geriatric depression scale [GDS-15/-30] – results

A more precise analysis of results was also done for the Geriatric Depression Scale (GDS-15/-30) scores. As already suggested by its name, all 223 participants were elderly. Because both GDS versions are based on the same questionnaire, we combined scores of the long (i.e., GDS-30) with the short (i.e., GDS-15) test version and found a total of 223 participants in six articles (e.g., Chan et al., 2009 ; Verrusio et al., 2014 ). A possible bias could be prevented because tests were evenly distributed in number, and with respect to higher GDS-30 as well as lower GDS-15 scores, calculations were adapted accordingly. Taking a closer look at the GDS-15/-30 results (Table ​ (Table3), 3 ), some similarities could be found for the most successful (all p ≤ 0.01) four research articles (Chan et al., 2009 , 2010 ; Guétin et al., 2009a ; Verrusio et al., 2014 ). All of them used and mainly focused on classical compositions as far as their music title selection was concerned. The average reduction in depression as measured by the GDS-15/-30 depression scores was 43% (−42.62%; SD = 6.24%). In comparison, every one of the remaining four research projects (Hanser and Thompson, 1994 ; Ashida, 2000 ; Han et al., 2011 ; Chan et al., 2012 ) also presented significant results, albeit not as good as the above-mentioned (all p ≤ 0.05). Interestingly, as far as music genres were concerned, the focus of these less successful projects was rhythmic drumming in two cases (Ashida, 2000 ; Han et al., 2011 ). For the remaining two (Hanser and Thompson, 1994 ; Chan et al., 2012 ) primarily relaxing, slow paced titles 43 were selected as intervention.

Comparison of GDS-15/-30 Results ( * )GDS-15, ( ** )GDS-30.

Other diagnostic measures for depression 44 – results 45

Several times, additional questionnaires were used to measure changes in the severity of depression.

Researchers performed those surveys (Table ​ (Table4) 4 ) in addition to their “main” depression questionnaire. Please refer to our Supplementary Material for a more comprehensive test description.

Additional tests, conducted by researchers within our article selection for investigating changes in depression.

Diagnostic measures for pathologies other than depression – results

In many instances, additional questionnaires were used (Table ​ (Table5 5 ) 49 to measure symptoms other than depression (e.g., Anxiety is known to be one of the most common depression comorbidities, Sartorius et al., 1996 ; Bradt et al., 2013 ; Tiller, 2013 ). Eight 46 researchers concentrated their investigation entirely on depression, and thus only performed questionnaires related to this pathology. In comparison, most of the remaining studies measured additional pathologies, with some of them known to be often associated comorbidities with depressive symptoms. However, because these topics were not the focus of this review, we won't discuss them here in detail. A much more detailed representation is available in the Supplementary Table. Please refer to the original studies for a more comprehensive test description.

Additional tests, conducted by researchers within our selection for investigating changes in other pathologies.

Discussion, conclusion and further thoughts

Depression often reduces participation in social activities. It also has an impact on reliability or stamina at daily work and may even result in a greater susceptibility to diseases. Music can be considered an emerging treatment option for mood disorders that has not yet been explored to its full potential. To the best of our knowledge, there were only very few meta-analyses, or systematic reviews of randomized controlled trials available that generated the amount of statistical data, which we presented here.

Certain individual-specific attributes of music are recognizable, when the medium of music is decomposed (Durkin, 2014 ) 47 into its components. Numerous researchers reported the beneficial effects of music, such as strengthening awareness and sensitiveness for positive emotions (Croom, 2012 ), or improvement of psychiatric symptoms (Nizamie and Tikka, 2014 ). Group drumming, for example, helped soldiers to deal with their traumatic experiences, while they were in the process of recovery (Bensimon et al., 2008 ). However, we have concentrated our focus of interest on patients diagnosed with clinical depression, one of the most serious and frequent mental disorders worldwide.

In this review we examined whether, and to what extent, music intervention could significantly affect the emotional state of people living with depression. Our primary objective was to accurately identify, select, and analyze up-to-date research literature, which utilized music as intervention to treat participants with depressive symptoms. After a multi-stage review process, a total of 1.810 participants in 28 scholarly papers met our inclusion criteria and were finally selected for further investigations about the effectiveness music had to treat their depression. Both, quantitative as well as qualitative empirical approaches were performed to interpret the data obtained from those original research papers. To consider the different methods researchers used, we presented a detailed illustration of approaches and evaluated them during our investigation process.

Interventions included, for example, various instrumental or vocal versions of classical compositions, Jazz, world music, and meditative songs to name just a few genres. Classical music (Classical or Baroque period) for treatment was used in nine articles. Notable composers were W.A. Mozart, L. v. Beethoven and J. S. Bach. Jazz was used five times for intervention. Vernon Duke (Title: “April in Paris”), M. Greger (Title: “Up to Date”), or Louis Armstrong (Title: “St. Louis Blues”) are some of the featured artists. The third major genre researchers used for their experimental groups was percussion and drumming-based music.

Significant criteria were complete trial duration, amount of intervention sessions, age distribution within participants, and individual or group setting. We compared passive listening to recorded music (e.g., CD), with active experiencing of live music (e.g., singing, improvising with instruments). Furthermore, the analysis of similar studies has enhanced and complemented our work. Previous studies indicated positive effects of music on emotions and anxiety, what we tried to confirm in more detail. The length of an entire music treatment procedure was suspected to be an important element for reducing symptoms of depression. A longer treatment duration of 7 weeks for an individual, compared to nearly 6 weeks in a group setting led to better (i.e., above average) outcomes. Although a difference was discovered, 1 week was not enough to draw further conclusions for each and every project. As far as intervals between sessions were concerned, we found no differences between those research articles that were among the best, compared to the remaining experimental designs. Consequently no trend was becoming apparent, favoring one over the others. We further investigated if there was any association between an individual or a group setting, if the length of a single session and trial duration were compared with regard to symptom improvement. Groups showed better improvements in depression, if each session had an average duration of 60 min, and a treatment between 4 and 8 weeks long. In comparison, the two variables, session length and trial duration, had different effects for individual treatment approaches. Above average results were found for sessions lasting 30 min combined with a treatment duration between 4 and 8 weeks. Furthermore, results were compared according to age groups (“young,” “medium,” and “elderly”). Overall, elderly people benefitted in particular from this kind of non-invasive treatment. During, but mainly after completion of music-driven interventions, positive effects became apparent. Those included primarily social aspects of life (e.g., an increased motivation to participate in life again), as well as concerned participants' psychological status (e.g., a strengthened self-confidence, an improved resilience to withstand stress).

We described similarities, the integration of different music intervention approaches had on participants in experimental vs. control groups, who received an alternative, or no additional treatment at all. Additional questionnaires confirmed further improvements regarding confidence, self-esteem and motivation. Trends in the improvement of frequently occurring comorbidities (e.g., anxiety, sleeping disorders, confidence and self-esteem) 48 , associated with depression, were also discussed briefly, and showed promising outcomes after intervention as well. Particularly anxiety (Sartorius et al., 1996 ; Tiller, 2013 ) is known to be a common burden, many patients with mood disorders are additionally affected with. Interpreted as manifestation of fear, anxiety is a basic feeling in situations that are regarded as threatening. Triggers can be expected threats such as physical integrity, self-esteem or self-image. Unfortunately, researchers merely distinguished between “anxiety disorder” (i.e., mildly exceeded anxiety) and the physiological reaction. Also, the question should be raised if the response to music differs if patients are suffering from both, depression and anxiety. Sleep quality in combination with symptoms of depression (Mayers and Baldwin, 2006 ) raised the question, whether sleep disturbances lead to depression or, vice versa, depression was responsible for a reduced quantity of sleep instead. Most studies used questionnaires that were based on self-assessment. However, it is unclear whether this approach is sufficiently valid and reliable enough to diagnose changes regarding to symptom improvement. Future approaches should not solely rely on questionnaires, but rather add measurements of physiological body reactions (e.g., skin conductance, heart and respiratory rate, or AEP's via an EEG) for more objectivity.

