Department of Nursing, University of West Attica, Athens, Greece

Corresponding author email: akoreli@uniwa.gr

Article Publishing History

Received: 22/03/2026

Accepted After Revision: 30/05/2026

ABSTRACT:

Music is increasingly recognised for its role in promoting health and well-being. Beyond its psychological effects, research suggests that music positively impacts immune function, supports medication adherence, and raises awareness of antibiotic resistance. This review explores the connection between music, immune response, and antibiotic adherence, examining how activities such as listening, playing, and singing can strengthen immunity and encourage healthy behaviour. Drawing on insights from psychoneuroimmunology, behavioural sciences, and music therapy, this review underscores the potential of music-based approaches in healthcare. The findings of the review demonstrate that music’s role in health communication extends to promoting preventive behaviours, influencing public attitudes, and increasing adherence to medical treatments. Given its accessibility and cost-effectiveness, integrating music-based interventions into healthcare strategies can complement traditional treatments and enhance holistic well-being. By embracing music as a therapeutic and educational tool, healthcare professionals can contribute to a healthier, more informed society.

KEYWORDS:

Music, Music Interventions, Preventive Interventions, Immune System, Biomarkers, Healthy Behaviour.

Download this article as: Copy the following to cite this article:

Alexandra K, Theodoula A, Martha K. S. The Role of Music in Immune Function and Public Health Interventions. Biosc.Biotech.Res.Comm. 2026;19(2).

Copy the following to cite this URL:

Alexandra K, Theodoula A, Martha K. S. The Role of Music in Immune Function and Public Health Interventions. Biosc.Biotech.Res.Comm. 2026;19(2). Available from: <ahref=”https://shorturl.at/q9FZX“>https://shorturl.at/q9FZX</a>

INTRODUCTION

Music is increasingly recognized for its role in promoting health and well-being, not only through its psychological effects but also by positively influencing immune function and supporting medical treatment. Research suggests that music can enhance adherence to medications and even raise awareness of antibiotic resistance, Benavides et al 2021, and Rebecchini (2021). Antimicrobial resistance (AMR) is a major global health concern, occurring when microorganisms, including bacteria, fungi, parasites, and viruses, develop resistance to drugs, making standard treatments ineffective and increasing the risk of severe infections, (Ahmed et al 2024). While drug-resistant bacteria may already be present at the start of antibiotic treatment, successful recovery often depends on both the drug and the immune system.

However, most research primarily focuses on bacteria and antibiotics, overlooking the immune system’s role. Based on this premise, Handel et al. (2009) developed mathematical models incorporating immune responses to analyze their influence on antibiotic resistance. Their findings suggest that a strong immune system helps control resistance and enhances treatment effectiveness. Traditional infection treatments prioritize the development of new drugs and vaccines, but alternative strategies focus on boosting the immune system before and during infections Dai et al (2021).

Various practices, including physical activity, yoga, a balanced diet, and music, have been shown to improve immunity when followed consistently Davison et al (2016) and Estevao  (2022). Music has been used therapeutically for centuries and has been found to reduce stress and anxiety while enhancing emotional well-being. Studies suggest that music therapy influences the psycho-neuro-immuno-endocrine system, leading to improved immune function, Diamond (2025).

Additionally, music-based interventions may increase self-efficacy, support adherence to medical treatments, and modulate immune responses. This article explores existing research on how music influences immune function and health behavior, emphasizing its potential as a complementary approach to improving overall health.

MUSIC AND IMMUNE FUNCTION

Scientific studies by Rebecchini (2021) and Fancourt et al  (2014)  show that music can enhance immune function by reducing stress and influencing psychoneuroimmunological pathways. The immune system defends the body against infections and harmful substances while also preventing self-attacks. It consists of two key branches: innate immunity and adaptive immunity. The first serves as the body’s initial line of defense, responding rapidly to pathogens. It includes immune cells like granulocytes and macrophages, which release pro-inflammatory cytokines to trigger inflammation. The second, adaptive immunity, is slower but more specialized, involving B and T cells. This system develops memory over time, allowing the body to recognize and fight specific pathogens more effectively Turvey et al (2010).

