"It's probably important for physicians to emphasize with patients that the difference between mind and body is more metaphor than reality," Dr. Eric D. Strachan from University of Washington School of Medicine, Seattle, told Reuters Health. "Good mental health and good physical health are very often the same thing."

Dr. Strachan and associates investigated whether psychiatric outpatients in a publicly funded HIV/AIDS clinic showed any relationship between disclosure of sexual orientation and HIV status and their immune functioning.

The study involved 373 patients. After controlling for "important biobehavioral covariates," disclosure of sexual orientation and HIV status was associated with higher CD4 cell counts over time than was concealment, the researchers found.

For sexual orientation, only those who were "always open" about their status showed increases in mean CD4 cell counts over time, the researchers note, whereas for HIV, both "always" and "mostly open" disclosure were associated with increases.

"Relieving potential psychological distress by disclosing sexual orientation and HIV status has a positive impact on CD4 cell counts over time even among outpatients stressed by psychiatric illness and economic disadvantage," the investigators conclude.

However, "As has been noted in all of the previous research, these data do not, in and of themselves, allow for causal inference," the investigators caution. "It would be premature to suggest that individuals should disclose sexual orientation and HIV status to be healthier, especially given one study showing concealment can be protective for gay men who are rejection-sensitive."

Nonetheless, "Let your patients at least talk with you about how they feel about disclosure and maybe even help them formulate a plan," Dr. Strachan said. "We don't know enough to say it will help, but if you are supporting the patient's existing desire to disclose, I certainly don't think it could hurt."

Psychosom Med 2007;69:74-80.