The way auditory stimuli were presented, also raised some additional questions. We found that for individual intervention most of the times headphones were used. For a group setting speakers were the number one choice instead. For elderly participants, a different sensitivity for music perception was a concern, when music was presented directly through headphones. Headphones add at least some isolation from background noises (i.e., able to reduce noise disturbances and surround-soundings). Another concern was that most of the time a certified hearing test was not used. Although, a tendency toward a reduction in the ability to hear higher frequencies is quite common with an increased age, there might still be substantial differences between participants.

Two authors (Deshmukh et al., 2009 ; Silverman, 2011 ) reported that participants within their respective music intervention group, did not present a significant reduction of depression. Those two had almost nothing in common 49 and were not investigated further.

Control groups, who received an alternative (“non-music”) intervention, were found in nine research articles. Significant reduction of depression in corresponding control (“non-music intervention”) groups was reported by two authors (Hendricks et al., 1999 ; Albornoz, 2011 ). In one instance (Albornoz, 2011 ) the relevant participants received only standard care, but in the other case (Hendricks et al., 1999 ) an alternative treatment (Cognitive-Behavioral activities) was reported. Medical conceptions are in a constant state of change. To achieve improvements in areas of disease prevention and treatment, psychology is increasingly associated with clinical medicine and general practitioners. Under the guidance of an experienced music therapist, the patient receives a multimodal and very structured treatment approach. That is the reason why we can find specialists for music therapy in fields other than psychosomatics or psychiatry today. Examples are internal medicine departments and almost all rehabilitation centers. The acoustic and musical environment literally opens a portal to our unconscious mind. Music therapy often comes into play when other forms of treatment are not effective enough or fail completely.

Music connects us to the time when we only had preverbal communication skills (Hwang and Hughes, 2000 ; Graham, 2004 ; i.e., communication before a fully functioning language is developed; e.g., infants or children with autism spectrum disorder), without being dependent on language. Although board-certified music therapy is undeniable the most regulated, developed and professional variant, this should not hinder health professionals and researchers from other areas in the execution of their own projects using music-based interventions. The only thing they should be very precise about, is the way they define their work. Within our selection of articles the expression music therapy was used sometimes, although a more detailed description or specific information was neither published nor available upon our request. In those cases, the term “music therapy” should not be used, but instead music medicine or some of the alternatives mentioned in this manuscript (e.g., therapy with music, music for treatment). This way many obstacles as well as misunderstandings can be prevented in the first place, but high-quality research is still produced. Also, it is very important that researchers contemplate and report the details of the music intervention that they use. For example, they should report whether the music is researcher-selected or participant-selected, the specific tracks they used, the delivery method (speakers, headphones), and any other relevant details.

Encouraged by the promising potential of music as an intervention (Kemper and Danhauer, 2005 ), we pursued our ambitious goal to contribute knowledge that provides help for the affected individuals, both the patients themselves as well as their nearest relatives. Furthermore, we wanted to provide detailed information about each randomized controlled study, and therefore made all our data available, so others may benefit for their potential upcoming research project. The overall outcome of our analysis, with all significant effects considered, produced highly convincing results that music is a potential treatment option, to improve depression symptoms and quality of life across many age groups. We hope that our results provide some support for future concepts.

Author contributions

DL (Substantial contributor who meets all four authorship criteria): (1) Project idea, article concept and design, as well as planning the timeline, substantially involved in the data, material, and article acquisition, (2) mainly responsible for drafting, writing, and revising the review article, (3) responsible for selecting and final approving of the scholarly publication, (4) agreed and is accountable for all aspects connected to the work. TH (Substantial contributor who meets all four authorship criteria): (1) Substantial help with the concept and design, substantially contributed to the article and material acquisition, (2) substantially contributed to the project by drafting and revising the review article, (3) responsible for final approval of the scholarly publication, (4) agreed and is accountable for all aspects connected to the work.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1 Participants in the two music groups (standard or patterning music) showed an increased belief in their personal power as well as a reduction in pain, depression and disability, compared to the relevant control group. The two experimental groups listened to 1 h of music each day for 7 days in a row.

2 Official definition of the American Music Therapy Association [AMTA]

3 Clinical speciality areas; Diagnostic, Treatment, and Therapeutic procedures, approaches, tools; Disorders; Age groups; Scientific; Country-specific; Musical Aspects; Recording hardware and equipment; Literature Genre; Publication type or medium; Year of publication; Number of authors.

4 Boolean Operators for searching databases: Concept explained by the Massachusetts Institute of Technology [MIT] .

5 Our preference was an experimental-control setting, but unfortunately three authors (Ashida, 2000 ; Guétin et al., 2009b ; Schwantes and Mckinney, 2010 ) did not use a control sample.

6 AMSTAR (Shea et al., 2007 )–Further Info & AMSTAR online calculator: ; National Collaborating Centre for Methods and Tools (NCCMT): Questions included in the AMSTAR-Checklist (Shea et al., 2007 ) are: (I) Was an “a priori” design provided? (II) Was there duplicate study selection and data extraction? (III) Was a comprehensive literature search performed? (IV) Was the status of publication (i.e. gray literature) used as an inclusion criterion? (V) Was a list of studies (included and excluded) provided? (VI) Were the characteristics of the included studies provided? (VII) Was the scientific quality of the included studies assessed and documented? (VIII) Was the scientific quality of the included studies used appropriately in formulating conclusions? (IX) Were the methods used to combine the findings of studies appropriate? (X) Was the likelihood of publication bias assessed? (XI) Was any conflict of interest included?

7 In our Supplementary Table (“Complete Display of Statistical Data”), DSI was referred to as “Change [%].”

8 A much More Detailed Representation of Demographics is Available in the Supplementary Table ( Appendix-B ).

9 9DSI: Depression Score Improvement stands for the mean difference between the pre-test and post-test results (i.e., score changes) in percent. Please refer to the supplementary materials for additional information.

10 Music interventions: Individual setting (Chang et al., 2008 ); Group setting (Esfandiari and Mansouri, 2014 ).

11 One [MT] music-therapy article (Silverman, 2011 ) was not used for comparison and calculations because the relevant data was unavailable.

12 Djembe is based on the expression “anke djé, anke bé” which roughly translates as “everyone should come together in peace and harmony.”

13 12-bar Blues: Traditional Blues pattern that is 12 measures long. This chord progression is also used for many other music genres and quite popular in pop-music.

14 Ambiguity of the term “classical” music: In our review, this term refers to “Western Art Music” and thus includes, but is not limited to the “Classical” music period. Most of the time we used this term for music from the Baroque (1600–1750), Classical (1750–1820), and Romantic (1804–1910) period.

15 Within percussion groups various types of drums presented the instrument of choice most of the time.

16 Eight out of nine articles because in on case (Castillo-Pérez et al., 2010 ) scores were missing. The remaining were: Hsu and Lai, 2004 ; Chang et al., 2008 ; Harmat et al., 2008 ; Chan et al., 2009 , 2010 ; Guétin et al., 2009a ; Koelsch et al., 2010 ; Verrusio et al., 2014 .

17 Average: Arithmetic mean of all score-changes in [%] for a defined selection (e.g., classical music). Example: We calculated the score-change in [%] for each of the eight experimental groups that received classical music as intervention. In this case the arithmetic mean (DSI Clas ) was 39.98% (i.e., average). Then every individual score can be compared to this average. If it was above, we called it “above average”.

18 Percussion music (drumming): Ashida, 2000 ; Choi et al., 2008 ; Schwantes and Mckinney, 2010 ; Albornoz, 2011 ; Erkkilä et al., 2011 ; Han et al., 2011 ; Lu et al., 2013 ; Chen et al., 2016 ; Fancourt et al., 2016 .

19 Jazz: Chan et al., 2009 , 2010 ; Guétin et al., 2009a ; Koelsch et al., 2010 ; Verrusio et al., 2014 .

20 In most cases there was no further categorization between different musical sub-genres of Jazz.

21 Greatest: Best in terms of depression score improvement (DSI) (i.e., pre-post score reduction in percent) with Jazz as intervention.