Rebicchini (2021) conducted a systematic review on interrelation between music, mental health and human immune system outlining six key connections between the immune system, psychological state, stress, inflammation, and pain:

The immune system is closely tied to mood, psychological health, and hormonal balance. Negative emotions and stress can disrupt immune function, increasing health risks. This disruption weakens immune defenses, making the body more vulnerable to infections and increasing systemic inflammation. Inflammation is crucial for protection against infections and injuries, but excessive or insufficient inflammatory responses can contribute to disease. Chronic stress leads to immune imbalances and raises the risk of both mental and physical health disorders. Pain, as a stressor, can disrupt the body’s balance by activating the hypothalamic-pituitary-adrenal (HPA) axis, affecting glucocorticoid release, which regulates immunity. Stress negatively affects multiple systems, including cardiovascular, neuroendocrine, and immune functions, slowing recovery and increasing complications.

By understanding these relationships, researchers highlight the potential of music as a natural and accessible tool to support immune function and overall well-being. Fancourt et al.  (2014), in their systematic review, analysed 29 studies examining the effects of music on cortisol levels. Findings showed that music interventions, whether through listening or active participation, generally reduced cortisol levels, particularly with relaxing music. However, studies on stimulating music yielded mixed results, with some reporting a decrease in cortisol while others found an increase, along with changes in epinephrine and growth hormone levels. One study suggested that self-selected music had a stronger impact on cortisol reduction. Additional findings included increases in oxytocin and testosterone (varying by gender) and shifts in stress-related hormone ratios. Overall, the review concluded that musical stimulation influences hormone regulation.

Immunoglobulin A (IgA), including both secretory (S-IgA) and serum IgA, is one of the most widely studied immune biomarkers in relation to music. IgA is a key antibody produced primarily in the bone marrow and plays a crucial role in first-line immune defense, particularly in the mucosal linings of the gastrointestinal, respiratory, and genitourinary tracts. Research consistently shows that music increases S-IgA concentrations or secretion rates, suggesting an immune-enhancing effect, especially in healthy individuals. Notably, group singing appears to produce a greater increase in S-IgA compared to passive listening; however, a few studies report no significant changes in IgA levels. Overall, S-IgA has shown the most consistent and robust response to music, supporting its role in immune enhancement, Koshimori  (2019).

Cytokines such as IL-4, IL-10, IL-13, and TNF-β help regulate immune responses and prevent excessive inflammation. Certain immune cells are not strictly categorized as pro- or anti-inflammatory; among them are natural killer (NK) and dendritic cells, as well as cytokines that may have both effects depending on the context (Liu et al 2021).

Koshimori  (2019)  reviewed studies on cytokine responses to music and highlighted IL-6, a cytokine with both pro- and anti-inflammatory properties, as a key area of focus. Research indicates that relaxing or classical music reduces IL-6 levels in patients recovering from surgery, as well as those with cerebrovascular disease and dementia. However, more stimulating musical activities, such as group drumming, have been linked to increased IL-6 levels in older adults.

MUSIC AS A PUBLIC HEALTH TOOL: INSPIRING BEHAVIORAL CHANGE THROUGH SOUND

Music has been increasingly explored as a tool in public health prevention strategies. However, despite numerous health promotion efforts using music, only a limited number of studies have systematically evaluated and documented their impact in academic literature, Redfern et al (2020).

The Public Health England (PHE), recognizing the alarming prediction that antimicrobial resistance (AMR) could lead to 10 million deaths annually by 2050, and the fact that antibiotic resistance already causes around 5,000 deaths per year in England, launched the “Keep Antibiotics Working” campaign in 2018. This £2 million initiative aimed to raise awareness about the dangers of antibiotic overuse. A key component was a catchy jingle featured in an animated TV advertisement, designed to reinforce the message memorably. Targeting older adults and parents, the campaign leveraged multiple channels, including TV, radio, print, social media, and GP surgeries. Additionally, it provided support to general practitioners under pressure to prescribe antibiotics unnecessarily. A trial in northwest England demonstrated its effectiveness, successfully raising awareness and reducing antibiotic prescriptions (Campaign Live 2025).

