  This study presents an approach to analyze health disparities in Sexual and
Gender Minority (SGM) populations, with a focus on the role of social support
levels as an example to allow causal interpretations of regression models. We
advocate for precisely defining the exposure variable and incorporating
mediators into analyses, to address the limitations of comparing counterfactual
outcomes solely between SGM and heterosexual populations. We define sexual
orientation into domains (attraction, behavior, and identity), and emphasize a
consideration of these elements either separately or together, depending on the
research question. We also introduce social support measured before and after
the disclosure of sexual orientation to facilitate inference. We illustrate
this approach by examining the association between SGM status and depression
diagnosis with data from the 2020 and 2021 National Health Interview Survey. We
find a direct effect of SGM status on depression (OR: 3.07, 95% CI: 2.64 -
3.58) and no indirect effect through social support (OR: 1.07, 95% CI:
0.87-1.31). Our research emphasizes the necessity of the comprehensive
measurement of sexual orientation and a focus on intervenable variables like
social support in order to empower SGM communities and address SGM related
health inequalities.