22 Raga: Classification system for music that originated during the eleventh century in Asia (mainly India).

23 Setting was always: Experimental group received music as intervention, and the corresponding control group received an (non-music) alternative.

24 For example, if elderly people lived in a retirement home, a standard daily routine or common everyday activities were seen as usual or regular treatment. If, on the other hand, a resting period (e.g., Chan et al., 2012 ) was carried out simultaneously, this was interpreted as an (“non-music”) alternative.

25 In all three of his articles within our selection (Chan et al., 2009 , 2010 , 2012 ) participants were instructed to rest.

26 Pharmacotherapy treatment included SSRI (Paroxetine 20mg/die), NaSSA (Mirtazapine 30 mg/die), and Benzodiazepine (Alprazolam).

27 As already described above, the other individual setting (Guétin Soua, et al., 2009) with pre-post results of p > 0.05 was still counted as significant.

28 Information regarding the duration for one group session was unavailable in two articles (Hendricks et al., 1999 ; Wang et al., 2011 ).

29 Hanser and Thompson, 1994 ; Hsu and Lai, 2004 ; Harmat et al., 2008 ; Chan et al., 2009 , 2010 , 2012 ; Guétin et al., 2009a ; Erkkilä et al., 2011 .

30 Average DSI for all 13 articles that used an individual ( * Ind) treatment as intervention was 36.50%.

31 Gupta and Gupta, 2005 ; Kim et al., 2006 ; Chang et al., 2008 ; Deshmukh et al., 2009 ; Guétin et al., 2009b .

32 Once (Esfandiari and Mansouri, 2014 ) the relevant score was unavailable.

33 Once (Wang et al., 2011 ) the relevant score was unavailable.

34 BDI: Original BDI from1961; (1st) Revision (=) BDI-I or BDI-1A from 1978; (2nd) Revision (=) BDI-II from 1996.

35 BDI-scores were measured only once (Silverman, 2011 ), either at the end (experimental group), or at the beginning (control group) and thus was excluded for this calculation.

36 Minimal depression: BDI-I (= BDI-1A) score (=) 00–09; BDI-II score (=) 00–13.

37 Mild depression: BDI-I (= BDI-1A) score (=) 10–18; BDI-II score (=) 14–19.

38 Moderate depression: BDI-I (= BDI-1A) score (=) 19–29; BDI-II score (=) 20–28.

39 Albornoz ( 2011 ) found in both groups a significant reduction for BDI scores albeit to a significantly greater extent in the experimental (−8.08; p < 0.01) than in the control (−2.25; p < 0.05) setting.

40 Severe depression: BDI-I (=BDI-1A) score (=) 30–63; BDI-II score (=) 29–63.

41 Pre-post difference: experimental (1) “light” music (=) 17.50; experimental (2) “heavy” music (=) 21.00 (both p < 0.05 within groups) (Esfandiari and Mansouri, 2014 ).

42 Average pre-post BDI reduction of −30.73 ( SD = 9.80) combined (Hendricks et al., 1999 ; Choi et al., 2008 ).

43 One author (Chan et al., 2012 ) limited his selection to slow music (60–80 beats per minute). The other researcher (Hanser and Thompson, 1994 ) also used some “energetic” or “empowering” titles, but mainly concentrated on relaxing compositions.

44 for a reference “intervention review” about music therapy for depression see: maratos et al. ( 2008 ).

45 Every available test-result (Pre-/Post-Scores for experimental/control) can be found in our Supplementary Table 12.

46 Hendricks et al., 1999 ; Ashida, 2000 ; Hsu and Lai, 2004 ; Kim et al., 2006 ; Chan et al., 2009 , 2012 ; Castillo-Pérez et al., 2010 ; Albornoz, 2011 .

47 We used the metaphor “decomposed” based on the inspiring book by Andrew Durkin (“Decomposition: A Music Manifesto”), who refers to it “as a way…to demythologize music without demeaning it” (Review by Madison Heying).

48 A complete list, with all results we could extract, can be found in the Supplementary Table.

49 Music Therapy; Duration 90min./session; Session Frequency 7x/week; Raagas Music (Deshmukh et al., 2009 ).

Supplementary material

The Supplementary Material for this article can be found online at:

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Music Research Paper

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The meaning of music and dance, performance, sacred performance, chant and recitation, instruments, critical musicology, globalization, gender and sexuality, race and ethnicity, nationalism, medical ethnomusicology, applied ethnomusicology.

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Ethnographic approaches to music and dance in the 21st century explore how modes of expression and performance practices are involved in the making of lifeworlds. Cultural production is situated in specific contexts that generate meaning as particular sonic and kinesthetic phenomena relate to discursive processes and social structures. Scholars of music and dance engage with cultural flow through dialogic encounters and interpretative analyses. These studies help illustrate how performance practices produce meanings, mediate socialities, and configure political relations.

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Ethnomusicology, which generally encompasses anthropology, dance ethnology, folklore, musicology, and sociology, situates specific theoretical issues in comparative social and historical contexts. Up to the late 1960s, the discipline explored and indexed the musical phenomena of non-Western cultures in ways that resonated with concurrent anthropological trends in area studies. Critical analysis of these approaches led to a rethinking of music in which music became not the object of culture, but rather the product and expression of human experience. In his writings on the relations between music and society, anthropologist John Blacking (1995) proposed:

We need to know what sounds and what kinds of behavior different societies have chosen to call “musical;” and until we know more about this we cannot begin to answer the question, “How musical is man?” As “humanly organized sound,” music is a bearer of meanings insofar as it exhibits and necessarily demonstrates a set of values that the society that generates it would otherwise lack. (p. 5) Relations between music, dance, and society are thus viewed as complex networks of interdependence through which a given act embodies temporal and emplaced experiences that structure social processes. Contemporary ethnomusicology pursues a rigorous analysis of how cultural production generates social significance by positioning the individual as the agent of social change through historical encounter. (adsbygoogle = window.adsbygoogle || []).push({});

Theoretical Approaches to Music and Dance

Musical and social structures mutually constitute each other through human interaction. This cultural-studies approach derives from the seminal work of Raymond Williams, who claimed that culture is not fixed as a bounded work or elite mode of production, but is instead embedded in everyday experience and activity. As a cultural materialist who challenged orthodox Marxist accounts of historical epochs or phases, Williams framed cultural practices as sites of political contestation through which groups reproduce and resist modes of domination, particularly those that critique industrial capitalism (Williams, 1977). Critical to his work are structures of feeling that configure the ways in which particular generations and social classes experience difference among social relations. These feelings beget a lived experience of a particular moment in society and history that brings meaning into the lives of individuals and the lifeworlds that they constitute. The production of cultural meaning is a fluid and dynamic process that emerges as a necessary process in which “new meanings and values, new practices, new relationships, and kinds of relationship are continually being created” (Williams, 1977, pp. 122–23).

Musical meaning is not itself generated through aesthetic critique, nor by reference to something extramusical, such as an emotion, landscape, or harmonic figure. Rather, musical elements and structures discursively relate to lived experience by an act of representation that fixes musical experiences to metaphoric and metonymic structures, forms, and works. These bounded entities are placed in a network of complex relations that can be explained through systems of representation in which musical ontologies serve as interpretive frameworks for diverse musical systems, whether Western symphonic music, Hindustani classical music, or Japanese gagaku court theater, or for categorization of musical cultures as classical, folk, popular, and traditional. Categories, however, do not necessarily correlate to an intrinsic value, but more productively relate to “how they are used and embodied in community relations to become structuring forces in musical life” (Holt, 2007, p. 29).

Ethnomusicologists today explore the discursive production of musical meaning as a contemporary response to what comparative musicologist Charles Seeger (1977) problematized as the “musicological juncture” (p. 16), or the gap of representation that occurs when communicating about one system of human communication (music) through another (speech). To redress claims that music is “untranslatable and irreducible to the verbal mode” (Feld, 1982, p. 91), ethnomusicology suggests that musical practice is less a latent mode of (artistic) representation but rather a (socially) active and engaged mode of producing reality. If speech is the communication of “worldview as the intellection of reality,” then music is the communication of “worldview as the feeling of reality” (Seeger, 1977, p. 7). What we perceive as “feelingful” occurs through the “generality and multiplicity of possible messages and interpretations . . . that unite the material and mental dimensions of musical experience as fully embodied” (Seeger, 1977, p. 91). As suggested by interpretive approaches to cultural anthropology, ethnographers study not experience, per se, but the feelingful and discursive structures through which experience occurs.

