According to ESRB, this game contains: Blood and Gore, Intense Violence, Sexual Themes
Parents will want to take heed of Silent Hill 4's Mature rating and steer the kids away from this one. The game is gruesome, violent, and creepy enough to give even older children nightmares for weeks.
Survival horror fans will want to check this one out, simply because the series has been known for delivering the goods in terms of whacked out stories and creepy visuals. Unfortunately, some will be disappointed by the fact that all of the evolutionary steps forward (first person mode in the apartment for example) are more cosmetic than anything and do little to address the game's genuine issues. However, the story will no doubt please the Silent Hill faithful.
Casual gamers could go either way on this one. If you liked previous entries in the series, this one is generally more of the same. If earlier Silent Hill games were a letdown, this one won't change anyone's mind.
Deaf and Hard of Hearing gamers will find this experience to be a mixed bag. On the one hand, dialogue is all subtitled (through a menu option). On the other, ambient sound is what makes the game creepy, and that's going to be lost on anyone who has a hearing impairment. Music and ambient noise are vitally important in horror, and not having them here would result in a far lesser gaming experience.