The creators of the Silent Hill series have credited the works of David Lynch as an influence on the games. Conan Doyles' The Lost World is credited with inspiring the design of one of the characters, albeit in the fictional context of the book being the favorite of the character Alessa Gilesspie.

The monsters faced in the game are almost universally designed to reflect the thoughts and fears of Alessa, and the appearances of the "god" final boss are based on how god was envisioned by Alessa (in the "bad" endings) or Dahlia (in the "Good" endings).The "Nurse" monster would be incorporated in later Silent Hill titles, although their appearance and origin have changed in each incarnation. The "Creeper" insect creatures would reappear in Silent Hill 2, while  Silent Hill 3 's "Split Worm" was designed with the first game's "Split Head" monster in mind. The design of the "Mumbler" monster went through four different incarnations before it was finally approved by censors.

In 2001, an altered version of Silent Hill was released for the Game Boy Advance. Entitled 'Silent Hill Play Novel', this version was a choose your own adventure styled digital graphic novel. The game contained a retelling of the original game's story through text based gameplay, with the player occasionally being confronted with questions concerning what direction to take their character as well as the puzzles which were a major part of the original game's gameplay. The player also has the option of playing as Cybil in a second scenario, with a third made available for download.

When the game was exhibited, western critics were unimpressed by the game, and criticized the lack of any soundtrack as severely detracting to the horror factor of the game. It has yet to be released outside Japan.