Musical experience is constituted as meaningful when social structures conjoin with individual consciousness through structures of feeling. Whereas structures suggest fixed relationships that are rigid and determined, feeling inflects the intense and personal experience of what is “believed, felt, and acted upon” (Frith, 1996, p. 252). This becomes important with regard to the construction of cultural forms, whether musical genres and styles or social categories and spaces. How people behave with regard to sound relates to what they perceive and think about such behavior. Anthropologist Alan Merriam (1964) proposed a model of musical anthropology that triangulates these axes of sound, concept, and behavior. This tripartite structure has been redressed by an interpretive analysis of dialectical processes that consist of historical construction, social maintenance, and individual adaptation and experience; in other words, an agency-centered inquiry into how people create, experience, and use music (Rice, 1987).

Feelingful experiences occur through culturally specific processes that produce and perceive sound. Recent directions in the phenomenology of acoustic phenomena argue that sound is not the property of a musical object separated from its origin, but rather, sonic significance lies in the encounter of sound as musical. Sensory dimensions of experience suggest that sonorities may be heard as affective, feelingful, and emotional when perceived as musical patterns in specific cultural contexts. Phenomenological studies suggest the ways in which people relate to each other through senses of hearing. A hearing culture may make it “possible to conceptualize new ways of knowing a culture and of gaining a deepened understanding of how the members of a society know each other” (Erlmann, 2004, p. 3). In turn, individual and social processes perceive musical encounter “not through layers of cognitive categories and symbolic associations, but with a trained and responsive body, through habits copied from others and strictly reinforced, by means of musical skills” (Downey, 2002, p. 490). Listeners’ acquired habits of assimilating sensory experience to musical systems affect them viscerally, and lived bodies are fashioned by patterns of acting in relation to music at the same time that they are responsive to sonic textures.

Performance emerges through the interaction of corporeal gestures, discursive tropes, and performative utterances in social settings that situate these actions as musical or extramusical, verbal or nonverbal, cognitive or affective, sacred or secular. These actions are held together by aesthetic principles that are represented in the social and material world, just as the social and material world is imbued with extraordinary value. Performance and listening are intersubjectively and physiologically experienced in a trained and socialized set of artistic bodily movements that reflect values and ideas (Meintjes, 2003, p. 176).

Embodied realms of experience situate cultural practices in the physiological and expressive body and the social forces that operate through those bodies. Performativity asserts the materiality of nonverbal communication and expression and the presence of the body as it is mediated by the production of sound. Whether sound is produced by a singer, a musician, or mediated by technology, the presence of the medium leaves a material trace that regulates its origin (Barthes, 1978). For example, analyses of timbre consider the grain of the voice in recording—in addition to elements of texture, attack, delay, and pitch—and interpret studio techniques as signifying practices that are deeply connected to the discursive production of style and genre (Théberge, 1997).

Embodied performance by a socialized musician or dancer suggests how bodies may be regulated or may resist forces of power (Comaroff, 1991). The discourse of bodies in motion at Greek weddings, for instance, produces the dialectical relationships and mutual dependencies that are also regulated and constrained by their repetitive power as a body politic, or collective unit. By introducing nonGreek Roma musicians at wedding parties as daulia, or drums (Cowan, 1990, p. 102), Greek townspeople exert power over the materiality of both resonant and outside bodies. As sites of reception and agency, bodies bear narratives of time and place that coalesce into corporeal memories. The ways individuals perform these narratives construct identity and differences that endow sound and movement with the capacity to represent lived experience.

As forms of social action and as meaningful activity, music and dance create and give expression to human and social experience. Epistemological concerns have critically responded to the ways in which a kinetic body and a sound dialogically compose form through performance events, structured practices, and representational strategies. Rather than treat music and dance as objects of discourse that possess meaning in and of themselves, or frame body movement techniques and sonic phenomena as abstract properties that may be reconfigured according to context, ethnographers seek to localize the very terms by which understanding and knowledge of these performative dynamics are produced.

Music Research Topics and Issues

Music plays a significant role in preserving and transmitting the world’s religions in terms of history, culture, and practice. The study of music in religious practices considers the ways in which music transforms experience into sacred meanings, narrates religious myths, and structures religious ritual and communities. The performative conditions associated with religious practice consider sacred sound not as the taxonomy of a particular belief system, but rather as a sensory spectacle through which experiences become enchanted. The sacred nature mediates by sonic utterances that may induce a phantasmagoric state of being, encode sacred language, or embody affective experience. Sound indexes religious experience through the presence of sacred instruments and the act of listening to liturgical chant. Sound also marks sacred spaces through pilgrimages and festival rituals, among other religious practices (Beck, 2006; Berliner, 1993).

The efficacy of music in sacred spaces suggests the ways in which sound may be sacred and how this sacred nature may be mediated through sonic practices. How sound conveys sacred meaning and experience in specific contexts raises ontological distinctions in that what is often perceived as musical in European and North American contexts may be considered nonmusical and sacred in other sacred spaces.

Contexts may determine how sound is received and interpreted and in what ways sound may be ontologically separate from music. Interpretation of sound also structures power relations, in which religious authority is maintained by ideological boundaries of sound seeking to differentiate between sacred practices and secular forms of expression (Baily, 2003).

Ethnographies of sacred performance practices have tended to focus on the capacity of music, dance, and ritual drama to organize religious activity through modes of social interaction that produce webs of associative meaning (Reily, 2002). Performance has been conceptualized as a medium through which participants demonstrate religious conviction and commitment; as a means to structure time, narrative, and symbolic systems; and as a mode of interaction that codifies organizational patterns and the conditions of participation in religious activity. For example, the sacred voice is a medium that binds individuals communally in religious activity. How these experiences shape and are shaped by musical practice is determined by the theological ways in which individuals engage with music and music making. More recently, ethnographers have considered ways in which religious-ritual activity depends on the act of performance in order to be perceived as sacred and, in particular, how sound and movements are mediums that frame a ritual act as sacred. As individuals negotiate moral boundaries between the sacred and the profane in contemporary contexts, the act of producing sound and movement becomes a contested arena where religious authorities judge the ethics of cultural production. Performance through music and dance may allow departure from the profane and entrance into the sacred, mark the aesthetic boundaries of secular space, or itself articulate the boundaries between the sacred and the profane by which religious practices acquired enchanted and sacred meaning.

Several bodies of scholarship have addressed musical change, religious renewal, soteriological potential, musicoreligious orthodoxy, and other related issues. These different forms of religious practice, or syncretism, may be marked through distinct genres and styles that expose moments of encounter and uneven relations of power. In colonial spaces, religious repertory may occupy cultural spaces in ways that reproduce a hegemonic religious order and erase subaltern religious practices (Comaroff, 1991). Folkloric ensembles typically relate to historical or contemporary religious practices through complex processes of aestheticization that problematically blur distinctions between sacred worship, cultural traditions, and popular culture. These distinctions are in part based on a collective memory of the sacred that is translated through aesthetic ideals. The embodiment of these ideals demonstrates how religious ideologies are manifested through bodily practices that themselves produce sacred sound, movement, and performance.

The power of sound embodied in speech patterns, or chant, may preserve and transmit knowledge and religious authority as well as mark historical change. For example, the Rigvedic texts of the Harappan in Pakistan and northwestern India are considered sacred when correctly rendered through transmission and pronunciation of Vedic hymns. Recitation of these hymns occurs through three types of spoken accent with a melodic contour dependent on the succession of accent in the sung syllables, as well as the duration of each relative pitch. The consideration of Vedic chant as the foundation of contemporary Hindustani music in South Asia is, in part, attributed to its preservation through Brahman recitation. Codification of early performance practices, such as Gregorian chant in southern Europe, began when clergy notated plainchant in order to correlate its liturgical function with the medieval Roman liturgical calendar. Compositional practices that developed from these notations are widely considered to be the conceptual and historical basis for Renaissance and late European courtly arts (Bergeron, 1998).