Another innovative example is “Artibiotics,” a project created by Professor Eduardo Miranda. This unique fusion of art and science translates real bacterial DNA data into sound, illustrating the hidden battle between bacteria and antibiotics. Developed in collaboration with scientists from the Institute of Medical Microbiology and Biofaction (Germany). “Artibiotics” was performed at the Peninsula Arts Contemporary Music Festival in 2018. However, no data is available on its impact or audience reception, (University of Plymouth 2025).

A strong example of high-impact musical public health messaging is Australia’s “Sun Sound” skin cancer prevention campaign (2009-2010), with advertising cost of A$257,785. This campaign used a catchy jingle broadcasted widely to encourage sun protection behaviors. The results were remarkable: The media launch generated 17.6 million audience impressions nationwide, 41% of people recalled the message unprompted, 79% of participants understood the song’s key message, 38% of young people in the study reported using additional sun protection after hearing the tune, Potente et al  (2013).

A notable example is The Mould that Changed the World, a musical created by a composer and a health professional. This production was conducted in two primary schools in the UK to educate students about antibiotics. The lyrics covered antibiotic discovery, resistance, and responsible use. Schoolchildren actively participated in rehearsals and staging the play. The intervention was evaluated before and after the performance using quantitative tools and follow-up interviews with schoolchildren. The results demonstrated a positive response and a significant increase in knowledge, which extended beyond the school community, influencing families and friends. Even six months later, participants remained motivated to reduce their antibiotic use (Hall et al 2020).

Similarly, researchers in Ghana identified 28 COVID-19 songs addressing topics like public health guidelines, the reality of the virus and its infectious nature, emotional impact, calls for unity and hope. These songs, as part of edutainment –a blend of education and entertainment- used media to influence public knowledge, attitudes, and behavior. The songs were created by independent musicians soon after the COVID-19 pandemic outbreak, and filled a gap left by government funding shortages for local-language education. With official updates limited to online platforms, non-literate citizens lacked crucial information. Songs became an innovative intervention, later supported by non-governmental agencies to address social issues. Their repetition and recall made them a powerful tool for health education, (Thompson et al 2021).

While music-based public health campaigns vary in their effectiveness, successful cases demonstrate the power of sound as a behavioral change tool. When strategically designed and widely disseminated, music has the potential to leave a lasting impression and drive meaningful health behavior changes.

Despite financial considerations, including artist compensation and marketing costs, music remains a cost-effective way to reach large audiences, particularly in resource-limited healthcare settings. Effective media partnership with public health authorities is essential in disseminating information, ensuring message relevance and accuracy, and facilitating data management and evaluation. Music-based interventions within interdisciplinary collaboration are a versatile approach to promoting health behavior and should be incorporated into disease prevention strategies (Benavides et al 2021, and Partanan, 2024).

CONCLUSION

Music is a powerful, non-invasive tool that supports immune function, enhances mental health, and promotes public health initiatives. In clinical settings, it reduces stress, alleviates pain, and fosters emotional resilience, improving patient outcomes. Additionally, music’s role in health communication extends to promoting preventive behaviors, influencing public attitudes, and increasing adherence to medical treatments. Given its accessibility and cost-effectiveness, integrating music-based interventions into healthcare strategies can complement traditional treatments and enhance holistic well-being. By embracing music as a therapeutic and educational tool, healthcare professionals can contribute to a healthier, more informed society.

Funding: Nil

Conflict of interest: Authors have no conflict of interest to declare

Data Availability:  Data are available with the corresponding author on request

REFERENCES

Ahmed SK, Hussein S, Qurbani K, Ibrahim RH, Fareeq A, Mahmood KA (2024) Antimicrobial resistance: Impacts, challenges, and future prospects. Journal of Medicine, Surgery, and Public Health. 2024 Apr;2:100081.

