The main character will be put into rooms with enemies who will stalk him in an attempt to hurt/kill him. There are also boss/mini-boss battles that involve a large figure with a giant knife stalking after the main character. This happens at least twice in the game.
Angela is revealed to be a CSA survivor prior to a boss battle.
The youngest member of the cast, Laura, is not abused. It's implied she does not experience the effects of Silent Hill in the way that James, Eddie or Angela do.
Angela was sexually abused by her father. It is implied through dialogue and a horrific monster that represents the abuse.
Pyramid head is shown throttling female enemies in a way that looks more like he is... well... in fact, that might be what he's doing.
not really, it's implied through backstory but not really shown, there's also a scene where James watches Pyramid Head kill an enemy in an oddly sexualised manner
The imagery of the main character's wife being smothered to death is shown in a very late scene in the game. There is no audio however the video makes it unmistakable what is happening.
Throughout the game the main character can kick or step on enemies to finish them off. This could be interpreted as the body or head being squashed, though nothing explicitly shows it and it more accurately appears to just be a kick
The lake is a central feature of the town. The park where an important cutscene occurs is next to it with a good view of it. The main character also has to row across the lake at one point in a playable section
When you first encounter Eddie in the apartments, he is seen vomiting in a cutscene.
Vomit is not shown, but there are very detailed and realistic noises - even nauseating to those without emetophobia - and he is hunched over a toilet.
The bathroom is very grimy, so this adds to the air of disgust.
The main character's wife is suffering from a very unspecific illness that is incurable. There are no mentions of it being specifically cancer, however, it may still trigger anyone who has experienced someone they know/care about going through a similar thing.
It is not shown in-game but there are very many mentions of self-harm with the character Angela, along with being gifted the knife that she has been presumably using to do so.
Two side characters - Angela and Eddie - are shown to be portrayed as violent, albeit with different contexts.
Eddie displays homicidal behaviour and describes killing a dog and enjoying it, and killing people because they "looked at [him] wrong".
Angela is not actively violent towards anyone - at most, she comes off as threatening and manipulative towards the end of the game. However, she is shown to be violent towards a boss enemy - kicking it and throwing a TV on it. In saying that, the boss is the manifestation of her trauma (see warnings for "Is there sexual abuse?")
Out of the two characters, Eddie is the main one that fits this question.
Massive spoilers
Angela ends up seemingly committing it after walking up a staircase ingulfed in flames
In one ending James can also commit suicide and it's implied his original reason for coming to the town was to do so
Not really. It can be said that Angela wearing a full length shirt/covering up as much skin as possible, is in response to her CSA past, making her uncomfortable in her own skin.
Eddie, one of the side characters, is implied to have body dysmorphia. There is no direct mentions of this, but some may relate to the symptoms he exhibits.
There is an ending where the main character drives off a bridge into a lake, killing himself. Another character in the game (Angela) carries a knife and makes comments about suicide, you later acquire the knife and see it has blood on it, implying it could be her blood. Later on this same character ascends into a staircase engulfed in flames, killing herself.
Angela very clearly suffers from PTSD due to being sexually abused by her father and brother when she was young. She is afraid of people suddenly approaching her and is implied to be having a flashback during a boss fight in which she pleads with her father (who is not in the room) to not harm her
There is a sound at one point in a basement (i believe in the hospital) that might be a baby crying, though it is unconfirmed. No baby's are ever seen in game
The character of Maria acts and dresses provocatively and there are many sexual scenes involving the monsters in the game. Pyramid Head is shown making thrusting motions against a feminine monster and mimicking oral sex upon another. The nurse monsters wear tight and short dresses
There are multiple endings to this game - all are upsetting in some manner due to the context of Mary's death.
There are some exceptions though - there are some light-hearted and comedic secret endings. However, these are only accessible on a second playthrough and you have to actively look for certain items that are not available in a first-time save.