Some religious cultures regard practices of recitation, or the sounding of religious text, as the divine act that makes speech patterns sacred by mediating the transmission of sacred texts through the vocal performance. The significance of such performances is governed not only by the syntactic conditions such as pitch and duration, but also by audition, or the appropriate response, performed by the ethical listener (Hirschkind, 2006).

Instruments embody religious experience when endowed with the capacity to produce sacred sound. In some ritual practices, performance on a particular instrument, such as batá percussion ensembles in Cuban Santería, realizes the divine potential of the ritual event and produces religious transformation. Instrumentalperformance practice marks the shift from secular to sacred contexts; produces the appropriate performance conditions for trance, ecstasy, possession, and other states of heightened sacrality; symbolizes tropes of religious narrative and function; and transfers knowledge and participation among believers (Hagedorn, 2001; Rouget, 1985; Wong, 2001).

Sacred musical practices are often narrative—telling stories and relating myths to generate a sense of historical and religious meaning. Narrative may be considered musical through, for example, the ways in which music marks the passage of time in ritual performance and in the narrative sequence of events, or through the juxtaposition of different musical genres that layer and texture religious stories. Instruments often play a significant role in narrating epic myths with sacred content, such as within bardic traditions or Sufi mysticism. One way in which narrative components of sacred music may shape a religious community is by mediating a sense of place. The act of recalling an original event, such as an act of martyrdom or a miracle, links the event to a specific site. When enacted through song and other musico-poetic genres, the act of recall layers subsequent events to that site in ways that parse history as locally meaningful in religious communities.

During the early 1990s, musicologists readjusted paradigms in which musical performance expresses a natural mode of human existence or formalizes a universal set of aesthetic ideals (Solie, 1993). The critical inquiry espoused by “new musicology” advocated for the deconstruction of ideologies into iconicities of style that are reproduced and transformed by acts of performance. Performance practices now produce social relations that are represented in different categories of gender and sexuality, race and ethnicity, generation, class and nation, and other forms of identity. Cultural meaning is discursively constructed by specific practices of signification, and links between signifier and signified are not fixed but arbitrary. These practices may construct meaningful experience in ways that depend on conventions of taste and class that are situated in a particular time and place.

Studies of place tend to be located in everyday life and explore the tactics by which people interact and engage with their environment. Gatherings, such as rehearsals among English rock musicians, are not only mediated by these practices, but also produce affective relationships to the settings in which social activities take place. Yet, as conditions of modernity separate space from place in lived experience, the physical settings of social activities are “thoroughly penetrated by and shaped in terms of social influences quite distant from them” (Giddens, as cited in Stokes, 1994, p. 1). Therefore, approaches to place, music, and dance seek to relocate cultural geographies within specific social, economic, and political spaces by addressing how individuals produce sound and movement in order “to reestablish their presence, situate events in a fixed place and time, and reembed actions within social structures” (Stokes, 1994, p. 3). Place becomes meaningful through affective processes that recognize and enable different experiences, mediate emotional relations to an environment, or produce nostalgia through acts of memory that bestow music and dance “with an intensity, power and simplicity unmatched by any other social activity” (Stokes, 1994, p. 3).

As individuals perceive what takes shape around them, they participate in the construction of a soundscape, or an environment structured by the perception and reception of sound. Soundscapes are differentiated not only by dynamics of power, class, and difference, but also by sentimentality, or the emotional and affective relationships that constitute a sense of place (Feld & Basso, 1996). An acoustemology of sound analyzes the sentimental relations to place that are embodied by sound production and reception among, for instance, Kaluli people in Papua New Guinea. Through interlocking, overlapping, and alternating singing that mimics bird calls in the rainforests, Kaluli voices index the natural environment; mediate places as sites of memory; and express an ecological sense of self, place, and time (Feld, 1982). Acoustic environments have also been critical to the historical progression of musical form in bourgeoisie European society and the displacement of instrumentalists to the role of musical interpreters. Early performance practices were comprised of extramusical, literary, or narrative material that was, in part, marked by a musician’s individualized embellishment of musical material.

In the 19th century, the concert room emerged as a performance setting that aestheticized the impression of immediate contact with the music as a listening ideal. Musical practices shifted to uphold universalist aesthetic ideals not only through listening appreciation, but also in celebration of a composer’s genius. Dramatic structures were communicated by composers such as Beethoven through “the abstract logic of pure form” and the formal properties of the music itself in ways that privileged structural-listening practices in European art music. Thus, the commodification of musical knowledge and musical emplacement fetishized sonata form in the historical development of instrumental Western art music (Leyshon, Matless, & Revill, 1998).

The commodification of musical place in a globalized world has induced a certain anxiety among critical musicologists over the ways that disembedding music and dance practices stimulates desires for authenticity by late-capital consumers in a hegemonic economic order. While the capacity for music to travel has augmented an appreciation for place and dismantled cultural borders, the poetics and politics of this have problematically differentiated relations between self and other. World music, and related configurations of art music, ritual, folk and ethnic genres, and world beat and roots music (Aubert, 2007), are authenticated by conditions of place. By privileging the geographically local as authentic, the particular can be naturalized in ways that fetishize locality through terms of belonging. The act of splitting sound from its source and reproducing it depends on uneven processes of representation that contest cultural rights and negotiate various modes of ownership (Feld & Basso, 1996). Styles associated with world music then demarcate community by linking dispersed places and allegiances that, through subjective identity, allow the strategies by which individuals register difference (Erlmann, 1999).

The globalization of world music has also been critiqued as a pastiche, or a process of reconfiguring time and space that detemporalizes the encounter between self and ethnographic others into an event beyond history, or perhaps at the horizon of a certain historical moment. For instance, the production and consumption of alternative folk rock links different historical moments into one bounded cultural space, while world-dance music may layer disparate local styles into a repetitive, temporal sequence (Erlmann, 1999). Cultural interchange and interaction in popular music thus depends upon a concept of culture that binds territory to groups in ways that demand the political engagement of cultural critique. Whereas narratives of cultural interchange such as hybridity, creolism, and syncretism tend to privilege myths of origin, postcolonial analyses encourage new approaches that no longer engender forms of being by binaries of self (self and ethnographic other), place (here and there), and time (then and now), but rather by a third space that is constituted by these boundaries.The circulatory relations of cultural flow have furthered understandings of how historical consciousness may undermine essentializing cultural strategies. Studies of the black Atlantic (Gilroy, 1993) address how black popular music and dance styles shape and are shaped by particular African retentions and situate the Atlantic as a site of crossings, mediations, and exchanges that continually reconsider the cultural flow of African and African American expressive forms.

In response to large-scale processes of migration, globalization, and transnationalism that destabilize structures of belonging, critical approaches to place have also emphasized the production of locality through cultural practices. Tropes of place may uneasily mark displacement from an imagined structure of belonging, for instance when tropes of the crowd and the machine in the South African vocal genre of isicathamiya signify a sense of nostalgia for rural agricultural economies among populations who migrated to cities in search of labor opportunities. Another example can be found in how the mapping of memory fragments onto musical events, instruments, and kinship narratives of a retired Jewish community in Liverpool, England, shapes collective relations that in turn construct an immigrant neighborhood whose identity is nurtured by newly mediated and localized imaginaries of home and community. Locality may also be produced by sound-engineering practices that index a particular place and authenticate a musical style through the technological reproduction of sound in specific performance conditions such as “live” Austin country music (Greene & Porcello, 2005).

