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IntroductionDepression is a common mental health condition that affects millions of people worldwide. Care pathways for depression are complex and the demand across different parts of the healthcare system is often uncertain and not entirely understood. Clinical progression with depression can be equally complex and relates to whether or not a patient is seeking care, the care pathway they are on, and the ability for timely access to healthcare services. Considering both pathways and progression for depression are however rarely studied together in the literature.MethodsThis paper presents a hybrid simulation modeling framework that is uniquely able to capture both disease progression, using Agent Based Modeling, and related care pathways, using a System Dynamics. The two simulation paradigms within the framework are connected to run synchronously to investigate the impact of depression progression on healthcare services and, conversely, how any limitations in access to services may impact clinical progression. The use of the developed framework is illustrated by parametrising it with published clinical data and local service level data from Wales, UK.Results and discussionThe framework is able to quantify demand, service capacities and costs across all care pathways for a range of different scenarios. These include those for varying service coverage and provision, such as the cost-effectiveness of treating patients more quickly in community settings to reduce patient progression to more severe states of depression, and thus reducing the costs and utilization of more expensive specialist settings.