Benavides JA, Caparrós C, Da Silva RM, Lembo T, Tem Dia P, Hampson K, et al. (2021) The Power of Music to Prevent and Control Emerging Infectious Diseases. Front Med. 2021 Nov 25;8:756152.

Campaign Live (2025) Public Health England’s catchy jingle aims to make the danger of antibiotic resistance unforgettable [Internet]. Campaign Live. Available from: https://www.campaignlive.co.uk/article/public-health-englands-catchy-jingle-aims-danger-antibiotic-resistance-unforgettable/1447966  [cited 2025 Mar 10].

Dai H, Han J, Lichtfouse E. (2021) Smarter cures to combat COVID-19 and future pathogens: a review. Environmental Chemistry Letters. 2021;19(4):2759–71.

Davison G, Kehaya C, Wyn Jones A. Nutritional and Physical Activity Interventions to Improve Immunity. American Journal of Lifestyle Medicine. 2016 May; 10(3):152–69.

Diamond J. The Therapeutic Power of Music. In: Handbook of Complementary and Alternative Therapies in Mental Health [Internet]. Elsevier; 2002 [cited 2025 Mar 25]. p. 517–37. Available: https://linkinghub.elsevier.com/retrieve/pii/B9780126382815500255

Estevao C. The role of yoga in inflammatory markers. Brain, Behav Immun Health. 2022 Mar;20:100421.

Fancourt D, Ockelford A, Belai A. The psychoneuroimmunological effects of music: A systematic review and a new model. Brain Behav Immun. 2014 Feb; 36:15–26.

Hall J, Jones L, Robertson G, Hiley R, Nathwani D, Perry MR.  (2020) ‘The Mould that Changed the World’: Quantitative and qualitative evaluation of children’s knowledge and motivation for behavioural change following participation in an antimicrobial resistance musical. PLoS One. 2020 Oct 29;15(10):e0240471.

Handel A, Margolis E, Levin BR. (2009) Exploring the role of the immune response in preventing antibiotic resistance. Journal of Theoretical Biology. 2009 Feb; 256(4):655–62.

Koshimori Y. Neurochemical Responses to Music. In: Thaut MH, Hodges DA, editors. The Oxford Handbook of Music and the Brain [Internet]. Oxford University Press; 2019 [cited 2025 March 25]. p. 332–63. Available: https://academic.oup.com/edited-volume/28334/chapter/215109141

Liu C, Chu D, Kalantar‐Zadeh K, George J, Young HA, Liu G. Cytokines: From Clinical Significance to Quantification. Adv Sci. 2021 Aug;8(15):2004433.

Partanen H.(2024)  Primary prevention of physical diseases through music-based health communication: towards wider utilization of music – an integrative review 2024.

Potente S, Rock V, McIver J, Williams M, Magee C, Chapman K.(2013)  Fighting Skin Cancer With a Musical Sound: The Innovative Australian Sun Sound Campaign. Soc Mar Q. 2013 Dec;19(4):279–89.

Rebecchini L.(2021) Music, mental health, and immunity. Brain, Behavior, & Immunity – Health. 2021 Dec;18:100374.

Redfern J, Bowater L, Coulthwaite L, Verran J. (2020) Raising awareness of antimicrobial resistance among the general public in the UK: the role of public engagement activities. JAC-Antimicrob Resis. 2020 March 1;2(1):dlaa012.

Thompson RGA, Nutor JJ, Johnson JK. (2021) Communicating Awareness about COVID-19 through songs: an example from Ghana. Front Public Health. 2021 Jan 18;8:607830.

Turvey SE, Broide DH. Innate immunity. J Allergy Clin Immunol. 2010 Feb;125(2):S24–32.

University of Plymouth  (2025)( Musical molecules and the battle for biological supremacy laid bare in new  performance – University of Plymouth [Internet]. Available from: https://www.plymouth.ac.uk/news/musical-molecules-performance [cited 2025 Mar 15].