Gender and sexuality analyses situate performers and their texts within specific musical worlds and examine how these worlds produce gendered ideologies through performance practice, singing style, repertory, performance events and occasions, lyrics and elaborations, and instrumental practice. Thus, gender and sexuality are mutually constitutive of cultural experiences, and also mutually construct processes of subjectivity and alterity in ways that have been binarily opposed to biological explanations of lived experience. As a method of cultural critique, gender and sexuality studies analyze the ways in which ideology is maintained and transformed through the performance of a gendered self. These studies also examine the ways that musical practices mediate social relations as variously gendered—masculine, feminine, and perhaps hyperreal. Because gender theorists have understood sexuality as constitutive of gendered norms, distinctions between gender and sexuality have been largely premised on identity construction as theorized in psychoanalytic discourse. Lacanian theory argues that linguistic signs triangulate the enlightened self from its other in ways that destabilize a sense of identity by the desire for an object that might represent such identity. By reading social and cultural texts for hidden and repressed desires, critical theorists reveal conditions of heteronormativity that shape and are shaped by cultural practices. Ultimately, gender and sexuality studies suggest how social distinctions may be magnified rather than ameliorated by the performative act of music making and structured movement.

A substantial body of literature has been devoted to highlighting and documenting women’s contribution and women’s roles in musical performance. As professional entertainers, as dramatic personalities, and as audiences, women convey social values and transmit cultural meanings in ways that may be different from those performed by men. The expression of sentimentality by women through forms and repertoires, such as sung poetry among Bedouin women in upper Egypt, resist, maneuver, and maintain patriarchal norms of modesty, honor, and shame that have been typified in Mediterranean studies (Abu-Lughod, 1986), whereas songs sung by Berber women in northern Morocco strategically empower potentialities of marital life (Magrini, 2003). Performance events and contexts have been analyzed with discourses surrounding these practices through elements of lyrics, style, technology, and appropriate behavior. These suggest how identity may be encoded and performed as masculine, feminine, or ambiguously gendered. Postmodernist approaches to the paradigmatic relations between musical and social structures have produced seminal readings of the gendered hierarchies in composition, such as immanent relations between the masculine and the feminine in sonata form (McClary, 1991), formulations of the Western music canon, constructions of ontological difference through gender (Solie, 1993), and the potential of music itself—as a performance rather than as text, to disrupt the masculine musicological narratives within which it is often contained (Abbate, 1991).

The broad compass of vocal performance in different registers constructs gendered and sexualized identities by embracing some, and refusing other, conventions of style and genre. Voice may characterize a range of erotic and emotional relationships among women who sing and women who listen in ways that “resonate in sonic space as lesbian difference and desire” (Brett, Wood, & Thomas, 1994, p. 28). This sapphonicvoice is found in operatic practices by female singers who assume “pants” roles, or castrato male roles sung by women, as well as other singers and singing personalities (Brett et al., 1994). Koestenbaum (1994) argued that the brea between registers is a gendered split that emplaces a voice between male and female. The ways in which the brea is negotiated may be “fatal to the act of natural voice production” (p. 220) when gender and sexuality are transferred beyond normativity, such as the sapphonicvoice’s synthesis of register; this replaces its splitting, or the falsetto register’s failure to disguise this break. The combination of different registers may refuse vocal categories and polarities of natural and unnatural, and may establish interpretations of female desire, male desire, and the relations of class, age, sexual status, and identity through vocal performance (Koestenbaum, 1994).

The performance of gender engages with the kinds of subjects that musical and dance performances engender, both onstage and among audiences, and the ways that such performance relates to everyday life as lived, embodied, and theorized. For instance, a feminized atmosphere at a wedding in Morocco is not dependent on the presence of female dancers, but rather on the performance of femininity among communal relations that may differentiate between gender, sexuality, and class. Perceptions and representations of Asian American femininity have shifted due to North American taiko performance that represents social space through gesture, movement, and the presence of women in drumming practices. In post-Apartheid South Africa, Zulu ngoma song and dance is critical to the performance of masculinity and the anxieties of retaining the presence of individualized expression and stylized body movement in the midst of unemployment, an AIDS epidemic, and a history of violence in KwaZulu-Natal (Meintjes, 2003).

Critical race studies examine how constructions of difference on the basis of body type and color are perpetuated by the representation of essentialized metaphysical conditions. Concepts of race are linked to the emergence of modern scientific inquiry into the natural world and are largely considered a product of Enlightenment thought and observation. The late 18th century produced a world “observed, processed and remapped on the imagination of Europe” (Radano & Bohlman, 2000, p. 13) in which race and music constituted logics of difference that categorized the natural world and sought to make it understandable. Moreover, racial discourse contributed to the formation of musical difference as human difference was mapped onto musical difference, that is, to the object of music itself. The epistemic model that measured harmonic relations on a mathematically proportionate scale and unified differences in pitch influenced Enlightenment thought on the structure and substance of not only resonating, but also racialized bodies. How music participates in the construction of race and racial imaginaries ultimately raises ontological questions of whether music itself represents these qualities, or whether our understandings of music are shaped by and through racial relations.

Racial constructs are connected to music through structures of understandability, that is, the capacity of sound to signify and communicate meaning, and through materiality, or the technologies, objects, and bodies that represent music and musical histories through particular ideologies (Brown, 2007). For example, the 19th-century German composer Richard Wagner claimed that the language of European opera and vocal music was degraded through the inability of European Jewish composers to fully control the language of music, which Wagner instantiated in terms of 19th-century German universalism that was first and foremost predicated on language and an assumption that music instantiates comparative linguistic properties. Elsewhere, race interacts with other systemic hierarchies, such as the historic provision of wedding and court entertainment by Jewish musicians in predominantly Muslim worlds situated along the Silk Road, from Bukharan weddings in central Asia to the Abbasid and Omayad caliphates of the 11th century. Categories in which instruments function as a racial mapping of power relations may be critiqued by participants themselves, such as Karnatak and Hindustani musicians who negotiate caste systems in South Asia that distinguish between the permissibility of Brahmin performance on the Karnatic vinalute and the delegation of instrumental performance on untouchable leather-skinned drums to less privileged castes. Conditions of difference, shaped by cultural practices, help to better understand relations of power in systems based on class, caste, kinship, religion, and other forms of belonging and ownership.

Racial conventions of blackness, whiteness, and other morphologies play a critical role in ideological distinctions of music as rational and intellectual, or as orally transmitted, communal, and embodied. The naturalization of certain structures as African retentions, such as improvised movement, antiphonal oppositions, and repeated cycles of interlocking rhythmic patterns, reinforces the putative inseparability of music and dance in the African diaspora (Meintjes, 2003). This becomes problematic when what is musical and universal is defined against conceptions of blackness as physical and embodied.Yet, performance practice and histories may join as lived experience in ways that affirm how blues practices in African American working-class communities in the southern United States influenced the emergence of jazz, gospel, soul, R&B, rock, hip-hop, and other black vernacular music. The problem of race translates into a cultural critique in which creative strategies destabilize the tropes through which they emerge by means of intertextuality, subversion, and other signifying techniques (Radano & Bohlman, 2000).

Ethnicity, like other forms of difference that participate in processes of exclusion and inclusion, is constructed on the basis of shared beliefs in a “common ancestry, memories of a shared historical past, and elements in common, such as kinship patterns, physical continuity, religious affiliation, language, or some combination of these” (Shelemay, 2001, p. 249). Musical and dance practices instantiate ethnic relations by performing social boundaries that reproduce and subvert ideologies; these relations simultaneously also produce meanings, that is, “a patterned context in which other things happen” (Waterman, 1990, p. 214). Ethnic identity is often discussed in terms of minority relations and population movements that are themselves predicated on political difference. Often, ethnic boundaries “define and maintain social identities which can only exist in context of oppositions and relativities”; thus, ethnography can engage with how “actors use music in specific local situations to erect boundaries, maintain distinctions between us and them, and use terms such as ‘authentic’ to justify these boundaries” (Stokes, 1994, p. 6).

