The Professional Counselor | Volume 14, Issue 2 199 factorial invariance (equivalence in meaning) of IWI scores with a national sample of U.S. adults. Pending evidence of factorial validity, we will test the convergent validity of IWI scores with established measures. The State of Mental and Physical Health Among U.S. Adults The comorbid nature of mental and physical health issues among U.S. adults has increased in severity and complexity since the COVID-19 pandemic (Clarke et al., 2020). Anxiety and depression are two of the most prevalent mental health issues among U.S. adults (National Alliance on Mental Illness [NAMI], 2022). Anxiety and depressive disorders tend to co-occur with a number of physical health issues, including heart disease and pain disorders (Winkler et al., 2015). In fact, heart diseases were the number one killer of adults over 18 in the United States from 1999–2020, with intentional selfharm (including suicide), and essential hypertension also in the top 15 (Centers for Disease Control and Prevention [CDC], n.d.). The pervasive and concurrent nature of anxiety, depression, and noncommunicable physical diseases is further exacerbated by sociodemographic factors. Sociodemographic Factors Past investigators documented a number of sociodemographic health disparities among adults in the United States by gender identity, ethnoracial identity, help-seeking history, income, and education (Kalkbrenner, 2022; Kobayashi et al., 2021; Patrick et al., 2020). Specifically, differences in power, privilege, and biological factors between females and males contribute to inequitable health outcomes (Pan American Health Organization & WHO, n.d.). Specifically, women reported higher rates of negative health outcomes and reduced health care access than men (Connor et al., 2020; Talevi et al., 2020). In terms of ethnoracial differences, U.S. adults who identified as racial minorities/non-White reported higher rates of both mental health concerns (i.e., any mental, behavioral, or emotional disorder) and physical concerns (e.g., heart disease, hypertension, asthma or emphysema) in comparison with their White counterparts (National Institute of Mental Health, 2023; Ramraj et al., 2016). Similarly, lower levels of education are a risk factor for poorer health conditions (van der Heide et al., 2013). In comparison to individuals with less than a high school degree, those with a degree higher than a high school degree reported better health conditions (Johnson-Lawrence et al., 2017). Moreover, individuals with college degrees reported better health in general in comparison to their counterparts with less education (Lawrence, 2017). Income is another sociodemographic factor that impacts wellness in a multifaceted manner (Beech et al., 2021). For instance, adults living under the poverty line are at risk for food insecurities and exposure to hazardous working environments (Laska et al., 2021; Mikati et al., 2018). Additionally, individuals living with a lower socioeconomic status are more at risk for COVID-19 and its aftermath (J. A. Patel et al., 2020). Help-seeking history is a relatively new demographic variable in the extant literature that is related to attitudes about counseling and utilization of counseling services (Kalkbrenner, 2023; Cheng et al., 2018). In the context of a demographic variable, help-seeking history is not intended to quantify a latent trait representing a comprehensive representation of one’s engagement in counseling. Rather in terms of a demographic variable, help-seeking history is quantified categorically as either 1 (attended at least one session of personal counseling) or 2 (never attended counseling; Cheng et al., 2018). A help-seeking history is a predictor of more positive attitudes about accessing mental health support services (Cheng et al., 2018). However, Kalkbrenner (2023) found that adults in the United States with a help-seeking history reported lower levels of mental and physical health than those without a help-seeking history. Accordingly, help-seeking history and other sociodemographic variables are important considerations when calibrating wellness-based screening tools (e.g., the IWI). The initial IWI score validation study (Bennett et al., 2023) established the IWI’s overall internal structure (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) and validity based
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