Cultural nationalism is a complex process by which institutions and actors integrate diverse populations into structures of national belonging. Ethnography investigates the ways in which music and dance practices—and the discursive spaces that are dialogically created and inhabited by such practices—generate national imaginaries in local contexts. Early forms of nationalism celebrated the universal claim to a single shared language and a set of particular customs and traditions situated in an ethnonational framework. Scholars have since criticized collective national identity as a product of state apparatuses that seek to reify lived experience into internationally recognized forms. Thus, the invention of tradition has been linked with nation-building projects in which state power emerges through the performance of national imaginaries and the efficacy of imagined communities (Askew, 2002). The extent to which symbolic production produces and sustains state hegemony through particular genres suggests whether these processes might be “multivalent, multivocal, and polyphonic” (Askew, 2002, p. 273) and how agents and institutions are involved in negotiating, defining, and contesting that which constitutes the nation. Musical ethnographies reveal the strategic shifts that characterize nationalist projects, ask whether events coincide with or interrupt official ideologies, illustrate why specific forms are chosen to represent the nation, and address how issues of authenticity and preservation are managed in these endeavors. Though global capital flow, access to electronic media, and transnational migration of people have decentered and deterritorialized processes of nationalism, the mediating structure of the nation continues to relate how people cross lines of difference through local transactions and cultural production.

Representation of the nation through music depends on a belief in the representational potential of music, that is, music’s capacity to embody a cultural whole that exists prior to its mediation. The production of national symbols, therefore, depends upon a modern discourse that is represented by cultural mediation. This discourse emerged from Johann Gottfried Herder’s claim that based national identity on the common narratives and histories of a given people and, in particular, on the capacity of language and folksong to represent such shared experiences. Herder’s proto-nationalist theory is comprised of a geographic model where music marks a place, such as the landscape of the nation, an acoustic model whereby sound distinguishes the nation as a whole, and a narrative model in which music encodes stories that represent the history of the nation (see Bohlman, 2004). The quintessential image of the nation, or a “preexisting entity that is more indefinite than definite,” is reflected by national music, “for whom it becomes the task to bring out as much of the definition as possible” (Bohlman, 2004, p. 83).

Conversely, nationalistic music does not harbor relations among a nationalized people, but rather services competition between nation-states. Nationalistic music secures the geographic identity of the nation-state by marking borders and producing alterity through the production of national difference. Alterity may be differentiated on the basis of class, race, ethnicity, and gender dynamics that exclude those whose presence prescribes the need to regulate desires and who trigger ambivalence as a condition of modernity. The marking of borders is instantiated by a presentation of the nation that embeds power in performance, or through a means of communicative interaction in which the act itself is privileged over that which it mediates. Thus, nonverbal performance may communicate messages whose meaning is located in elements of sound and movement and in dialogic interaction between performers and audiences, or between modes of modernity—contingent on the specifics of the temporal and spatial moment.

Early studies of population movement addressed patterns of assimilation and acculturation through theories of culturecontact that failed to engage with political disparities and the contradictions of multiculturalism in modern societies. More recent approaches redressed these patterns as a postmodern condition that negotiates instantiations of nationalism, transnationalism, and displacement through the appropriation of expressive culture and the making of political alliances among transnational populations (Garofalo, 1992). However, the rigidities and essentialisms of diasporic identity created by multiculturalism may articulate or contradict the politics of national, postcolonial, and minority identities even as they stress emergent forms of culture, uneven relations of cultural hybridity, and ambivalent relations to national homelands (Ramnarine, 2007). Contemporary diaspora studies thus emphasize the “newness” of the diasporic experience, and address political belongings and further substitutions as historically specific and shaped by a historical consciousness. Fragments of this consciousness are inscribed within an in-between space by which immigrants may register a sense of loss, exile, and rupture through cultural production. Diasporic music making may thus be a practice of everyday life in local communities by individuals making strategic choices through music festivals, individual biographies, song texts, musical instruments, and intellectual movements. Politically articulated readings of these social relations and creative processes reveal economies of desire in colonial encounters, performances that mourn and remember ancestors, intercultural borrowings in African-Peruvian theater, or state interventions in the creation of broader diasporic groups (Ramnarine, 2007).

Studies of popular culture and music have helped to differentiate between experiences of voluntary and forced migration. The actions and behavior of refugees affect how groups produce and give meaning to their music as they negotiate loss and trauma, and pursue a state of stability that is represented by resettlement. For instance, Vietnamese refugee communities in the United States tend to display a preference for love songs and Western-oriented popular music that convey anticommunist nostalgia for a pre-1975 period of French, U.S., and Japanese colonial influence in Vietnam (Reyes, 1999). Other histories of dispossession and violence have prompted ethnographers to consider the social construction of place, self, and other through aesthetic experience as a means for understanding the performative capacities of particular histories and repertories of violence and “the ensuing meanings violent performances carry for victims, perpetrators, and witnesses alike” (McDonald, 2009, p. 59).

Future Directions

Medical ethnomusicology seeks to integrate disciplines of music; health sciences; integrative, complementary and alternative medicine (ICAM); the physical and social sciences; medical humanities; and the healing arts through integrative research and applied practice. Research in music, medicine, and culture recognizes the dynamic and diverse practices by which specialized music and sound phenomena function as therapeutic strategies and as a means to cure illness and disease. Ethnomusicological discourse has demonstrated the extent to which specialized music emerges from a spiritual or religious ontology and is practiced in ritual or ceremonial events. When music combines with or functions as prayer or meditation, it may constitute preventive and/or curative practices that can be situated among a set of local medical practices. Medical ethnomusicology focuses on the performance of healing and the culture of health in order to better understand disease and illness, health and healing, as well as the performative nature of diagnosis, treatment, and healing. Recent studies and interventions include locating sites of ritual healing in ngoma practice among disparate communities; correlating beliefs about spirit possession to the intricacies of indigenous health care systems in Tumbuka communities; advocating and critiquing how the decline of HIV infection rates in Uganda correspond to the use of local musical traditions that support medical initiatives; engaging with science and religion through a focus on music, prayer, meditation, and healing; and the ways that these processes intimately link with transformational cognitive states in Tajikistan (Koen, 2008).

Applied ethnomusicology refers to work in the public sector that encourages the advocacy, curation, documentation, education, and performance of music and dance. These efforts apply the perspectives, principles, theories, and methods of ethnomusicology to encourage public awareness and participation in broadly defined fields of cultural practice. Advocacy engages with public-policy issues, such as arts access and participation, artists’ rights, censorship, intellectual property, and cultural heritage through institutional and noninstitutional efforts. The Society for Ethnomusicology debates and assumes positions on the ethics of music and fair use, music and torture, and the rights of human subjects in scholarly research. Cultural initiatives facilitate opportunities for performers and performance practices through festival and concert organization, recording and documentary film production, and museum exhibitions.

Efforts to document and archive materials are encouraged through the acquisition and digitalization of archives, collaboration between institutions, improved access, and the support of scholarship, publications, and public programs. Public education and outreach develop curriculum at the primary and secondary levels; establish performance ensembles and programs to nurture skills; and foster audiences and public awareness through the promotion and distribution of related events, productions, and publications. Performance of music and dance by specialists is encouraged not only as a research method in observing participants, but also as a means to preserve, transmit, and produce communities based on knowledge production and creative expression.


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February 16, 2024

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Music education, support networks, and continuity are key factors regulating adolescents' arts participation, says study

by University of the Arts Helsinki


How do young people find their way to music-making? Researchers Anna Kuoppamäki from the University of the Arts Helsinki and Fanny Vilmilä from the Finnish Youth Research Network identified factors that had a significant impact on the formation of the musical life courses of the young people interviewed in their study.

The researchers conclude that among young music-makers, access to music education such as available music tuition or living place; varying support networks including important motivators like family members, peers, or teachers; and continuity of musical activities seemed to be the key factors regulating their arts participation and agency in cultural authorship.

Kuoppamäki and Vilmilä also constructed five musical pathways understood as ongoing processes in which learning may take on varying forms and intensities.

Within the pathways they identified different ways and modes of arts participation—but also the sense of it as one's own mindset connected to both identity formation and to acting musically in the world. The ways of arts participation varied between the pathways. Also, the sense of arts participation alternated and was, in that way, pathway -sensitive.

Extensively supported formal pathway

The interviewees on this pathway started their musical training in early childhood, and their mothers were an important source of inspiration when applying to an extra-curricular music school.

They all participated in several musical activities: learning one or more musical instruments in a music school, participating actively in school music education, singing in a choir in commercial productions, or playing in a pop or jazz band. They all had plans for musical careers.

Kuoppamäki and Vilmilä point out that all these young people received extensive social and economic support from their families and teachers, as well as their music schools, to pursue their musical ambitions.

Self-forged pathway

The interviewees on this pathway started their musical activities in their primary school years. Two of them started to learn an instrument with private teachers. The third one applied to an extra-curricular music school at the age of 9.

According to the researchers, all these young people were learning-oriented. However, in contrast to the first group, their musical pathways were not straightforward. The researchers describe their musical pathways as self-forged.

On the self-forged pathway, arts participation manifested in an ability to make individual choices when authoring one's musical life.

On the other hand, two of the three interviewees expressed how they lacked peers at primary school with whom to share their musical interests. One of them, who had taken private lessons in piano, remembered:

" It was just that no one else was interested in it [classical music]. So, I was a bit different from the others, and they wanted to bully me for that [. . .] at the time it was quite heavy. "

Kuoppamäki and Vilmilä conclude that for the male interviewees on this pathway, the challenges in arts participation came down to a lack of collective meaning-making and a sense of belonging. Their peer groups supported the ideal of hegemonic masculinity in which the arts were not included.

Family and nonformal activity-oriented pathway

The third group took part in daily music-making with their family members already from early childhood . The researchers see this low-profile music-making not just as a way to engage in meaningful relationships within their families but also as an important environment for early-stage musical learning and cultural production as part of everyday life.

For example, one interviewee saw his father as a musical role model and started to play in the same church band:

"I remember how I looked up at him [. . .] how on earth can he play all those different instruments, and I wanted to be able to do it one day, too. And ever since, when at the age of five . . . I began to learn [to play instruments], I started to make my own music as well."

Later in their adolescence, these young people found their way to music-related youth work.

Consequently, for these young people, it was collective endeavors through which cultural participation took place. Moreover, their agency was distinctive in searching out opportunities for music-making and their energetic attitude toward nonformal music activities, the researchers conclude.

Open-access-oriented pathway

A strong self-directiveness in making music was typical for young people on the fourth pathway—even though the families or music teachers were supportive.

Two of the interviewees expressed interest in music at an early age but could not find either the space or activities for sustained music-making. Later, in their adolescence, they both found a musical community at school. The third interviewee of this group started his own rock band with his classmates at the age of 10 and carried on playing.

Research has emphasized the school's role in the formation of bands as social spaces to share musical interests and aspirations and in offering varied resources to explore music. This is evident in one of the interviewee's narrations, "Our music teacher told us that in his point of view, a music classroom is useless if it isn't used outside of classes. [. . .] And I took it like literally. [. . .] He was so jazzed up for the fact that I was always using it [the classroom] so actively."

In addition to school, friendships and the sharing of musical tastes play an important role in young people's musical learning practices in general as was the case also with these interviewees.

Peer-oriented pathway

In contrast to the other pathways, the interviewees on the peer-oriented pathway became interested in music relatively late, during their early adolescence. The defining factor was their involvement with music together with peers.

Kuoppamäki and Vilmilä state that the collective dimension of musical agency was significant throughout the peer-oriented pathway. Together with their peers, they engaged in music-making facilitated through youth work.

Unlike in the other pathways, these adolescents also facilitated opportunities for their peers. According to them, sharing opportunities and skills complemented their own.

The interviewees all experienced their musical skills to be insufficient compared to others who, for example, had made music longer or had had some tuition beyond music classes in school.

Nevertheless, these adolescents did not become discouraged by this feeling of being an underdog. Instead, they actively aimed at developing their musical skills within the settngs they could access.

Young people should be seen as cultural agents, says researcher Anna Kuoppamäki.

Young people as cultural agents and authors

The researchers point out that access to music education is regulated by various social and cultural factors, such as one's knowledge of existing opportunities or types of tuition, gender, or even age. However, not all young people are interested in formal music programs, which tend to offer limited opportunities for individual creative expression and independent art-making.

"Not only does this suggest that institutions need to learn and transform, but that the way young people are perceived in music education also needs to develop toward a broader view in which they are not merely seen as music learners but simultaneously as cultural agents and authors of their own musical lives," they write.

The work is published in the journal Research Studies in Music Education .

Provided by University of the Arts Helsinki

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EU AI Act: first regulation on artificial intelligence

The use of artificial intelligence in the EU will be regulated by the AI Act, the world’s first comprehensive AI law. Find out how it will protect you.

A man faces a computer generated figure with programming language in the background

As part of its digital strategy , the EU wants to regulate artificial intelligence (AI) to ensure better conditions for the development and use of this innovative technology. AI can create many benefits , such as better healthcare; safer and cleaner transport; more efficient manufacturing; and cheaper and more sustainable energy.

In April 2021, the European Commission proposed the first EU regulatory framework for AI. It says that AI systems that can be used in different applications are analysed and classified according to the risk they pose to users. The different risk levels will mean more or less regulation. Once approved, these will be the world’s first rules on AI.

Learn more about what artificial intelligence is and how it is used

What Parliament wants in AI legislation

Parliament’s priority is to make sure that AI systems used in the EU are safe, transparent, traceable, non-discriminatory and environmentally friendly. AI systems should be overseen by people, rather than by automation, to prevent harmful outcomes.

Parliament also wants to establish a technology-neutral, uniform definition for AI that could be applied to future AI systems.

Learn more about Parliament’s work on AI and its vision for AI’s future

AI Act: different rules for different risk levels

The new rules establish obligations for providers and users depending on the level of risk from artificial intelligence. While many AI systems pose minimal risk, they need to be assessed.

Unacceptable risk

Unacceptable risk AI systems are systems considered a threat to people and will be banned. They include:

  • Cognitive behavioural manipulation of people or specific vulnerable groups: for example voice-activated toys that encourage dangerous behaviour in children
  • Social scoring: classifying people based on behaviour, socio-economic status or personal characteristics
  • Biometric identification and categorisation of people
  • Real-time and remote biometric identification systems, such as facial recognition

Some exceptions may be allowed for law enforcement purposes. “Real-time” remote biometric identification systems will be allowed in a limited number of serious cases, while “post” remote biometric identification systems, where identification occurs after a significant delay, will be allowed to prosecute serious crimes and only after court approval.

AI systems that negatively affect safety or fundamental rights will be considered high risk and will be divided into two categories:

1) AI systems that are used in products falling under the EU’s product safety legislation . This includes toys, aviation, cars, medical devices and lifts.

2) AI systems falling into specific areas that will have to be registered in an EU database:

  • Management and operation of critical infrastructure
  • Education and vocational training
  • Employment, worker management and access to self-employment
  • Access to and enjoyment of essential private services and public services and benefits
  • Law enforcement
  • Migration, asylum and border control management
  • Assistance in legal interpretation and application of the law.

All high-risk AI systems will be assessed before being put on the market and also throughout their lifecycle.

General purpose and generative AI

Generative AI, like ChatGPT, would have to comply with transparency requirements:

  • Disclosing that the content was generated by AI
  • Designing the model to prevent it from generating illegal content
  • Publishing summaries of copyrighted data used for training

High-impact general-purpose AI models that might pose systemic risk, such as the more advanced AI model GPT-4, would have to undergo thorough evaluations and any serious incidents would have to be reported to the European Commission.

Limited risk

Limited risk AI systems should comply with minimal transparency requirements that would allow users to make informed decisions. After interacting with the applications, the user can then decide whether they want to continue using it. Users should be made aware when they are interacting with AI. This includes AI systems that generate or manipulate image, audio or video content, for example deepfakes.

On December 9 2023, Parliament reached a provisional agreement with the Council on the AI act . The agreed text will now have to be formally adopted by both Parliament and Council to become EU law. Before all MEPs have their say on the agreement, Parliament’s internal market and civil liberties committees will vote on it.

More on the EU’s digital measures

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